Some doctors are finding it challenging to balance the mandate to reduce opioid prescriptions with a federal policy that links hospital payments to patient satisfaction surveys, Kaiser Health News reports.

As part of the surveys, required by a provision of a 2010 federal health law, patients can evaluate how doctors manage their pain and if they did all they could to treat the pain. Doctors say this means their ratings are caught between sound medical judgment and patient demand for painkillers.

In March, the Centers for Disease Control and Prevention issued new guidelines that advise doctors to prescribe opioids in smaller doses, and only when really needed.

Doctors “feel like they’re getting mixed signals,” said Nancy Foster, Vice President for Quality and Patient Safety Policy at the American Hospital Association. On one hand, “they’re getting this signal [from the CDC] to not prescribe opioids. And on the other, they’re getting this signal to manage patient pain so it’s zero.”

Some organizations, including the American Hospital Association and the advocacy group Physicians for Responsible Opioid Prescribing, want federal authorities to change patient satisfaction surveys. They are calling for eliminating the questions, rephrasing them or disconnecting them from hospital payments.

The Centers for Medicare & Medicaid Services, the agency responsible for the surveys, is testing different phrasing, according to Jonathan Gold, a spokesman at the Department of Health and Human Services. New questions would cover how doctors discuss pain with patients, instead of how they treat it.