State Drafts New, Tougher Rules for Pain Clinics

Pain management clinics in Tennessee will face new, stricter rules after the first of the year, as the state tries to clamp down on the over-prescribing of pain medications.

The new rules are aimed at reining in potential “bad actors” who over-prescribe the powerful drugs.

Robert Twillman is policy spokesman for the American Academy of Pain Management. He says five states including Tennessee have passed laws to get pain clinics under control.

“Where a lot of the concern with that has come from is the case of Florida, where they’ve such a problem with pill mills. And what they are finding there is that people own these clinics and hire doctors to come in and work in them. And many of the people who own the clinics are pretty unsavory characters.”

Tennessee’s law sets, for the first time, standards for being a medical director for such a clinic, and requires a criminal background check on the owners.

The state health department is drafting rules to put the law in effect by January 1.

The committee drafting the rules is looking at the long-term in setting up the new restrictions. Currently the application fee for a pain clinic license costs $200.

When committee members learned that some states charge up to $1,500 for the initial application and two-year license, they asked health department staffers to investigate whether such a fee could pay for annual inspections for pain clinics, something the department currently can’t afford.

The Health Department is working out rules to implement Public Chapter 340, which was passed in the 2011 session of the General Assembly.

It passed unanimously in both chambers.

Twillman was one of several representatives of health care groups who weighed in on a meeting of health officials who are penciling in the new rules.

Twillman says the potential for abuse is great – up to two million Tennesseans suffer chronic pain. Though, he says most of those can be treated by their primary care doctor.

“As the population ages, and as we develop treatments that tend to be more toxic and cause more pain, what we’re going to expect to see is, we’re going to see more people who have these kinds of chronic pain problems.”

As the patient load grows, legitimate pain management clinics want to get the “pill mills” shut down, he says.

“They see themselves being sullied by what’s going on with these other places that are calling themselves pain clinics, and they want to get rid of that…problem, they want to be perceived as doing the right thing.”

Representatives of several licensing boards, including the State Board of Nursing and the Physicians Assistants board are reviewing the process. They’ll file the draft rules to the Health commissioner, who’ll run them by the attorney general’s office before they go to formal “rule-making hearings” at the Secretary of State’s office. Deadline to put the new rules into effect: Jan. 1, 2012.

Twillman says the problem is a minority of clinics – they are owned by non-health care providers, and thus unregulated by physician boards in various states. He says “pockets” of such clinics show up in many states.

Twillman says there are really two kinds of pain management clinics.

“You see one type of clinic where most of what’s done is procedures – nerve blocks, spinal cord stimulators, those types of things. The other type of clinic is one that’s more multi-disciplinary, more focused on prescribing and physical therapy and those types of interventions.”

“For the most part these are really oriented toward people who have chronic pain, in particular chronic pain that’s not related to cancer, although cancer patients can benefit.”

There are currently no specific qualifications to be a medical director of a pain clinic in Tennessee, he says. A medical director must spend 20 percent of his or her time overseeing the work of the clinic, under the new rules. But pain management is a recognized medical specialty with national standards, he says.

“What we have is a number of board certifications, which is sort of a step above a medical license, in respect to pain management, and in the state of Tennessee there are about 106 of those people who have that additional certification.”

“On the one hand, 106 people sounds like a lot, but balance that against the fact that there are probably two million people in Tennessee that have chronic pain, and the numbers start to get a little bit out of whack. The good news is that most people with chronic pain can be managed well by their primary care physicians. So it’s really those who have complicated situations, who have lots of fallout in the arena of their psychological health, their ability to function, and so forth, that need these specialized clinics.”

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