Some physicians, especially emergency physicians, worry that the opioid crisis in the country may be worsened by one of the US government’s own policies, according to a recent New York Times article.
“Many medical professionals and policy makers are challenging the wisdom of asking patients to rate how hospital employees manage pain. Doing so, they argue, creates a dangerous incentive for doctors to prescribe powerful and potentially addictive painkillers,” Times reporters Jan Hoffman and Sabrina Tavernise write.
The evidence linking patient surveys to overprescribing opioid painkillers is limited. In fact, three studies cited in a February 2016 Press Ganey blog showed the opposite: that a patient’s perception of pain control or the actual practice of administering pain medicine was not directly linked to overall patient satisfaction. A study from the American Journal of Medical Quality in 2012 showed that patients gave higher experience scores if they felt “that caregivers did everything they could to control their pain” than just if their pain was well controlled. Likewise, a 2014 study in the Annals of Emergency Medicine revealed no correlation between a patient’s experience scores and opioids administered in the emergency department. Also, an analysis of early adopters of the Emergency Department Consumer Assessment of Healthcare Providers and Systems (EDCAHPS) survey revealed that a patient’s feeling that ED caregivers “did everything they could to help with pain” resulted in better patient experience scores than receiving pain medication.
On the other hand, patients who score higher on satisfaction surveys generally spend more on prescription drugs, according to a 2012 study in the Archives of Internal Medicine cited in an April 2016 Time Magazine feature article. And perhaps most telling, a 2014 survey published in Patient Preference and Adherence showed that more than 48 percent of doctors say they prescribed inappropriate narcotic pain medication because of patient-satisfaction questions. Time author Sean Gregory said that one of the respondents said that drug seekers “are well aware of the patient satisfaction scores and how they can use these threats and complaints to obtain narcotics.”
Addressing the Problem
So whether the link between patient surveys and overprescribing opioids is a patient problem, or a physician problem, more and more industry players are paying attention to the issue. The American College of Emergency Physicians (ACEP) has asked the Department of Health and Human Services (HHS) to remove questions about pain from patient satisfaction surveys.“We urge the Department to undertake a robust examination of whether there is a connection between these measurements and potentially inappropriate prescribing patterns, and, until that is completed, we urge you to remove pain questions from the various CAHPS surveys,” ACEP President Jay Kaplan wrote in a letter to HHS Secretary Sylvia Mathews Burwell.
As well, the federal government is taking a closer look at whether incentivizing higher patient scores that include questions about pain management may in fact be influencing how and when opioids are prescribed. In July, the Centers for Medicare and Medicaid Services (CMS) proposed eliminating pain management survey questions from the value-based purchasing (VBP) program for hospitals, which withholds and redistributes money to hospitals based on inpatient performance. In that proposed rule, CMS said some stakeholders expressed concern that evaluating hospitals based on the pain management perceptions of patients may inadvertently “create pressure on hospital staff to prescribe more opioids in order to achieve higher scores on this dimension.”
Even though the questions will be excluded from VBP, the questions will remain on the HCAHPS surveys, and the results will be published publicly while CMS works on an alternate set of pain management questions. HHS spokesman Kevin Griffis told the New York Times that CMS is revising the language of the program to avoid “exert[ing] any unintended, negative influence over prescribing practices.”
With the opioid crisis garnering national attention, legislators also have entered the conversation about patient surveys and overprescribing. According to Time Magazine, Senator Susan Collins, R-Maine, recently called for an HHS investigation into the connection between the two, and in April, a bipartisan group of four Senators sponsored a bill separating reimbursements from pain-management questions.
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