Undoubtedly, most doctors don't want to contribute to the opioid abuse epidemic sweeping the nation. But they also want to keep their patients satisfied. And often, the only way to satisfy a patient is to give him his fix.
In addition to the human instinct to ease a person's pain, at least in the short term, doctors are under pressure to prescribe powerful painkillers from a provision of the Affordable Care Act that partially bases Medicare payments to hospitals based on patient satisfaction.
Patient satisfaction surveys are only one of a number of factors that shape a hospital's Medicare reimbursement, and the surveys take into account a number of satisfaction measures, including noise and wait times, but they also ask patients to rate how well the provider was able to manage his or her pain.
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Consciously or subconsciously, doctors are going to be influenced by the grading system, Steve Diaz, an emergency room doctor as well as chief medical officer of AugustaMaine's General Health, told Kaiser Health News. And although the payments are only linked to hospitals, not physicians, it is common for hospitals to link physician pay to their performance on such report cards.
"No one will overtly say, 'I'm doing this to not get a bad score," But in the back of their mind … and knowing they'll be publicly rated, I think it leads to making that subconscious decision."
Indeed, notes Kaiser, a 2014 survey of 150 doctors found that roughly half said they had felt pressure to prescribe painkillers based on such performance ratings.
At the same time, the federal government is telling physicians that they have been prescribing far too many opioids. In a new guideline on opioid prescriptions released in March, the Centers for Disease Control says doctors should much more closely scrutinize requests for opioid prescriptions from patients and that it should closely monitor patients on painkillers for signs of abuse or addiction.
"Nonpharmacologic therapy and nonopioid pharmacologic therapy are preferred for chronic pain," states the first of 12 recommendations from the CDC. "Clinicians should consider opioid therapy only if expected benefits for both pain and function are anticipated to outweigh risks to the patient."
Medical groups are urging the feds to rethink the patient surveys, and the government appears to be listening. A spokesman for the Department of Health and Human Services told Kaiser that it is considering re-writing the survey to focus more on the information the doctor provides the patient about pain management, rather than the patient's satisfaction with the outcome.
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