CMS proposes nixing pain-management questions from HCAHPS in response to opioid epidemic

Opioids
CMS may cut a set of questions on pain management from its patient experience survey. (Moussa81)

The Centers for Medicare & Medicaid Services is planning to eliminate a set of questions on pain management from its nationwide patient experience survey, just months after rolling out updates to the questions. 

The changes to Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) are part of its proposed Outpatient Prospective Payment System (OPPS) update (PDF) for this year. CMS said that it's looking to cut the questions as part of its response to the opioid epidemic, following recommendations from the White House's commission on the matter. 

The questions ask patients if they experienced pain during a hospital stay and if they felt the care team communicated with them adequately about it. Prior to this year, the survey instead asked patients if they believed their pain was effectively controlled. The first surveys with the updated questions were issued in January, but the changes were approved in 2016. 

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The revised versions were aimed at preventing the survey—which impacts reimbursements—from leading hospitals to overprescribe opioids to boost scores on pain-management questions. But stakeholders warned that the revised versions could have a similar effect, CMS said. 

RELATED: CMS finalizes regulations to curb opioid misuse among Part D beneficiaries 

"Since finalization of the 'communication about pain' questions, we have received feedback that some stakeholders are concerned that … the questions still could potentially impose pressure on hospital staff to prescribe more opioids in order to achieve higher scores on the HCAHPS survey," according to the rule. 

The agency is planning to nix the questions as part of an "abundance of caution" in the wake of the opioid epidemic. 

CMS also said in the rule that some providers may be using the HCAHPS results to analyze emergency departments or outpatient care, which it was not intended to do. Doing so would apply the survey responses—many of which are post-surgical patients with pain—to the wrong patient population, which could impact prescribing tends in the ED.

Should the changes to the survey make it into the final rule, the questions would be eliminated beginning January 2022, according to a fact sheet from CMS. The final survey results including those questions would be published in October of that year; the first data from the survey with responses to the revised questions will be released in October 2020. 

RELATED: CMS urges states to better utilize Medicaid to treat opioid-addicted infants 

As part of the comment period on the proposed rule, CMS is seeking feedback from stakeholders on how eliminating the questions could impact patient care. It is also asking researchers to weigh-in with any evidence that supports the theory that the surveys could drive opioid prescribing and if providers would need additional guidance that suggests hospitals avoid surveys with questions on pain management. 

It also asked that stakeholders suggest alternatives to the current questions that would still allow the survey to measure pain management in some capacity. 

"We continue to believe that pain management is a critical part of routine patient care on which hospitals should focus and an important concern for patients, their families, and their caregivers," CMS said in the rule. 

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