Is Obamacare Accidentally Fueling The Prescription Painkiller Epidemic?

By John Lavitt 05/09/16

A clause within Obamacare is leading physicians to overprescribe painkillers to appease pain patients and maintain hospital funding.

Is Obamacare Accidentally Fueling The Prescription Painkiller Epidemic?
photo viaShutterstock

Here's an example of how a good policy in theory can often turn bad in practice. Many more people are paying attention to how a misguided incentive offered under the Affordable Care Act has spurred the spread of opioid abuse. Senior Time writer, Sean Gregory, explained in a recent article the role that patient satisfaction surveys have had in fueling abuse nationwide. 

Under the Affordable Care Act, funding for hospitals was determined by these patient satisfaction surveys, which asked questions like, “During this hospital stay, how often did the hospital staff do everything they could to help you with your pain?” And, “How often was your pain well controlled?” Such questions have been around since 2001, when a new pain management approach began to put a greater emphasis on the treatment of pain. The funding clause, though designed to reward quality care, ultimately became a twisted incentive for doctors to overprescribe painkillers. 

Physicians placed in this no-win situation are not happy. “The government is telling us we need to make sure a patient’s pain is under control,” Dr. Nick Sawyer, a health policy fellow at the UC Davis department of emergency medicine, told Time. “It’s hard to make them happy without a narcotic. This policy is leading to ongoing opioid abuse.”

According to the CDC, more than 165,000 Americans died from a prescription opioid-related overdose between 1999 and 2014. Although patient satisfaction surveys are not the only thing that's driving America's opioid epidemic, it has no doubt played a significant role in doing so, Gregory says. Nearly half of physicians in a 2014 survey, published in Patient Preference and Adherence, reported prescribing inappropriate opioid pain medication because of the patient satisfaction survey. And patients who report high satisfaction were found to spend more on prescription drugs and have higher mortality rates, according to a 2012 study published in the Archives of Internal Medicine.

Congress is trying to undo this phenomenon. U.S. Senator Susan Collins (R-Maine) called on the Department of Health & Human Services to investigate the connection between the surveys and inappropriate prescriptions. "Health providers are telling me that these questions are written in a way that make them fear a lower reimbursement if patients did not answer them in the affirmative," she said. "For a small rural hospital in Maine to lose a certain percentage of their Medicare reimbursements is a big deal."

In February, Rep. Alex Mooney (R-W.Va.) introduced bill H.R. 4499, the Promoting Responsible Opioid Prescribing Act, which attempts to correct this misguided policy. The PROP Act would "remove an Obamacare penalty on doctors who refuse to overprescribe prescription painkillers. In doing so, this bill empowers doctors, not the federal government, to choose what is right for patients."

Please read our comment policy. - The Fix

Growing up in Manhattan as a stutterer, John Lavitt discovered that writing was the best way to express himself when the words would not come. After graduating with honors from Brown University, he lived on the Greek island of Patmos, studying with his mentor, the late American poet Robert Lax. As a writer, John’s published work includes three articles in Chicken Soup For The Soul volumes and poems in multiple poetry journals and compilations. Active in recovery, John has been the Treatment Professional News Editor for The Fix. Since 2015, he has published over 500 articles on the addiction and recovery news website. Today, he lives in Los Angeles, trying his best to be happy and creative. Find John on Facebook, Twitter, and LinkedIn.