Prescribing more opioids won’t affect HCAHPS scores

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 - Jay S Lee MD
Jay S. Lee, MD, general surgery resident at the University of Michigan

University of Michigan researchers found no association between prescribing more opioid painkillers to postoperative patients and higher pain management scores on patient satisfaction surveys, undercutting physicians’ perceptions that they’ve been incentivized to prescribe the potentially addictive drugs.  

In their JAMA study, Jay S. Lee, MD, and his coauthors examined data from more than 31,000 patients who underwent surgery at 47 hospitals in Michigan from 2012 to 2014 using insurance claims from Blue Cross Blue Shield of Michigan. The variable was the mean quantity of opioids those patients filled in the 30 days after discharge, which were measured as oral morphine equivalents (OMEs).

Those numbers were compared to pain management and pain dimension scores recorded over the corresponding year in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey.

The opioid prescription was broken down into quintiles, with the lowest cutoff at less than 356 OMEs and the highest at greater than 465 OMEs. Despite the difference in how many opioids were being prescribed, patients in those quintiles showed nearly identical pain management scores (69.5 in the first quintile and 69.1 in the fifth), showing no correlation between prescribing more opioids and higher scores on pain management within HCAHPS.

“Nonetheless, surgical patients are a key contributor to HCAHPS scores, and opioids account for almost 40 percent of surgical prescriptions,” Lee and his coauthors wrote. “Given the growing evidence demonstrating postoperative opioid prescriptions exceed patient requirements, these findings suggest reducing opioid prescriptions may not worsen HCAHPS scores and hospital reimbursement in Michigan.”

The conclusion goes against what other physicians have argued. In April 2016, an advocacy group called Physicians for Responsible Opioid Prescribing asked CMS to remove pain treatment questions from HCAHPS to fight the growing problem of opioid addiction.

“Hospitals are financially incentivized by CMS to obtain high scores on HCAHPS survey questions," its statement said. "The questions on the survey pertaining to treatment of pain have had the unintended consequence of encouraging aggressive opioid use in hospitalized patients and upon discharge.”

CMS agreed to those demands in November 2016, removing the pain management dimension from HCAHPS as part of the final rule on the 2017 Medicare hospital outpatient prospective payment system (OPPS).