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The Contribution of Patient Satisfaction to the Opiate Abuse Epidemic

2014; Elsevier BV; Volume: 89; Issue: 8 Linguagem: Inglês

10.1016/j.mayocp.2014.06.006

1942-5546

R. Hirsch,

Healthcare Policy and Management

In their editorial on opiate overdose, Berge and Burkle1Berge K.H. Burkle C.M. Opioid overdose: when good drugs break bad [editorial].Mayo Clin Proc. 2014; 89: 437-439Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar list the release of new opioid drugs, the aggressive marketing to physicians, the declaration of pain as "the fifth vital sign," and the increased willingness of physicians to treat noncancer pain with opioids as the measures that led to the explosion of sales of prescription opioid pain relievers. It is imperative that 3 others be added to this list: the patient satisfaction survey industry, the Centers for Medicare and Medicaid Services (CMS), and hospital administrators. Despite conflicting literature, the patient satisfaction survey industry was able to convince payers and hospitals that patient satisfaction and quality of care are directly correlated. The CMS, in their drive to pay for quality instead of quantity, had such faith in this flawed concept that they weighed patient satisfaction at 30% in their value-based purchasing program. As a result, hospitals bought patient satisfaction survey tools and consulting services from these companies and started providing physicians with "feedback" on their performance, asking those with poor scores to improve. To that end, physicians started working harder to please patients, giving them what they wanted (which was not always the same as what they needed) and erring on the side of overprescribing to avoid being scored poorly. Patients seeking opiate prescriptions then learned to tell physicians that an opiate prescription would make them "highly satisfied," a not-so-veiled threat that anything less would result in a poor satisfaction score and the resultant increased scrutiny by hospital administration. Until the CMS and hospital administrators realize that patient satisfaction is not an accurate measure of the quality of care, the role of prescribed opiates in the opiate abuse epidemic is unlikely to lessen. Opioid Overdose: When Good Drugs Break BadMayo Clinic ProceedingsVol. 89Issue 4PreviewActor Philip Seymour Hoffman died on February 2, 2014, at age 46 years of an apparent accidental overdose (OD) of an opioid drug. He is yet another in a long series of talented entertainers to succumb to this class of drug; others include Elvis Presley, John Belushi, Heath Ledger, and many more. Although these celebrity deaths generate great interest in the media, journalists and the public often underappreciate that these celebrity deaths are but a single manifestation of an ongoing population-wide epidemic of opioid OD deaths. Full-Text PDF In reply—The Contribution of Patient Satisfaction to the Opiate Abuse EpidemicMayo Clinic ProceedingsVol. 89Issue 8PreviewWe agree with Dr Hirsch in his contention that patient satisfaction surveys and ratings can create perverse incentives for physicians to overprescribe controlled substances. Physicians wish to maximize satisfaction ratings in order to preserve reimbursement levels and their online reputations as caring and compassionate practitioners. Doubtless, this creates, in many cases, a motivation to prescribe simply because the patient desires it and to not aggressively question the necessity or appropriateness. Full-Text PDF