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Congressman Randy Hultgren

Representing the 14th District of ILLINOIS

Op-ed: Are government patient satisfaction surveys undermining the Hippocratic Oath?

Aug 5, 2014
In The News

Washington Examiner

“Just give me antibiotics; that’s what worked last year.” So demanded a character of Dr. Mark Greene on the long-running show “ER” while suffering from the seasonal flu.

Greene refused, saying that antibiotics wouldn’t help his viral infection and furthermore that prescribing them would contribute to the problem of superbugs that are resistant to normal antibiotics. The patient was upset, but Greene held his ground.

Back in the 1990s, Greene would have been commended for practicing good medicine. Unfortunately, more recent regulations handed down from the Centers for Medicare & Medicaid Services and bolstered by the Affordable Care Act — Obamacare — would punish Greene for his decision to go against his patient’s wishes.

How is that possible? In 2002, CMS began using the Hospital Consumer Assessment of Healthcare Providers and Systems survey, a method of rating the care given by doctors and hospitals which relies largely on patient opinion.

In 2007, CMS started using the survey to determine funding reductions or bonuses to hospitals providing care to Medicare patients.

The intentions of the survey are generally good. Patients walking out of their doctor’s office should be happy with the care they are receiving. In the interest of fiscal responsibility, tax money should not pay for subpar health care for poor doctors and care centers. That is unfair to seniors who receive care and American taxpayers who are on the hook for it.

But it brings into question the proper balance between patient satisfaction and a doctor’s autonomy to decide what is best for them. There’s good reason to believe weighing patient satisfaction too heavily creates a tremendous burden on both physicians and health care facilities and warps the incentives when doctors practice medicine.

Following a surgery, a patient may rate a doctor’s performance on how much pain they felt, even if they were prescribed the proper dose of pain medication.

In this area — pain management — the survey’s power to reduce funding to hospitals can put downward pressure on doctors to do whatever they can to increase their ratings, leading to unintended yet harmful consequences.

In order to please the patient, the doctor may feel pressure to overprescribe pain medication to ensure their patient does not rate them poorly on pain management. The danger of overprescribing pain medication is well-known, in many cases leading to prescription drug abuse and addiction.

I have been greatly concerned with the pressing issue of drug, and particularly opiate, abuse on multiple levels. According to a study by the Centers for Disease Control and Prevention, drug overdose death rates in our country have more than tripled since 1990. In 2008, the CDC reported that more than 36,000 people died from drug overdose, most of which involved prescription drugs.

During a March 7 community forum on the issue that I hosted at the Kane County Government Center in Geneva, Ill., a diverse array of experts and local and state leaders, including law enforcement, drug courts, elected officials, educators, treatment providers and recovery centers, tackled the issue of opiate abuse in all its forms.

Among other things, we addressed the growing link between prescription opioid painkillers and rising heroin use. When law enforcement cracks down on prescription painkillers like Oxycontin and Vicodin, users turn to heroin, which gives a similar high and is cheaper and easier to access.

So if doctors are incentivized to overprescribe opioids to demanding patients, this could exacerbate the epidemic of opiate abuse. Like the "ER" scenario, putting the patient’s most immediate wishes over that of the doctor’s wisdom and knowledge can lead to unintended-yet-harmful results.

Doctors should be able to practice medicine in the way they deem best for their patients, not be hired or fired based on surveys that don’t tell the full picture.

In fighting heroin and opiate abuse, my goal has been to develop a model that will help engage the community to help fix this issue and to remove the stigma of addiction so that those affected can get the proper care. But these CMS regulations can break down that model.

Doctors providing great health care should not be punished for being unable to live up to the unreasonable expectations of unhappy patients and a flawed survey. Regulations by the CMS must be changed in order to preserve the holy grail of medicine — the Hippocratic Oath.

Only when we get the government out of the way of our doctors and restore to them the full authority to "do no harm" will we be able to unwind the damage being done to patients, especially those being treated with opioid painkillers.

Republican Randy Hultgren represents Illinois' 14th U.S. congressional district.