FAQ - Follow-up Visits

Q: Will I have to come in every month to clinic in order to receive my medication?

A: When you are a new patient to our clinic, and you are prescribed opioid or narcotic medications, you may be required to be seen monthly. Ultimately, the decision regarding medication management and monthly visits is a decision made by the Physician and Provider after taking into account the patient’s medications, health history, medical problems, overall level of health, other prescribed medications that may cause sedation, and the patient’s compliance with medical therapy. Our clinic is also required to comply with Federal, State, and local laws and with State and Federal licensing boards. Some of the various agencies which are involved in the oversight of medication prescribing in the United States include: the DEA (Drug Enforcement Agency) and the Alabama State Medical Board. State of Alabama laws, Insurance Requirements, Center for Medicare and Medicaid Services, and Compliance monitoring requirements also play a role in determining the frequency of follow up appointments.

Q: When do I get to come less frequently?

A: If a patient has demonstrated compliance with our clinic over a period of time, is deemed relatively low risk, and is on relatively low doses of medications, then that patient may be eligible for every 2 or 3 month visits. Some patients who are taking controlled substances will be required to be seen monthly. Examples of patients who will likely be required to be seen monthly include: patient on high-dose opioid therapy (more than 90mg Morphine equivalents per month), patient taking other medications that may cause sedation, patient who has a history of noncompliance with therapy, patient who is taking buprenorphine/ naloxone (Suboxone ™), and a patient who has multiple medical issues.

Q: Will I be seeing a mid level provider at each visit?

A: Many, if not most, follow-up visits in our clinic will be performed by a midlevel provider, such as a Certified Registered Nurse Practitioner (CRNP) or Physician's Assistant (PA) in conjunction with a Physician. All of our midlevels collaborate with Physicians at each office visit and are supervised by Physicians. Although you may not see a Physician at each follow-up visit, the Physician has reviewed all new information at follow-up including: imaging, x-rays, MRI’s, CT scans, labs, any notes from other physicians, new surgeries, procedures since last visit, new medications, and any new information. The Physician collaborates with the midlevel to formulate a plan at each visit, and the Physician prescribes any medications which are necessary. Your new patient visit and any procedures will be performed by a Physician. The physician will see you for any new problems, including new types of pain, or new issues related to your treatment. A Physician is in the office at each visit.

Q: How often will I see my doctor?

A: As discussed above, your care will always be performed in conjunction and collaboration with the Physician, although you may not see your Physician if you are doing well, are stable, and have no new issues to discuss. Many of our patients question the use of midlevels, however, in our current healthcare delivery environment, midlevels are an essential and important part of our team who are our eyes and ears at each visit. Given the requirements for documentation of office visits which are determined by federal authorities, state medical boards, and insurance companies for payment, and the number and complexity of patients who are seen in our Pain Management clinic, Midlevels will continue to provide essential cost-effective care for our patients.

Q: Can I get my procedure done on the same day as my follow up appointment?

A: Many times a procedure may be performed on the same date as a follow-up visit, however, this will depend on the requirements of your insurance company. Typically we will schedule your follow-up appointment first and then schedule your procedure afterward. Of course, this will also depend on the availability of appointments and your insurance requirements.

Q: Can you prescribe me medication for pain after a surgery done by another provider?

A: If you are prescribed opioid or narcotic medications by our clinic, and are scheduled for surgery, please inform our clinic. We prefer to work with your surgeon to provide the best pain control possible after surgery. Your plan will be individualized. Many times, this means that we will discuss your pain control strategy with your surgeon, and recommend specific medications and techniques for post-operative pain control. The plan may involve your surgeon prescribing specific medications, or may involve our clinic increasing your medication temporarily during your recovery.

Q: Why do I have to leave a Urine Drug Screen? Do you think I am a drug addict?

A: You will not need a urine drug screen if our clinic is not prescribing you any opioid or controlled substances. Urine drug screens (UDS) are an essential part of compliance monitoring for patients who are on controlled substances. If you are a new patient in our clinic, and you are on opioid therapy and you would like to continue opioid therapy with our clinic, we will obtain a urine drug screen before considering continuing or changing any opioid therapy. We know you are in pain, and we understand that you may not have a history of noncompliance with therapy, however, we are required to ensure that you are taking your medications appropriately according to your physician’s directions, and that you are not using illegal drugs. This requirement ensures our compliance with State and Federal laws, ensures that we maintain our certification and registration as a Pain Management provider with the State of Alabama Board of Medical Examiners, allows us to maintain our license to prescribed controlled substances (Alabama Controlled Substances Certificate and DEA registration), and UDS is required by many insurance companies for continuing opioid management. In order to serve you and many of our other patients, urine drug screens are a necessary inconvenience. Please understand that, just because we ask for a UDS, does not mean we think you are misusing or abusing your medications. It is simply a requirement of the therapy. Please remember that our ability to prescribe controlled substances for pain management is a privilege afforded to us by authorities. Any UDS or other compliance monitoring should be considered your opportunity to show us that you are taking your medications appropriately.

Q: Why do I have to leave a Urine Drug Screen so frequently?

A: The frequency of UDS for an individual patient may vary based on: type of medication prescribed, risk level of the medication, patient’s individual risk level, patient compliance with therapy, what the last UDS showed, whether a patient was chosen for a pill count and/or random urine drug screen, amount of medication prescribed/ morphine millequivalents, concurrent medications prescribed, social and family factors, change to other medications, and insurance and regulatory requirements. We will obtain UDS only as necessary. However, even low-risk patients who are prescribed opioid therapy can expect a UDS at least once yearly.