A federal agency is removing questions from hospital patient satisfaction surveys that some say may have given hospitals incentives to overprescribe opioids, taking the action at the request of Sen. Susan Collins of Maine and 25 other senators.

The U.S. Centers for Medicare and Medicaid Services said Wednesday that removing the questions was done to “eliminate any financial pressure clinicians may feel to overprescribe medications.” In the future, CMS may come up with new survey questions regarding how hospitals managed patients’ pain, the agency said in a news release.

The pain questions have been included in patient satisfaction surveys given to discharged patients for many years. Survey responses are factored into hospital reimbursement rates from the federal government.

Maine’s other U.S. senator, independent Angus King, also signed the bipartisan letter that was sent to federal health officials in February.

Collins, a Republican, has argued that the questions may give hospitals an incentive to overprescribe pain medication, knowing that failing to do so could affect survey responses and result in lower reimbursements.

The survey asked discharged patients questions, including, “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?”


Collins, in a statement Wednesday, applauded the action, saying that she is “so pleased that (CMS) has taken action to eliminate this possible contributing factor to this burgeoning crisis.”

Four out of every five new heroin users were first abusing prescription painkillers, according to the American Society of Addiction Medicine.

Maine’s opioid crisis continues to deepen, with a record 272 drug overdose deaths in 2015 and 189 deaths through the first six months of this year.

“Physicians now face the complicated task of treating pain in an environment where abuse of prescription painkillers is one of the foremost public health challenges facing our nation,” Collins said. “This epidemic requires us to examine our existing policies to ensure that they are not inadvertently contributing to our vast oversupply of opioids, which harms families and communities across America.”

Jeffrey Austin, vice president of the Maine Hospital Association, said the association is glad to see the questions removed.

“Pain management is important, but pain is a normal side effect of healing and experiencing some pain, sometimes, is not evidence of poor care,” Austin said in a statement.


Part of Maine’s response to the opioid crisis is to limit opioid prescribing for chronic pain.

This spring the Legislature approved one of the strictest opioid prescribing laws in the country. The new law limits the dose and length of time that opioids can be prescribed for some conditions.

Gordon Smith, executive vice president of the Maine Medical Association, which represents physicians before the Legislature, said the federal agency’s decision to remove the questions is “wonderful news.”

Smith said there’s no way to prove to what extent the questions affected prescribing patterns, but it was an example of the medical community’s mindset to more aggressively treat pain. Opioid prescribing accelerated in the late 1990s, when the painkillers became more prevalent, and prescribing patterns didn’t start changing until the past few years, when doctors and others started recognizing the harm opioids were causing to society, Smith said.

He said eliminating the questions are “an important piece of the puzzle.”

“It was frustrating to physicians to be getting dinged on these survey questions for trying to do the right thing,” Smith said.

Joe Lawlor can be contacted at 791-6376 or at:

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Twitter: joelawlorph

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