The Obamacare Quirk That Is Fueling the Opioid Epidemic

Patient survey questions about pain management are leading hospitals to prescribe potentially dangerous drugs.

Not long ago, Dr. Bill Sullivan, an emergency-room physician in rural Spring Valley, Ill., treated a type of patient that has become all too familiar in hospitals across the country. Complaining of abdominal pain, the man asked specifically for Dilaudid, a potentially habit-forming painkiller. Noticing that his record showed a long history of opioid prescriptions, Sullivan suggested a less potent option. The patient’s response, according to the doctor: “Morphine is sh-t.”

Sullivan refused to prescribe the patient’s drug of choice. By doing so, he may have put his hospital at financial risk. That might seem strange, since opioid addiction has become a national epidemic. But the potential economic hit is a direct, if unintended, result of reforms put in place under the Affordable Care Act.

As part of an Obamacare initiative meant to reward quality care, the Centers for Medicare and Medicaid Services (CMS) is allocating some $1.5 billion in Medicare payments to hospitals on the basis of criteria that include patient-satisfaction surveys. Among the questions: “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?”

To many physicians and lawmakers struggling to contain the nation’s opioid crisis, tying a patient’s feelings about pain management to a hospital’s bottom line is deeply misguided—-if not downright dangerous.

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