Can Medical Marijuana Help Your Practice Thrive?

Leigh Page

Disclosures

January 15, 2019

In This Article

How Cannabis Practices Operate

Many cannabis clinics are chain operations. Doner's company, Compassionate Certification Centers, operates at eight locations with 13-14 doctors, most of whom work part-time. They include emergency physicians, internists, anesthesiologists, and a gynecologist.

Doner says the company has installed a cannabis-specific electronic health record system. It gathers data on the cannabis each patient is taking and tracks its effectiveness. This helps doctors find ways to improve treatment, he says.

Goldstein says adjusting dosages is one of the most challenging parts of the work. "We have to do a lot of trial and error with dosing," she says. However, "if you overdose, it's not likely to damage your organs, like with many prescription drugs."

Goldstein has been exclusively dealing with medical cannabis since 2008, but she still focuses on pediatric patients whose treatment under traditional methods wasn't working. These patients have epilepsy, cancer, autism, and mental illness.

Hergenrather has been involved in medical cannabis for more than 40 years. In the 1970s, he served as doctor for a commune in the marijuana-growing area of northern California. "It was a unique opportunity to get involved with cannabis," he recalls.

The honest truth is that cannabis can replace [certain] meds.

Hergenrather serves as a general practitioner for his patients, but he has chosen not to write certain prescriptions. He doesn't prescribe sleep medications or antianxiety drugs. "The honest truth is that cannabis can replace many of those meds," he says.

Liu got involved in medical cannabis a few years ago, when the Illinois program started. Because of the precarious status of cannabis, "I am very careful to make sure that I am following the Illinois law," she says. "I deny requests from many patients who call asking for appointments solely to get a medical cannabis card. My staff does a lot of education and prescreening on the phone."

Who Pays for a Cannabis Visit?

Many cannabis doctors operate cash-only practices. Hergenrather, for example, employs one person part-time and handles billing by asking for a credit card payment at end of the visit. He charges $300 for a 90-minute initial visit and $70 for a 15-minute follow-up visit.

Hergenrather's prices are at the high end, according to CostHelper, which provides typical prices for a variety of services. A first-time appointment in a cannabis clinic typically costs $80-$200, and a follow-up visit costs $60-$150, the service says.[8]

Meanwhile, some practices charge health insurers for the cannabis assessment, apparently by billing it as a regular office visit.

The New York Department of Financial Services upholds this approach. In a letter to insurers, the department stated that if they normally cover office visits, insurers "may not deny coverage for the office visit solely on the basis that the visit also resulted in the insured receiving a medical marijuana [recommendation]."[9]

Knowledge About Medical Cannabis Is Often Needed

Advising patients about cannabis use would be a tall order for most doctors, because they know very little about it. Although roughly 80% of oncologists have talked with their patients about marijuana, less than 30% felt they had sufficient knowledge to advise them about its medicinal use, according to a 2018 survey.[10]

Doctors who start studying cannabis quickly understand how little they know. For years, "I had steadily reviewed the scientific literature on medical marijuana from the United States and thought it was fairly unimpressive," wrote neurosurgeon Sanjay Gupta, MD, CNN's chief medical correspondent. But after he looked into the medical breakthroughs from cannabis for a CNN series, he changed his mind.

"I didn't look hard enough, until now," he wrote. "I didn't look far enough. I didn't review papers from smaller labs in other countries doing some remarkable research, and I was too dismissive of the loud chorus of legitimate patients whose symptoms improved on cannabis."[11]

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