CMS Opts to Drop Pain Management Questions from HCAHPS Survey
Move seeks to address overprescribing in opioid epidemic
By Jennifer Larson, contributor
Pain management is a critical issue when it comes to caring for hospitalized patients. In fact, about three-quarters of people who are hospitalized report they needed pain relief during their hospital stay.
But their assessments of how the hospital staff managed their pain may no longer be incorporated into a facility’s reimbursement rates. The Centers for Medicare and Medicaid Services (CMS) recently proposed removing questions about pain management from the standardized Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey that is part of the Hospital Value-Based Purchasing (VBP) program.
Earlier this year, the American Hospital Association (AHA) urged CMS to drop the pain management questions until it could better address the possibility that the questions may be inadvertently contributing to an ongoing opioid epidemic. The AHA and other advocacy groups believe these questions set unrealistic expectations and may lead patients to falsely equate pain management with prescription medication; they could also incentivize providers to prescribe more pain medication to attempt to improve patients’ perception of care.
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The pain-related questions in question
The HCAHPS survey was designed to elicit feedback from patients about their experiences during their hospital stays. The survey was launched in 2006, and the scores were linked to VBP in 2012.
The survey consists of 32 questions, including 21 questions about how often (or not) a patient experienced a particular critical aspect of hospital care. Some of the measures, or dimensions, are included in the VBP, including the patient’s perspective on pain management.
The three pain management questions currently included as part of HCAHPS are:
1. During this hospital stay, did you need medicine for pain?
2. During this hospital stay, how often was your pain well controlled?
3. During this hospital stay, how often did the hospital staff do everything they could to help you with your pain?
CMS is actually proposing leaving the questions in the HCAHPS survey but not including them (and the responses) in reimbursement formulas. CMS officials have said that removing the pain management questions’ impact on VBP payment incentives will remove any insinuation or perception that providers might be financially pressured to overprescribe opioid painkillers.
By doing so, CMS is still allowing the possibility for hospitals to learn more about their patients’ perspectives on how well their pain was acknowledged and handled during their hospital stays, said Ellyn Schreiner, MPH, RN-BC, CHPN, president of the American Society for Pain Management Nursing (ASPMN). And that’s important.
“We still want to make sure that people are addressing the pain,” she said.
For example, without good pain control, many patients experience prolonged hospitalization, which can be costly on a personal level and for the hospital. They’re also more likely to experience adverse effects and complications, such as pneumonias or wounds that are slow to heal, according to Schreiner.
“You want that patient to be comfortable enough to participate in their recovery and have as short as possible a hospital stay,” she explained.
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The road ahead?
Is the move by CMS a sign that pain management may be entering into a new phase? Perhaps. Dubbed the “opioid crisis,” a growing number of opioid-related overdoses and deaths have captured national attention this year, raising questions about whether the nation is responding adequately to addressing the causes and the effects.
One result: Pres. Barack Obama recently signed into law the bipartisan Comprehensive Addiction and Recovery Act (CARA), which was designed to create and expand programs to fight opioid abuse and addiction. The initiative was praised by professional organizations like the Emergency Nurses Association. The proposed CMS change to VBP is another effect.
All nurses can benefit from staying up to date on pain management. For more information, including online education offerings and webinars, visit the American Society for Pain Management Nursing site.
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