The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a 32 question survey given to hospital inpatients upon discharge to evaluate their stay.  The survey measures, from the patient’s point of view, how well the nurses and doctors communicate with the patient, how responsive the hospital staff are to the patient’s needs, how well hospital staff help patients manage their pain, how well the staff communicates with patients about new medicines, whether key information is provided at discharge, and how well the patient understood the type of care they would need after discharge.  Nurses, doctors, and hospitals as a whole are evaluated as to their effectiveness based on these surveys and they affect the CMS (Centers for Medicare & Medicaid Services) payments made to the hospitals.

According to a 2016 study of the HCAHPS, 73% of patients report needing medicine for pain during their hospital stay.  The questions asked about pain management within the survey are “During this hospital stay did you need medicine for the pain?”, “During this hospital stay how often was your pain well controlled?”, and “During this hospital stay how often did the hospital staff do everything they could to help you with your pain?”.   Without this point I think the survey would be fine, however allowing patients to affect the hospitals pay, or even worse, someone’s job because they don’t think they were given enough pain meds is ludicrous.

How often do you think drug seeking individuals go into an emergency room with an ailment just to then receive their drug of choice?  How often do you think hospital patients tell their doctors “it still hurts” even though it doesn’t, “I’m in a lot of pain” even though they’re not, “please make the pain go away” even though it doesn’t exist, or “it’s a 10 Doc” even though it’s really a 2?  This happens all the time.

Now, hospitals are having these same individuals fill out a survey about how well their “pain” was managed by the staff and the survey results can affect the jobs of doctors and nurses .  Also, on the flip side, knowing they are constantly being scored on such things, doctors who know a patient is drug seeking, or doesn’t really think their patient needs a morphine drip, may be more inclined to order it anyway for fear of being scored negatively.

A couple of weeks ago, I didn’t even know this survey existed.   I had just posted a blog about Xanax,  when I received a private message from a friend of mine who is a nurse in the Northeast.  She wrote

“Health care has been changing quite a bit.  Within the past year, doctors are actually being rewarded for ordering alternative pain management i.e. acupuncture, etc.  However they are still evaluated by the patient and scored on pain management.  A survey will go home and that will determine our HCAHP score.  If a particular doctor is scoring badly on that, he or she will eventually be fired.  They have the added pressure to order narcotics to basically keep their job. ”

“I know I was asked not to be someone’s nurse because I refused to administer dilaudid to a pregnant woman every two hourr.  I have been screamed at and spit on for not administering narcotics to a patient whose liver/kidney could not handle the narcotics.    I’ve even had family members come after me for not administering more pain meds when the patient couldn’t open their eyes. “

“In my hospital they actually have continuing competencies on pain management for pain control and how to lessen narcotic use.  One doctor I work with in particular, a palliative care doctor, does quite a bit to lessen narcotic use. It is not only addictive but causes complications after surgery. I’ve had patients become so constipated (from the opiates) that they needed surgery. “

“Anyway … awesome article! Keep it up. I don’t get to see what happens to our patients after we send them home with a prescription.”

Written by Guest Blogger Tara Smith

Tara’s involvement in substance abuse treatment followed her involvement helping a loved one through an addiction. She works in the substance abuse field at Narconon New Life Retreat while following in her mother’s footsteps by pursuing a Bachelors in Social Work.