Medicare Pain Questions Being Dropped in 2017

By Pat Anson, Editor

Hospital patients will no longer be asked about the quality of their pain care under new rules released this week by the Centers for Medicare and Medicaid Services (CMS) for 2017.

Medicare uses a funding formula that rewards hospitals that provide good care and are rated highly in patient satisfaction surveys. Critics claimed that three questions in the survey asking patients about the quality of the pain care created a financial incentive for doctors to prescribe opioid pain medication to boost their hospital’s scores.

The three questions being dropped, which don’t even mention opioids, are as follows:

During this hospital stay, did you need medicine for pain?

During this hospital stay, how often was your pain well controlled?

During this hospital stay, how often did the hospital staff do everything they could to help you with your pain?

CMS said it was still developing and field testing alternative pain questions to replace the ones being eliminated.

“Today’s final rule would address physicians’ and other health care providers’ concerns that patient survey questions about pain management in the Hospital Value-Based Purchasing program unduly influence prescribing practices," CMS said in a statement.

"While there is no empirical evidence of such an effect, we are finalizing the removal of the pain management dimension of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Survey… to eliminate any financial pressure clinicians may feel to overprescribe medications.”

The American Medical Association (AMA), one of the groups that lobbied CMS to drop the pain questions, applauded the move.

"CMS understands that these policies effect how physicians practice medicine and how patients receive treatment," said AMA President Andrew Gurman, MD, in a statement. "By listening to our concerns, CMS made clear that patient care was the top priority. We look forward to continuing to work with CMS to improve patient health and enhance access to affordable quality care."

CMS was under intense political pressure to drop the pain questions. Twenty-six U.S. senators sent a letter to Health and Human Services Secretary Sylvia Mathews Burwell claiming “physicians may feel compelled to prescribe opioid pain relievers in order to improve hospital performance."

Physicians for Responsible Opioid Prescribing (PROP), an anti-opioid activist group,also said the patient survey "fosters dangerous pain control practices."

But a top Medicare official disputed those claims in an article published in JAMA, saying “nothing in the survey suggests that opioids are a preferred way to control pain.”

Pain patients have long complained about the poor quality of their treatment in hospitals. In a survey of over 1,250 patients by Pain News Network and the International Pain Foundation, nine out of ten said patients should be asked about their pain care in hospital satisfaction surveys. Over half rated the quality of their pain treatment in hospitals as poor or very poor, and over 80 percent said hospital staffs are not adequately trained in pain management. 

‘No Opioids’ Hospital Gets Poor Medicare Rating

By Pat Anson, Editor

A New Jersey hospital touted for its policy of prescribing few opioid painkillers has received poor ratings from Hospital Compare, a Medicare website that tracks the quality scores of hospitals.

The one star overall rating for St. Joseph’s Regional Medical Center in Paterson, NJ puts it in the bottom 3 percent of hospitals nationwide.

St. Joseph rated below the national average on safety, complications, readmissions and deaths, patient experience, timeliness of care, and payment and value of care. The hospital was rated as average for mortality, effectiveness of care, and efficient use of medical imaging.

St. Joseph, which has one of the busiest emergency rooms in the nation, has received international attention for its Alternatives to Opiates program, which emphasizes treatments such as non-opioid pain relievers, trigger point injections, nerve blocks, music therapy and laughing gas (nitrous oxide). Opioid pain medication is only given as a last resort to ER patients.

St. Joseph’s opioid policy has been featured by CNN, The New York Times, National Public Radio, The Guardian and Agency French Presse (AFP). The hospital says it has received inquiries from around the world about its non-opioid alternatives.

"If you can sleep, if you can walk, then pain is not going to be your enemy. That's what our goal is, to make you functional in pain, not to eliminate it completely," St. Joseph’s Mark Rosenberg, MD, told AFP.

Medicare this week revised its Hospital Compare ratings for over 3,600 hospitals to make them more understandable and accessible to the public. Medicare bases its rating on 64 different quality measures and summarizes them into a unified rating of one to five stars. You can see how your own hospital is rated by clicking here.

“We have received numerous letters from national patient and consumer advocacy groups supporting the release of these ratings because it improves the transparency and accessibility of hospital quality information. In addition, researchers found that hospitals with more stars on the Hospital Compare website have tended to have lower death and readmission rates,” Medicare said in a statement.

St. Joseph is one of 133 hospitals in the country given a one-star rating. Sixteen percent of hospitals received two stars, 38% received three stars, 20% received four stars and only about 2% received the highest rating of five stars. There wasn’t enough data to give the remaining hospitals a rating.

The American Hospital Association unsuccessfully lobbied to block the new ratings from being released, saying they unfairly penalized teaching hospitals and those that serve low-income areas.

Patient Satisfaction Surveys

In Medicare patient satisfaction surveys, conducted before St. Joseph’s opioid policy went into effect, patients generally gave the hospital below average ratings on issues such as pain care. Only 68 percent of patients said their pain was “always” well controlled at St. Joseph, and only 69 percent said they would definitely recommend the hospital.

Medicare recently announced that it would revise the pain questions on patient surveys, after politicians and anti-opioid lobbying groups complained that they promote opioid overprescribing. A Medicare funding formula requires hospitals to prove they provide quality care through patient surveys. The formula rewards hospitals that provide good care and are rated highly by patients, while penalizing those that are not. 

Critics claimed that three pain questions in the survey -- known as the Hospital Consumer Assessment of Healthcare Providers and Systems survey (HCAHPS) -- encourage doctors to overprescribe opioid pain medication to boost their hospital's scores.

Medicare officials said there was no evidence of that, but they would develop alternative questions about pain care for the survey. Public comments on the proposed change will be accepted until September 6, 2016. You can submit a comment by clicking here.