The American College of Emergency Physicians (ACEP) agrees with the national effort to tackle opioid drug abuse, but they see just one problem. The current system may actually reward those who prescribe opioids more frequently, ACEP claims.
The Wrong Incentive
“In spite of the multiple efforts the Federal government has undertaken to tackle this crisis, we must point to a glaring issue that has worked at cross purposes not only for hospitals but soon for emergency physicians. Patient experience/satisfaction surveys are important, particularly regarding issues of treating patients with dignity and respect, but questions about pain have resulted in unintended consequences and the pursuit of high patient satisfaction scores may actually lead health professionals and institutions to practice bad medicine by honoring patient requests for unnecessary and even harmful treatments,” writes ACEP President Jay A. Kaplan, MD, FACEP in a March letter to Department of Health and Human Services (HHS) Secretary Sylvia Mathews Burwell.
Particularly, Kaplan points out that questions on the HCAHPS, Emergency Department Patient Experience of Care, and even Press Ganey surveys, which “provide an opportunity for patients to express dissatisfaction because they didn’t get the drugs they sought,” potentially penalize physicians for prescribing non-opioid medications.
“We are concerned that the current evaluation system may inappropriately penalize hospitals and physicians who, in the exercise of medical judgment, opt to limit opioid pain relievers to certain patients and instead reward those who prescribe opioids more frequently.”
The organization is asking HHS to remove questions about pain from patient satisfaction surveys, at least until the department can determine whether and to what extent the presence of those questions on such surveys does or does not influence prescribing patterns.
A Larger Conversation
Earlier in March, the Office of the Assistant Secretary for Health at HHS released a National Pain Strategy to transform how the nation understands and approaches pain management and prevention, including population research; prevention and care; disparities; service delivery and payment; professional education and training; and public education and communication.
Just two days earlier, in an interview with Kevin Klauer, DO, EJD, FACEP, ACEP Now Medical Editor-in-Chief, Kaplan talked about the role of emergency physicians in addressing issues of pain control: “There are a number of other areas we are also very focused on to provide better care for patients. One is the opioid crisis, where more patients are dying from prescription drug overdoses than they are from motor vehicle accidents.”
Opioid Alternatives
Also in March, the Centers for Disease Control and Prevention, as well as the American Society of Anesthesiologists, released recommendations for physicians prescribing opioids. Both sets of recommendations included pursuing non-opioid pain therapies.
AP Reporters David Porter and Josh Cornfield wrote about the opioid crisis in a recent Washington Post article. There, they outlined one emergency room’s new opioid alternative protocol. St. Joseph’s Regional Medical Center in Paterson, N.J., created the Alternatives to Opiates (ALTO) program, which seeks to treat all patients with non-opioid pain options before considering opioid prescriptions.
“In the first two months, 75 percent of the 300 patients that have gone through the program did not need opioids,” said Mark Rosenberg, chairman of emergency medicine at St. Joseph.
According to the Post, “Opioids are highly addictive drugs that include both prescription painkillers like codeine and morphine, as well as illegal narcotics, mainly heroin. More than 29,000 people died from opioid misuse nationwide in 2014, the highest figure on record, according to the Centers for Disease Control.”
For an historical perspective on how the United States arrived at the opioid crisis, read Medscape’s “The Opioid Crisis: Anatomy of a Doctor-Driven Epidemic.”
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