When a patient is in pain, that patient wants relief—fast. And even if the patient knows medication is only a temporary fix—and a potentially dangerous one, at that—he or she will probably still choose drugs over longer-lasting, less-instant treatment options like physical therapy. For healthcare providers beholden to payment structures that incentivize patient satisfaction, that preference presents a real pickle: give the patient what he or she wants—long-term consequences be damned—or risk lower satisfaction scores (and potentially lower reimbursements) by prescribing treatment interventions that often prove infinitely more effective on a longer timeline.

Taking the Pain Out of HCAHPS  

In an effort to make that pickle a little less, well, pickley, the US Department of Health and Human Services (HHS) recently issued a proposal to eliminate pain management questions included in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey as a factor in hospital payments. In other words, if this proposal goes into effect, hospitals will no longer have to worry about receiving lower payments as a result of low scores on pain-related HCAHPS survey questions.

According to this Healthcare Dive article, the proposal “comes in response to feedback from clinicians who reported feeling pressured to overprescribe opioids in order to achieve the best possible scores on pain management survey questions that are connected to Medicare payments.” The hope is that by severing the link between payments and pain management, HHS will discourage hospitals from prescribing opioids and other painkillers unless it is truly in the patient’s best interest to do so.

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Treating the Source—Not the Symptoms

On that note, most healthcare providers would argue that it’s in the “patient’s best interest” to undergo whatever treatment has the best chance of not only mitigating the patient’s symptoms (i.e., the pain), but also eliminating the source of those symptoms (i.e., the injury or condition causing the pain). As physical therapists—and physical therapy advocates—are well aware, that kind of treatment doesn’t come in a bottle; it comes from expertly crafted rehabilitative care plans focused on correcting the underlying musculoskeletal weaknesses and imbalances that eventually manifest as pain.

Leveraging the Power of Hospital-Based PT

So, as payment structures and incentives continue evolving to promote the delivery of valuable care, providers must look beyond “quick fixes” like prescription drugs—which mask, rather than actually treat, patients’ pain—and instead factor the long-term effects of care into their treatment protocols. This shift in the standard approach to pain management is especially pertinent within large hospital systems, where the overprescription of pain medications is arguably a bigger problem than it is in any other setting. And that means that, as time goes on—and the trend toward value-based payment moves the entire US health system toward a patient-centered mode of care delivery—safe, effective, low-cost care alternatives will play an increasingly important role in hospital environments. Hello, physical therapy.


Do you believe physical therapists are being leveraged to their fullest potential in hospital organizations? What ideas do you have for advancing the movement to end prescription opioid abuse—and encouraging patients and providers alike to #ChoosePT? Share your thoughts in the comment section below.