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Medicare Proposes Omitting Pain Management Questions from HCAHPS

News  |  By HealthLeaders Media News  
   July 11, 2016

The agency aims to remove 'even the perception that there is financial pressure [on hospitals] to overprescribe opioids,' says HHS.

The pressure to effectively manage hospital patients' pain while simultaneously reducing opioid prescribing has proven difficult for doctors, especially when Medicare payments are tied to patient experience scores.

Now, HHS wants to eliminate that catch-22 by removing pain management questions from the HCAHPS survey and from the hospital payment scoring calculation.

Even though HHS says that "those payments currently have a very limited connection to the pain management questions on the HCAHPS survey," HHS Secretary Sylvia M. Burwell's proposal aims to "mitigate even the perception that there is financial pressure to overprescribe opioids," according to an HHS announcement.

The proposal doesn't mean that hospitals would stop surveying patients about pain, but that they would stop getting paid based on answers about pain.

"Hospitals would continue to use the questions to survey patients about their in-patient pain management experience, but these questions would not affect the level of payment hospitals receive," HHS said.

The proposal was met with enthusiasm by the American College of Emergency Physicians (ACEP).

"ACEP commends Secretary Burwell's proposal to remove pain management questions from patient satisfaction surveys. These questions have been used to influence Medicare reimbursement rates and have resulted in unintended consequences in light of the nation's opioid epidemic," ACEP president Jay Kaplan, MD, FACEP said in a statement.

"The pursuit of high patient satisfaction scores can create incentives for medical providers to honor patient requests for unnecessary and even harmful treatments. The HHS proposal will align federal policies to be consistent with current efforts to reduce opioid use."

The proposal to eliminate pain management scores from hospital payment scoring calculations is one of several actions from HHS designed to reduce opioid use. Others include:

  • The Buprenorphine Final Rule finalized by the Substance Abuse and Mental Health Services Administration, which allows practitioners who have had a waiver to prescribe buprenorphine for up to 100 patients for a year or more, to now obtain a waiver to treat up to 275 patients.
  • A new policy requiring Indian Health Service opioid prescribers and pharmacists to check their state Prescription Drug Monitoring Program database prior to prescribing or dispensing any opioid for more than seven days.
  • Launching more than a dozen scientific studies on opioid misuse and pain treatment, plus a report on and inventory of opioid misuse and pain treatment research being conducted or funded by its agencies
  • A request for information that seeks comment on current HHS prescriber education and training programs and proposals that would augment ongoing HHS activities

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