The proposal to remove pain from patient satisfaction scores may decrease the incentives for clinicians to prescribe medically unnecessary opioids in an effort to keep satisfaction scores high, as Medicare reimbursement rates were pegged to these satisfaction metrics.

Jay Kaplan, MD, FACEP, President of the American College of Emergency Physicians (ACEP), released a statement commending the proposal by Sylvia Burwell, the Health and Human Services (HHS) Secretary, that pain questions be removed from various Centers for Medicare and Medicaid Services (CMS) Patient Experience of Care surveys, because this could make a difference in efforts to reduce opioid abuse.

“[The ACEP] commends Secretary Burwell’s proposal to remove pain management questions from patient satisfaction surveys,” he said. “The pursuit of high patient-satisfaction scores can create incentives for medical providers to honor patient requests for unnecessary and even harmful treatments.  The HHS proposal will align federal policies to be consistent with current efforts to reduce opioid use… these questions have been used to influence Medicare reimbursement rates and have resulted in unintended consequences in light of the nation’s opioid epidemic.”

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He added that in the attempt to reach high patient satisfaction scores, clinicians may be encouraged to honor patients’ requests for unnecessary prescriptions for pain medication. “The HHS proposal will align federal policies to be consistent with current efforts to reduce opioid use,” he said.

According to the statement by the ACEP, more than 136 million patients visit emergency departments annually in the United States, and only about 42% of those visits are related to legitimate pain issues. “Emergency physicians see first-hand the devastating consequences of drug misuse and abuse, and we are committed to working with the federal government and the house of medicine to reduce opioid addiction in America.”

“We need to ensure that patients with pain are cared for in a compassionate way at the same time that we work to decrease the number of patients who become dependent on prescription medications.”

The largest decrease in opioid-prescribing rates among medical specialties occurred in emergency medicine between 2007 and 2012, according to the American Journal of Preventive Medicine. In that study, emergency department clinicians were found to have written less than 5% of all opioid prescriptions in the United States.

ACEP is the national medical specialty society representing emergency medicine. ACEP is committed to advancing emergency care through continuing education, research and public education. Headquartered in Dallas, TX, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies.


American College of Emergency Physicians (ACEP) Press Release Office. ACEP Applauds HHS Proposal to Remove Pain Questions From Federal Patient Satisfaction Surveys.  Published online July 6, 2016. Accessed July 14, 2016. 

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