Every Florida physician who serves as the primary care provider (“PCP”) for some or all of his or her patients should consider whether to become a “Qualified Ordering Physician” (“QOP”), with the ability to authorize Qualified Patients (“QP”) to receive medical marijuana (“cannabis”). Physicians in a number of specialties (i.e., pain management and oncology) are recognizing the value of cannabis for treating their QPs’ medical issues and are becoming QOPs.

The number of Floridians who are QPs and using cannabis continues to grow exponentially. According to the Office of Medical Marijuana Use (“OMMU”), one year ago, on March 16, 2018, there were 88,154 QPs. By March 15, 2019,that number had more than doubled to 194,997 QPs. During that same time period, the number of QOPs grew from 1,225to 2,106, again nearly doubling the number of QOPs in just one year. Besides the obvious economic reasons to consider becoming a QOP, there are compelling clinical reasons to seriously consider adding cannabis to your treatment recommendations to your patients.

Clinical Perspective

Along with “do no harm”, a fundamental principle of any medical practice is to alleviate a patient’s pain and suffering to the extent possible. It is entirely feasible that the debate about the efficacy and safety of cannabis may never be resolved definitively (although clinical and epidemiological studies in Europe do support reported improvement in patients’ conditions, particularly with the elderly). See Epidemiological characteristics, safety and efficacy of medical cannabis in the elderly, European Journal of Internal Medicine, March 2918, Volume 49, pp 44-50; https://www.ejinme.com/article/S0953-6205(18)30019-0/fulltext. Although there is a dearth of clinical and epidemiological studies in the United States, due in part by the classification of cannabis as a Schedule I drug, the anecdotal evidence suggests that, at a minimum, using cannabis can alleviate a patient’s pain, epileptic episodes, nausea from chemotherapy, etc. Consequently, the number of patients seeking this treatment, and the number of physicians who are permitted to authorize it, are predicted to continue to increase greatly.

The Florida Legislature recognized that cannabis has value in treating a wide range of patients when it incorporated thirteen (13) “qualifying medical conditions” into the statutory scheme regulating medical marijuana in Florida. Many of these conditions are treated by most PCPs; for example, cancer, glaucoma, Crohn’s disease, multiple sclerosis, and chronic nonmalignant pain.

Patients no longer are passive observers of their medical conditions. Many patients will decide to try medical marijuana. They will either seek a QOP on their own or ask their PCPs for referrals. Either way, there is likely to be some level of disruption in those patients’ plans of treatment. Possibly the best way to avoid this disruption is for patients to receive or have supervised all their medical care by one physician--their PCP.

Economic Perspective

Physician income from providing traditional clinical services is flat, at best, or, more likely, stagnating. Physicians in general, and PCPs in particular, cannot render more services or increase their rates in order to cover the gap between reality and their expectations.

PCPs recognize patient retention is critical to their financial success. Regardless of whether patient payments are made by fee-for-service, capitated, global fee, or some other basis, a loyal and stable base of patients is necessary for a physician to succeed in private practice. In order to develop patients who look to their PCPs for guidance and direction in making clinical decisions (“sticky patients”), medical practices have adopted satisfaction surveys and other measures that recognize that patients are not only medical care seekers, but also customers and have the same expectations as customers in other industries.

In order to develop and maintain “sticky patients”, physicians should offer patients as many medical services as they require from one source (of course, assuming that source is appropriately medically qualified to provide such services). Accordingly, physicians in general, and PCPs particularly, can minimize the likelihood of patients looking elsewhere for a QOP, or asking the physician for a referral to a QOP, thereby losing some or all their business. Becoming a QOP not only strengthens the “stickiness” of current patients, it may likely attract additional patients whose PCPs have not adopted this business model.

For both clinical and economic reasons (as well as a minimal capital investment), becoming a QOP is an attractive option for many physicians. Achieving this designation adds both another treatment modality and a new revenue stream. Working with legal and other advisors, every Florida PCP should evaluate whether becoming a QOP fits into, and will enhance, his or her practice.

By Stephen H. Siegel, Esq. and Cynthia Barnett Hibnick, Esq.

Original Article: South Florida Hospital News