Are Medicare’s patient satisfaction surveys contributing to opioid abuse?

Could Medicare’s patient satisfaction surveys be contributing to the abuse of prescription opioid pain relievers (OPRs)? Two U.S. senators think so, and they want the Centers for Medicare and Medicaid (CMS) to investigate.

Dianne Feinstein (D-California)In a recent letter to CMS Administrator Marilyn Tavenner, Senators Dianne Feinstein (D-California) and Charles Grassley (R-Iowa), note that Medicare increasingly is linking hospital reimbursement to performance. And while it is important for hospitals to get patient feedback, “…there is growing anecdotal evidence that these [patient satisfaction] surveys may be having the unintended effect of encouraging practitioners to prescribe OPRs unnecessarily and improperly, which can ultimately harm patients and further contribute to the United States’ prescription OPR epidemic,” the senators wrote.

Feinstein and Grassley are chair and co-chair, respectively, of the Senate Caucus on International Narcotics Control.

The letter cites examples such as a South Carolina physician who reportedly prescribed the powerful pain killer hydromorphone (Dilaudid) for a patient with a toothache because of his low patient satisfaction scores, and a hospital that dispenses hydrocodone/acetaminophen (Vicodin) “goody bags” to patients discharged from its emergency department in an effort to raise its patient satisfaction scores.

Charles Grassley (R-Iowa)

A provision of the Affordable Care Act provides incentive payments to acute-care hospitals based on the quality of care they provide to Medicare patients, as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems survey. The survey includes questions that ask whether the patient needed pain medication, how often the pain was well-controlled, and how often hospital staff members did everything they could to help with the patient’s pain.

 “As a result, a patient’s answers to these questions can affect the Medicare payments made to these hospitals,” the senators wrote. They requested a response from Tavenner by July 14.