Are Opioids Over-Prescribed to “Satisfy” Patients and Improve Hospitals’ Bottom Line?

Drug overdose is the leading cause of accidental deaths in the US. In 2014, 18,893 overdose deaths were related to prescription pain relievers, according to the American Society of Addiction Medicine. The alarming rise of today’s opioid epidemic has healthcare providers petitioning for reform when it comes to pain management. 

An advocacy group, Physicians for Responsible Opioid Prescribing, in conjunction with other provider organizations has been pressuring the Centers for Medicare & Medicaid Services (CMS) and the Joint Commission for change because they believe that the patient satisfaction survey and accreditation standards are inadvertently aiding the opioid epidemic. The group of providers is asking CMS to eliminate the HCAHPS questions that relate to pain. They are also asking the Joint Commission to review their pain management standards, as they are the ones to accredit and certify healthcare organizations. 

Hospitals and doctors explain that these current pain management standards create the expectation that pain levels should be at a zero, thus fostering a dangerous prescribing practice.  Definitive Healthcare’s Drug Market Analytics database shows that in 2013 (the most recent data available) physicians wrote over 29 million prescriptions for opioid analgesics just to Medicare patients (at a cost of over $2.1 billion).

Healthcare providers argue that questions on the HCAHPS survey have “unintended consequences of encouraging aggressive opioid use in hospitalized patients and upon discharge”. Harry Chen, M.D., the commissioner of the Vermont Department of Health, states that “we’ve equated aggressive pain management with quality and that’s not necessarily the case”. He notes that this is why there is a push for change, a change for the way we view pain. Healthcare providers say we should be looking to improve the quality of living and how much the pain gets in the way of living a “rewarding and healthy life” versus masking pain through consistent use of opioids.

Doctors worry that HCAHPS questions such as, “Patients who reported that their pain was always well controlled” set unrealistic expectations. They believe that this HCAHPS question creates a standard for satisfaction or in some cases dissatisfaction with care when not met. Definitive Healthcare’s Hospital database shows that for the year ending March 2015 (the most recent data available), patients gave the following star ratings to relay their level of satisfaction with their pain control experience.

Interestingly enough, the chart shows that majority of hospitals receive a fair or better rating when it comes to pain being well controlled. However, the chart also clearly shows that only a small portion of hospitals received a perfect score. This low count of 5 star ratings could be attributed to the fact that there is an expectation to have pain levels at zero. It could be implied that providers are facilitating necessary care to eliminate enough pain to live a healthy life, but they may not be prescribing the dosage of opioids to get pain to a complete zero; thus the rating for a good experience, but not a perfect one in terms of pain management.

Providers are worried that patients’ misconception of zero pain being the ultimate goal is negatively impacting hospitals financially. Providers are concerned that patients are/will give low satisfaction ratings, as a result of these expectations, which in turn will lead to the hospital being financially penalized.  Providers argue that they should not be penalized for treating pain appropriately.

The Joint Commission disputed the group’s claims on Wednesday and CMS says they will too respond. In the meantime, providers have high hopes that officials will re-think pain management standards. With an opioid epidemic reaching alarming heights and hospitals being held financially responsible for patient satisfaction, the pressure is on CMS and the Joint Commission for the future of how we regulate and define pain management.

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