The Centers for Disease Control and Prevention data shows that the drug overdose death rate from opioids increased by 200% between the years 2000 and 2014.
I started medical school in 2000, just as pain was becoming the fifth vital sign and pain management became a focus of care. Sixteen years later, reimbursement is now directly tied to pain management through HCAHPS questions and CMS rules. The question “during your hospital stay, how often was your pain well controlled?” and answers “never, sometimes, usually or always” seem straight forward. However, CMS only counts this as binary answer, always or not, and you only get credit for always. This can clearly lead physicians feeling an increased pressure to treat pain and prescribe opioids. Even for those Plastic Surgeons in private practice, this can be an issue with patient satisfaction surveys and online reviews.
There may not be any easy answers, but it does not mean we shouldn’t start to look for solutions.