Posted on 05/07/2015 2:58:26 AM PDT by markomalley
Experts say too many patients are being prescribed opioid painkillers by emergency room doctors, and a program created by Obamacare could be enabling the problem.
A new study released this week found 17 percent of nearly 20,000 patients were discharged from emergency rooms with an opioid prescription. Experts and lawmakers say a push under Obamacare for hospitals to get good patient satisfaction scores is one cause of the problem.
America is in the midst of an opioid "epidemic," according to the Centers for Disease Control and Prevention. Painkillers killed more than 16,000 people in 2013. A huge part of the problem is the prescribing of painkillers, which quadrupled from 1999 to 2013.
Emergency room prescriptions are part of this trend, but data are lacking on the reasons opioids are given out, according to the study published in the Annals of Emergency Medicine.
Patients with back pain got the most opioids, followed by those with abdominal pain. "The majority of prescriptions had small pill counts and almost exclusively immediate-release formulations," according to the study.
Oxycodone, the active ingredient in Oxycontin, was the most prescribed, with 52 percent.
Doctors may feel pressured by hospital administrators to prescribe opioids because it may lead to a better score on a patient satisfaction survey, experts said.
A program created by Obamacare tied extra funding to high scores on the survey.
"Their reimbursement and quality ratings are linked to ways patients rate them on categories," said Dr. Andrew Kolodny, president of the doctor advocacy group Physicians for Responsible Opioid Prescribing.
The survey has three questions about pain, including whether the physician adequately treated pain.
While it sounds like a benign question, "it forces physicians and surgeons to not only ask about pain but be sure they are prescribing appropriate medication," said Dr. David St. Peter, a hospitalist with Saratoga Hospital in New York. St. Peter works to admit patients to the hospital if they need further treatment after the emergency room.
The Centers for Medicare and Medicaid Services recently announced publication of a five-star rating system for hospitals based in part on satisfaction survey scores.
This practice hasn't gone unnoticed by Congress.
Sens. Chuck Grassley, R-Iowa, and Dianne Feinstein, D-Calif., wrote to CMS last year that the surveys could impact opioid prescribing. The senators cited news reports of doctors in South Carolina admitting to prescribing more opioids in response to patient survey scores.
"One hospital with low satisfaction scores even went so far as to offer Vicodin 'goody bags' to patients discharged from its emergency room in an effort to improve its scores," the letter from the senators reads.
Emergency doctors face other challenges.
For instance, opioid addicts will sometimes injure themselves just to get access to a small amount of painkillers, said Kolodny.
It can be hard to tell whether the patient is actually hurt or an opioid addict, said St. Peter, who is also vice president of medical affairs for Pacira Pharmaceuticals, which markets a non-opioid painkiller for surgeries.
He said that state databases that log prescriptions could help. For instance, a patient could get 90 Oxycontins from a primary doctor and arrive in the emergency room asking for painkillers a few days later.
"That is a red flag," he said.
Some emergency room doctors are starting to incorporate addiction treatment into their practice.
For instance, a recent clinical trial involved 329 opioid addicts treated in the emergency room at a teaching hospital from 2009-13. Doctors assigned 215 of the patients to counseling or an intervention group, and the rest prescribed buprenorphine which helps treat opioid addiction.
The group that got buprenorphine was more likely to reduce opioid use than the others, according to the study published last week in the Journal of the American Medical Association.
The last time I went to the emergency room (8 years ago) was when I feel on my bike and broke my collarbone. I was glad for the opiates I was prescribed. Pain sucks.
And I didn’t become a junkie.
17% of people going to the emergency room getting some Vicodin does not seem out of order.
BTDT, but when I went to the ER, they just sewed up the gash in my elbow. They missed the broken collarbone completely.
Obama knows best. Opium is a real crowd pleaser.
It can be hard to tell whether the patient is actually hurt or an opioid addict, said St. Peter, who is also vice president of medical affairs for Pacira Pharmaceuticals, which markets a non-opioid painkiller for surgeries.<<
St. Peter is a VP of Medical Affairs?
One of the problems we had in WA and was exposed by a newspaper was a major increase in the use of Methodone for back pain...it was cheap addictive and responsible for a major uptick in patient death, but it was a public program and VERY cost effect! It took a public report to stop the practice. One wonders about other practices that are not so obvious.
DK
People with legitimate opiod dependence will deliberately harm themselves to get more pain killers. My brother was an addict for years, now 3 years clean, and the stuff he used to do to get opiods would make you cringe.
My wife’s late ex-husband was an addict and would get high as a kite, get in his car, drive like a maniac, get into an accident, and refuse to leave the ER until he was given pain medication.
The addiction to pain medication is like nothing I’ve ever seen.
“It’s not as easy as they make it sound..”
No, it isn’t. I think if a person is truly addicted, ten pills at most will last what? A day or two? For what it is worth, many ER’s won’t prescribe pain pills for teens and young adults EVEN if they would with an older person. I had two experiences with that.. when my son broke his foot and when he was stabbed in the leg (long story.. and it doesn’t involve anything bad). They wouldn’t give him one codeine and told me it was because of his age. I asked if I had the same injury, would I get pain medication. The answer was yes. ER’s also have medical records they pull on patients.. and that would show if the person is a constant visitor.
Makes me wonder whether Freddie Grey was on this stuff.
Given the distribution of the issue, I would say there’s a good chance.
My understanding is that he was slinging heroin. If that’s the case, he would’ve been a fool to dip into his own product, but then anyone who would run from cops probably doesn’t rank in the lower ranges of MENSA-smart.
It’s not just satisfaction surveys. The JCAHO,
(Joint Commission) a peer review organization for all aspects of healthcare delivery, has made a hot button issue of each person admitted into a health system recieving a comprehensive pain assessment. “Frequent flyers” will keep going until they get what they want
I have never heard of that and our ED docs, while they do not prescribe large amounts, frequently prescribe more than 10 tablets. Where is this or where do you get your info?
ERs have records, pharmacies too. That’s where you can really get tripped up. They keep good records on this kind of thing. The Shop Rite pharmacy I go to is always on the ball. Not that I’m on Oxycotin mind you! But for the meds my wife and I need if I’m not sure of when the last time I had a prescription filled or whatever or an insurance card hassle(hate those things) they can pull the info right up on the computer. And that’s another way you can get smoked out. Insurances companies along with pharmacies keep an eye out if you’re trying to get an opiate med refilled too early. They ain’t dumb. And doctors and clinics network. They’re always on the lookout for ‘’doctor shoppers’’, people who go running from one doctor to another looking for opiate drugs and they will refuse you and ‘’flag ‘’ you. Some will even call the cops on you. This is not a very well researched article.
St. Peter is in health care! Who knew? What, St. Luke gave up his practice? OY!
I guess the new “opiate of the masses” is... opiates.
On two trips to the ER, I was prescribed Vicodin and Oxycontin and received more than 10 pills. The first trip was for a broken ankle and the second for kidney stones.
I have all of them and always take one bottle with me when I travel. Kidney stone recurrence in a remote location would be problematic
But didn’t Obama say “just give them the pain pill”? They are just following orders!
You can’t get it like ordering pizza, but I have never heard of the 10 pill limit. It must be the policy at your local hospital, but certainly is not law.
When I discharge people from the hospital, there is no limit to the amount of narcotics I can write for, and I write for what I feel is appropriate
I am actually kind of surprised only 17% of ER visits leave with an opiate prescription. Most people go to the ER for injuries, kidney stones and other painful conditions. I would think the majority leave with a prescription for pain meds
That being said, we are pretty good at picking up people who are scamming us. There is also a state data base of all narcotic prescriptions filled, and it is fairly easy to look someone up and see how many narcotics they have been prescribed. Those folks get non narcotic treatment and sent out with no prescriptions.
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