Hospitals in Medicare’s pay-for-performance reimbursement system appear to have over-prescribed opioid pain medication to boost their ratings, according to a new analysis.
In a paper published on April 20 in the Journal of Public Policy and Marketing, researchers describe how they analyzed hospital data over multiple years and found no other metric showed as much potential for growth as pain management, which suggests that opioid prescriptions could help hospitals get higher ratings.
Pay-for-performance incentives for hospitals were created by the Centers for Medicare and Medicaid Services in 2003. The goals, according to the National Institutes of Health, were to incentivize, publicly recognize, and financially reward high-quality care based on 34 quality measures.
Metrics Cause Uneasiness
Study authors said physicians and hospitals felt uneasy asking patients about pain management. Some providers reported feeling pressured to alleviate pain with drugs because higher satisfaction scores meant higher reimbursements.
Powerful opioids like oxycodone became more widely prescribed in the late 1990s when pharmaceutical companies reassured providers that the drugs would not become addictive. But that turned out to be false and by 2017, the U.S. Department of Health and Human Services declared opioid addiction to be a public health crisis. More than 450,000 Americans have died from an opioid drug overdose.
Under the Trump administration, the survey questions were revised to focus on pain communication- whether a patient experienced pain at the hospital and how often staff talked with a patient regarding level and treatment of pain. The CMS would later announce a full removal of pain management questions in keeping with the Outpatient Prospective Payment System Final Rule.
Last year, a study from BMC Health Services Research found the “majority of clinicians believed hospitals contributed to the opioid epidemic.” Clinicians cited CMS’s pay-for-performance reimbursement policy as the main driver. “Inappropriate” administration of the drugs in hospital emergency rooms was also considered a major component of the problem.
The JPPM authors concluded that, since no other input measure showed much improvement, “removing pain management from the formula may weaken the effectiveness of the Hospital Value-Based Purchasing Program,” defeating the purpose of the program: improving patient satisfaction.
Ashley Bateman (bateman.ae@googlemail.com) writes from Virginia.
Internet info:
Lu Liu, Dinesh K. Gauri, Rupinder Jindal, “The Role of Patient Satisfaction in Hospitals’ Medicare Reimbursements,” Journal of Public Policy & Marketing, April 20, 2021: https://journals.sagepub.com/doi/abs/10.1177/0743915620984723?journalCode=ppoa