In a response to pressure from stakeholders, the Centers for Medicare and Medicaid Services (CMS) proposed to remove the pain management dimension from the current Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) for purposes of funding. Currently, HCAHPS scores are used for the Hospital Value-Based Purchasing (VBP) program, which redistributes a portion of Medicare payments to hospitals based on performance in the surveys.
CMS currently attempts to provide a standardized survey that measures patients' perspective on hospital care, which continues to be an area of contention for most healthcare providers — especially regarding the pain management questions.
The survey contains 21 patient-perspective rating items that encompass nine topics, including communication with doctors, communication with nurses, responsiveness of hospital staff, pain management, communication about medicines, discharge information, cleanliness of hospital environment, quietness and transition of care.
The current pain management section comprises questions 12-14 of the survey:
12. During this hospital stay, did you need medicine for pain? (if no, go to question 15)
13. During this hospital stay, how often was your pain well controlled?
14. During the hospital stay, how often did the hospital staff do everything they could to help you with your pain?
CMS is quick to point out there is no direct question regarding only using medications for pain management. However, the healthcare community maintains that the survey strongly suggests and encourages the use of pain medication to the public.
As the opioid epidemic continues to be a public health concern, it is clear efforts need to be taken to discourage the continued use of medications as the only source of pain management. As many healthcare providers will attest, not "everything" can be done to help patients' pain.
Unfortunately, sometimes due to other physiologic processes, all pain cannot be eradicated as many patients desire. However, the question of "everything" being done implies efforts were not taken by choice instead of the circumstances of their condition.
As the healthcare community and the public look for solutions for the opioid epidemic, they have continued to apply pressure to CMS.
In a letter from the American Hospital Association, Ashley Thompson, Senior Vice President of Public Policy Analysis and Development, asked for CMS to reassess the pain questions as they may inadvertently contribute to the opioid epidemic. They recognized that "linking the pain control questions to payment through the VBP program is seen by clinicians as encouragement from CMS to provide pain medication."
Although CMS noted in their current proposal that this is the perception of healthcare providers, officials insist there is no clear research that supports this claim. CMS maintains they are removing the questions for the purpose of the Hospital VBP in "an abundance of caution."
Of interest, HCAHPS scores only measure patient perceptions of care, which CMS holds in high value. However, healthcare providers' perceptions are immediately discredited and undervalued when concern is raised.
Under the new CMS proposal, the removal of the pain management dimension would affect funding of FY 2018, which is based on data from 2016. Although the current questions will remain and be reported to the public, they will not be included in the VBP for hospitals if the proposal is approved.
CMS is accepting comments on the new proposal rule until Sept. 6.
