Alexander: Obama Administration Takes "East Tennessee Common Sense Advice," Will Remove Pain Management Questions from Medicare Payment Calculations

Calls news a big win for Tennessee, as hospital survey questions on pain management are said to contribute to overprescribing of opioids, a concern raised by State Representative Bill Dunn at Knoxville roundtable

Posted on July 6, 2016

WASHINGTON, July 6 — Senate health committee Chairman Lamar Alexander (R-Tenn.) today commended U.S. Department of Health and Human Services Secretary Sylvia Burwell for heeding "East Tennessee common-sense advice" to remove from Medicare payment calculations pain management questions said to contribute to the overprescribing of opioids.

“Opioid abuse kills more Tennesseans than car accidents or gun shots each year, so this is a big win for the state of Tennessee and State Representative Bill Dunn, who deserves great credit for bringing this issue to my attention at our Knoxville roundtable last September,” said Senator Alexander. “These survey questions had the unintended consequence of actually encouraging the overprescribing of painkilling opioids and I’m glad to see the administration correct this mistake by removing them from Medicare payment calculations.”


The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey currently includes questions asking patients how well physicians treated their pain. Many doctors have raised concerns that unless they prescribe painkillers, patients will give them a lower score. Because the HCAHPS survey is linked to Medicare payments for hospitals, many physicians claimed they felt pressure to prescribe painkillers or see their reimbursement levels go down.

After a Knoxville roundtable with Centers for Disease Control and Prevention (CDC) Director Tom Frieden in September 2015, Senator Alexander asked Secretary Burwell to consider removing pain management questions from Medicare payment calculations. The roundtable explored ways public health officials, health care providers, law enforcement, and families can work together to reverse the prescription drug abuse epidemic in Tennessee and throughout the country.

State Rep. Bill Dunn (R-Knoxville) in that roundtable told Alexander that the patient satisfaction survey for Medicare patients actually has the perverse effect of encouraging physicians to overprescribe painkilling opiates because reimbursements for hospitals are based to some extent upon the score that patients give doctors about how well they’re satisfied with their treatment. According to those in the roundtable, patients are unlikely to give doctors a high score unless they prescribe the maximum amount of painkilling opioids – and if doctors don’t get a high score, their Medicare reimbursement is reduced.

At an event in West Virginia in October 2015, President Obama announced a review of the patient satisfaction survey used by Medicare to see if it is a contributing factor to the overprescribing of painkilling opioid medicines. Senator Alexander commented at the time:

“This is a direct response to the concern that State Representative Bill Dunn, law enforcement officials, doctors and community leaders in Knoxville had about whether the patient satisfaction survey actually encouraged the overprescribing of painkilling opioids. This is a health crisis that has reached epidemic proportions in our country, especially in Tennessee, that needs to be addressed at every level.”



For access to this release and the senator’s other statements, click here.

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