Technically, patient surveys shouldn’t affect an individual doctors’ pay. The surveys are meant, according to CMS, to measure the hospital’s culture as a whole.
But in practice, it’s hardly unusual for hospitals to pay physicians at least in part based on patient ratings, Diaz said. So those doctors can perceive a direct connection between making money and convincing patients they’ve thoroughly treated their pain.
CMS officials say, though, that there is no evidence that prescribing painkillers improves a hospital’s scores. Though a June study suggested a possible relationship between opioid prescribing and higher scores, the authors cautioned that the difference was small and could have had other causes. In addition, research from 2014 found that, in emergency departments, prescribing opioid painkillers didn’t help scores. Still others argue the pain questions are just a small part of a large survey.
But that all misses the point, said Andrew Kolodny, executive director of Physicians for Responsible Opioid Prescribing. Even if giving painkillers doesn’t actually boost hospital ratings, many doctors think it does. That adds pressure to give patients unnecessary drugs that could hook them.
For example, another 2014 study, which surveyed about 150 doctors, found that almost half said pressure to get better scores encouraged them to give unnecessary or inappropriate treatment, including prescribing heavy-duty painkillers.
“Our epidemic of opioid addiction has been caused by over-exposure to prescription opioids,” he said. Creating incentives for hospitals “to make sure nobody ever walks out the door feeling they should have gotten a pain medication and they didn’t — that isn’t a cause of the opioid epidemic, but it’s a contributing factor.”
Doctors are feeling the pressure less now than they did even five years ago, said Wanda Filer, president of the American Academy of Family Physicians and a practicing doctor, as a result of rising concerns regarding painkiller abuse. But the tension still exists.
“I have many members who tell me they’ve been threatened [by patients] when they won’t give a prescription,” she said.
Meanwhile, no one’s been able to measure how much overprescribing by physicians contributes to the problem. Researchers are still identifying all the factors that have pushed more opioids into the public sphere. And that complexity, advocates said, makes it difficult to quantify the impact of removing the survey questions.
“There are many, many, many fronts which need action,” Filer said. But making sure doctors don’t have extra reason to push painkillers should be part of that, she said.
Given the scope of painkiller addiction, that’s an essential part of policy makers’ approach, Kolodny argued.
“The problem we’re dealing with is an epidemic of addiction. Some people develop addiction because they took drugs to feel effects. But many people develop addiction by taking drugs prescribed by doctors,” he said. “Once people are addicted, they’re not using the drugs because it’s fun. They’re taking them because they’re addicted, and feel that they have to. And it’s awful.”
By Shefali Luthra, Kaiser Health News
Kaiser Health News is a national health policy news service that is part of the nonpartisan Henry J. Kaiser Family Foundation.