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Sen. Johnson: Changing Medicare Survey Rules Will Curtail Opioid Prescriptions

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Experts say abuse of prescription painkillers like Vicodin can be a gateway to heroin use

Wisconsin U.S. Sen. Ron Johnson is putting forward an idea to help the country reduce its heroin epidemic. His plan would impact senior citizens.

Johnson says the U.S. must tighten its border security to stop the flow of illegal drugs into the country. Yet he knows plenty of people develop heroin addictions because they first become hooked on opioid painkillers.

The senator wants to tweak Medicare rules so they don’t inadvertently encourage physicians to over-prescribe drugs such as OxyContin and Vicodin to seniors.

Christina Zawadiwsky knows about pain. She works to keep it at bay at the Washington Park Senior Center in Milwaukee. There, she does exercises her physical therapist recommends.

"Because my knees are in constant pain, I can often not be on the treadmill or the bike. But on the NuStep, you move the handles back and forth and they help your heart," she says.

Zawadiwsky was unhappy to learn of Sen. Johnson's proposal targeting prescription opioids.

Johnson says the plan will keep doctors from prescribing too many of the painkillers to seniors. Those on Medicare are asked to fill out a patient satisfaction survey after doctor's visits. The program reimburses providers based on results. Part of the survey focuses on how well doctors are managing a patient's pain. Johnson's plan would scrap the connection between pain management and Medicare reimbursements.

"I would be very concerned if someone were not even looking at the surveys that we're taking and caring about our pain management -- especially chronic pain management is very, very difficult," Zawadiwsky says.

Johnson defends his proposal, saying survey results can interfere with a doctor's best judgment.

"The problem is, is that could put undue pressure on physicians to potentially over-prescribe painkillers. Over-prescription of opiates can be a real problem, and obviously, opiate addiction can lead to what we're seeing is such a huge problem: heroin addiction and heroin overdoses," Johnson says.

Johnson says the patient satisfaction surveys are part of President Obama's Affordable Care Act. He says they're well-intentioned, but flawed.

Dr. David Gummin, medical director of the Wisconsin Poison Center, agrees.

"Conceptually, that's wonderful. But unfortunately in practice, those surveys lack scientific validity," Gummin says.

He says the surveys don't accurately capture what patients experience. "The vast majority of them never get completed and returned. So really, the surveys that are being used in health care today are dramatically skewed toward people who have a bone to pick with the care that was provided, or with the system," Gummin says.

Yet Gummin says the surveys can determine doctors' pay, and therefore affect their decisions. "It has absolutely changed practice, and it's been a significant contributor to the prescription opioid epidemic and the heroin and opioid epidemic that we're in today," he says.

A contributor, Gummin says, because too many opioids end up falling into the wrong hands, and become the gateway to heroin use. He says too often, children steal their parent's or grandparent's prescription painkillers.

Sen. Johnson's bill might be one solution to the over-prescription and movement of opiates. But the plan comes with its own drawbacks, according to Dr. Jerry Halverson, past president of the Wisconsin Medical Society.

"This is going to prevent some people that really need pain medicines from getting as much medicines as they might need, but we are right now cracking down on all prescribing of opiates, based on some egregiously bad actors," Halverson says.

If Johnson's proposal to reduce over-prescriptions for seniors becomes law, there's a good chance other health care payers will follow suit.

Ann-Elise is WUWM's news director.
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