When You Care Enough to Do the Very Worst

A colleague told me this week that the Pennsylvania Senate had a bill in committee that someone thought was going to help with the State’s opioid problem. The upshot of SB 1054 is that any doctors prescribing buprenorphine for addiction involving opioids would need to get a special license and pay a fee of $10,000. Yes, $10,000. What in the world are they thinking?

Well, actually there’s some logic in this. It turns out that the fear is that some pain pill mills have turned into buprenorphine clinics where people are just buying prescriptions without getting care. The idea is to rack up the amount of money necessary to do business so that those clinics will not have an incentive. Let’s look at the economics of this.

Let’s say I open such a clinic with a minimum staff. I don’t really do care, just give people scripts when they pay. I charge $300 a month and have the maximum 100 patients. That’s $30,000/month or $360,000. Now I also could leverage this with hiring a few Nurse Practitioners who could add their own patients to this number, but who don’t make anywhere near this much in salary. Conservatively I could clear $500,000 a year, just like a pill mill before buprenorphine. Well, hell, you’d want to stop me to, right?

But if I’m clearing $500,000 a year, will I mind paying $10,000 for the right? No, not at all. But what about my well meaning colleagues who do provide good treatment?

They have the same 100 patients, but they only charge for an office visit what they charged everyone. They get maybe $50 from the insurance company. That’s $5000 a month or $60,000 a year. And they are paying for a counselor, doing more paper work, and probably spending way more time with each patient than the insurance company felt they needed to. I know I did when I was in private practice, and my colleagues do as well. So there’s not a lot of money in this “racket,” unless of course you really make it a racket.

So here’s a question. Did the senators in Penn get the idea of a $10,000 license from people wanting to stop the buprenorphine mills, or did they get the idea from some well heeled buprenorphine mill owners who would like to see my professional colleagues priced out of the business? Let’s see what the Penn senate does with this, and maybe we’ll find out.

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