Can Medical Marijuana Help Your Practice Thrive?

Leigh Page

Disclosures

January 15, 2019

In This Article

Rules on Doctors' Relationships With Patients

State programs often want physicians to have a "bona fide" relationship with the patient, so practices don't become cannabis mills for anonymous patients.

In Massachusetts, this means that "the doctor has completed a full assessment of the patient's medical history and current medical condition, has explained the potential risks and benefits of marijuana use, and has a role in the patient's ongoing care and treatment," according to Patriot Care, a chain of cannabis dispensaries in the state.[4]

The Illinois program states that the physician must "have responsibility for the ongoing care and treatment of the qualifying patient's debilitating condition."[5] Liu's Illinois practice fits this requirement. She says she has a primary care practice with a "special interest" in medical cannabis.

Another way of handling the state requirement is to schedule several visits before the patient can be certified. This is how a Chicago-area physician handles patients at a satellite facility in downstate Illinois, according to a local newspaper.[6]

Typically, cannabis physicians want patients with unusual conditions to go to specialists for the initial diagnosis and treatment. Once a standard treatment has failed, patients can try medical cannabis. "You have to have a diagnosis when you come to me," says Bonni Goldstein, MD, a Los Angeles, California, pediatrician. "We require you send your medical records in advance."

In addition, many states require a periodic follow-up visit to establish continuity. Doctors' certificates are typically valid for 1-2 years, and then the patient has to come in for a follow-up.

Telemedicine and Medical Cannabis

California, New York, and Nevada allow the visit to be done via telemedicine. California first allowed the option in 2015, and several telemedicine firms sprouted up specifically for medical cannabis.

PrestoDoctor has processed more than 50,000 appointments in all three states, according to CEO Kyle Powers. He says patients book the appointment, provide documents from their regular physician, and have an online chat with the doctor that lasts about 15 minutes on average.

The company uses 20-25 doctors who have varying availability. "Doctors can be available as little or as much as they want," Powers says. "Some doctors do this full-time; others do it on off-hours from their practice."

Some cannabis physicians who stick with office visits are not in favor of telemedicine. "Telemedicine companies are pushing the limit," says Jeffrey Hergenrather, MD, a primary care physician who has a cannabis practice in Sebastopol, California.

For this reason, most state cannabis programs don't allow telemedicine visits. Pennsylvania recently ended them, and Washington, Arkansas, Illinois, Colorado, and Florida specifically require in-person exams.[7]

But Powers says telemedicine opens up the field. It makes cannabis an option where no local physicians offer it; it is more convenient than going to a doctor's office; and it's less expensive. Owing to the different requirements in each state, PrestoDoctor charges $49 in California, $109 in Nevada, and $139 in New York for the initial visit, he says.

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