The opioid war wins again

The CMS has responded to calls to eliminate patient satisfaction on pain management from Medicare’s value-based purchasing program…

The AHA was among several prominent healthcare associations that had called on the Obama administration to stop incorporating patients’ responses to pain-management questions in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) in the value-based purchasing program. HCAHPS results are a significant factor in how hospitals fare under value-based purchasing, and providers have complained the program gives them a financial incentive to over-prescribe painkillers to keep patients happy.

The survey asks patients if they needed medicine for pain, how often their pain was well controlled and—of most concern to the healthcare industry—if the hospital staff did everything they could to help with the pain.

“Some stakeholders believe that the linkage of the pain management dimension questions to the Hospital VBP program payment incentives creates pressure on hospital staff to prescribe more opioids,” the CMS said in the proposed rule. The agency said removing the questions from the survey would “mitigate even the perception that there is financial pressure to overprescribe opioids.” …

If you were a doctor, which would you be more afraid of, CMS or the DEA? In other words, the opioid war has pretty much removed all financial “pressure” to overprescribe opioids. The pressures doctors are under now when it comes to opioid prescribing are from the DEA and insurance companies, not patient surveys.

To me, patient surveys are not important, because it doesn’t matter what I say on a patient survey, doctors aren’t going to treat my pain anyway. But with this amazing amount of pressure brought to bare against CMS for patient surveys — specifically regarding the treatment of pain — I wonder if I’m wrong. If maybe sometime in the future, chronic pain patients will be kicking themselves because they didn’t fight against this change. Who knows?

4 thoughts on “The opioid war wins again

  1. As a doctor, I’m not afraid of these bad wolves. What I, and most other prescribers, am afraid of, is the licensing regulatory agencies. For instance, the State of New York has been requiring triplicate prescription forms for Schedule II substances (hydrocodone, oxycodone, etc, including compounds with acetaminophen) since 1990. I don’t worry about them, because that system is long established and the fear is no longer there. However, my current active license in North Carolina is governed by a bunch of knee jerk hysterical fanatics who are now monitoring every licensee’s prescribing habits, censuring those who exceed the monthly limit of 100 morphine equivalent doses (for comparison, hydrocodone oral dosing is the same as morphine, so 10 mg of hydrocodone X 10 doses is 100 morphine equivalents!), publicly publishing the names of the prescribers who sin in this way. Whoa, TEN pills of 10 mg hydrocodone?!?!

    Then I get a red flagged bulletin from the NC Medical Board saying that they are getting complaints from patients whose doctors have drastically reduced or suddenly discontinued their pain meds.


    The bulletin continues, This new policy only applies to docs who prescribe more than 100, etc, so don’t be alarmed….unless you go over that magic number, and then you can expect to be audited and censured.

    What unmitigated bullshit.

    “First, do no harm.”

    But first be sure to lick your regulatory agency’s backside. And abandon your patients, leaving them with nowhere to turn for relief except the streets. And don’t be surprised to see their names in the paper when they turn up dead from a heroin overdose.

    I’m so disgusted with the devolution of the “medical profession,” I don’t know whether to shit or go blind. I’m too disabled to practice at the moment, mostly due to disabling chronic pain from degenerative spine and other joint disease, for which I am offered only more and more steroid injections that don’t work and cause more trauma to the joints when large needles are forced into spaces already crowded with bone growths. I have a small stash of pain meds that I’m saving for the end, when I become unable to care for myself. That’s the State of the Art and Science of Medicine, folks. Don’t expect any more from it, unless you have an officially Terminal Disease, and maybe not even then, if they can worm out of it.

    Liked by 1 person

    • Thanks so much for your input. I know doctors are having a hard time, although it’s hard for me to feel any sympathy for them.

      When you say “licensing regulatory agencies,” are you talking about State Medical Boards and Departments of Health? Seems like they’ve just become an extension of the DEA. Really, I don’t see much difference between them.


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