Patient satisfaction surveys used by Medicare to help identify good hospitals could be contributing to the “growing epidemic” of abuse of prescription opioid drugs, according to two U.S. senators.
In a letter to the head of the Centers for Medicare and Medicaid Services (CMS), Sen. Chuck Grassley of Iowa and Sen. Dianne Feinstein of California claim “there is growing anecdotal evidence that these surveys may be having the unintended effect of encouraging practitioners to prescribe (opioid pain relievers) unnecessarily and improperly.”
Under the 2010 Affordable Care Act, a Hospital Value-Based Purchasing program was established to reward acute-care hospitals with incentive payments when they are ranked highly by patients for their quality of care.
Medicare patients are asked to complete surveys asking them whether they needed pain medication, whether their pain was well controlled, and how often hospital staff helped with their pain.
Linking pay with performance was the goal, but according to Sens. Grassley and Feinstein, some doctors have prescribed opioids to improve their scores on the patient satisfaction survey.
“A doctor in South Carolina reportedly cited low patient satisfaction scores as the reason why he prescribed Dilaudid (hydromorphone), a powerful painkiller commonly used to treat cancer pain, to treat a patient’s toothache,” they wrote to CMS Administrator Marilyn Tavenner.
“Indeed, almost half the members of the South Carolina Medical Association have admitted to prescribing opioids in response to patient survey scores. One hospital with low satisfaction scores even went so far as to offer Vicodin ‘goody bags’ to patients discharged from its emergency room in an effort to improve its scores.”
Grassley and Feinstein also cited an emergency room doctor in the Midwest who “quit the profession altogether” because he felt pressured to prescribe opioids to drug seeking patients.
The senators asked Tavenner to explain in writing what is being done to address the impact of patient surveys on the prescribing of opioid pain relievers. Grassley and Feinstein are co-chairs of the Senate Caucus on International Narcotics Control.
A large study recently published in the Journal of Hospital Medicine found that U.S. hospitals were already prescribing opioids at high rates to patients in 2009 and 2010 – before the Medicare satisfaction surveys were even used. Over half of all nonsurgical patients were given painkillers during their hospitalization, often at high doses.