Pubdate: Sat, 20 Feb 2016
Source: Day, The (New London,CT)
Copyright: 2016 The Day Publishing Co.
Contact:  http://www.theday.com/
Details: http://www.mapinc.org/media/293
Note: This editorial originally appeared in the The Portland Press 
Herald of Maine.

DANGEROUS INCENTIVES

Americans consume opioid painkillers at twice the rate of our 
neighbors in Canada. Since it can't be because people on this side of 
the border are in twice as much pain as Canadians, we have to 
conclude that there is a difference in the way that pain medication 
is distributed.

That difference is important to understand. America is in the middle 
of a prescription opioid epidemic. There are more than 2 million 
people addicted to pain medication, and more people die of drug 
overdoses - mostly involving prescription drugs - than are killed in 
car crashes.

Throughout the northeastern states, we have seen prescription 
painkillers become the gateway drug to heroin addiction, as users 
move from pills to the dangerous street drug because it's less 
expensive and more available. It is a complicated, multifaceted 
problem, but it is clear that well-intentioned drug-prescribing 
practices have an unintended impact on the abuse of these 
medications, which is leading to so many problems.

Currently, hospitals are judged on four quality measures, including a 
patient's care experience. The score the hospital receives will 
affect how the institution is reimbursed by Medicare. Since there is 
no objective measure of pain, that part of the performance evaluation 
relies on patient surveys.

Before being discharged from a hospital, a patient is asked, "How 
often was your pain well-controlled?" and "How often did the hospital 
staff do everything they could to help you with your pain?"

A letter written by Maine Sen. Susan Collins and signed by 26 of her 
colleagues that asks health regulators whether it's wise to put such 
a high premium on these subjective judgments. Prompt pain relief is 
appropriate for some patients, but overuse of painkillers can cause 
harm, and a person in pain will not always be the best judge of 
whether the care was appropriate. If making sure that patients leave 
the hospital happy plays a role in the institution's reimbursement 
rate, it could create an incentive for clinicians to over-prescribe.

With the nation facing a crisis caused by the over-prescribing of 
painkillers, we should not have a medical financing system with 
built-in incentives for undesirable behavior. The senators are asking 
the right questions and they deserve an answer.
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MAP posted-by: Jay Bergstrom