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Practice Rounds: More Narcotics for Cranky Patients


Docs say they feel pressure from hospitals to make patients happy by prescribing narcotics. Also, text messaging patients may be the next frontier.

Welcome to Practice Rounds, our new weekly column exploring what's being covered in the larger world of healthcare.

Surveys Pressure Docs to Prescribe Narcotics

Physicians may be experiencing institutional pressure to prescribe narcotics, according to Kaiser Health News. Medicare patients are commonly asked to complete a patient satisfaction survey about their care during recent hospital stays - which asks patients how physicians managed their pain - potentially setting up a conflict of interest for docs. Because patient surveys are linked to hospital reimbursement, they can also affect physician compensation. Physicians are caught in the middle: On one hand trying to comply with new guidelines that recommend more stringent prescribing of opioid pain medication, yet also "managing patient pain so it's zero," said Nancy Foster of the American Hospital Association.

Payer Uses Data for Patient Outreach

Physicians are often hard-pressed to compile and analyze practice-wide data for population health purposes. But this is not the case for large payers like BCBS of Tennessee. The payer has instituted an outreach program for its members, using claims data to identify gaps in preventative care and routine health screenings, according to Fierce Healthcare. The health insurer developed a color-coded scorecard for members to let them know which screenings or tests, such as mammograms or colonoscopies, were outstanding, which incented 20 percent of that group to take action. BCBS of Tennessee also developed an outreach team that travels throughout the state to offer preventative screenings like blood pressure checks and bone density tests.

Uncompensated Care for Victims of Mass Shootings

Researcher Ted Miller at the Pacific Institute for Research and Evaluation estimated that the lifetime total cost of care for U.S. Representative Gabby Giffords and the 18 other 2011 gunshot victims in Arizona to be roughly $4 to $7 million, reports Kaiser Health News. Compounding the high cost of care for gunshot victims, is the fact that they are often under- or uninsured. That's the case for many victims of the Pulse nightclub shooting in Orlando, Fla. "They're young, primarily Latino, and living in Florida," says Embry Howell, senior fellow at the Urban Institute, noting that Florida did not expand Medicaid coverage through the Affordable Care Act. Forty-four of the Pulse nightclub victims were cared for at Orlando Regional Hospital, which expects uncompensated costs to reach more than $5 million.

What You Should Know About Texting Patients

Not all patients are comfortable communicating with their physicians via a patient portal, reports Medical Economics. Younger patients prefer text messaging, which is much more congruent with the way they interact with the rest of their world. There are a number of mobile apps and EHR add-ons that allow physicians to text with patients in a secure manner, and the advantages are almost obvious - the physician can respond at his or her leisure, it takes less than a few minutes to text a patient, and conversations are documented in the patient chart. Patients can even text photographs to their physicians, illustrating a sore eye or rash, for instance.

Quote of the Week:

Can You Turn Away a Bed Bug Ridden-Patient?

"There is a lot of literature about how to handle patients who bring bed bugs into the office setting … Certainly all of these steps will assist in preventing the spread of the bed bugs and avoid an infestation among practice staff and patients. Unfortunately, these same steps can cause a patient with bed bugs to feel mistreated, angry, and humiliated."  

Ericka L. Adler, healthcare attorney

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