Feds want to remove pain questions from hospital report cards to combat opioid abuse

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Clinicians may feel less pressure to prescribe opioids to hospital patients under a proposal made Thursday by the Centers for Medicare & Medicaid Services.

CMS is considering taking pain management questions out of hospitals' value-based purchasing (VBP) scores to help decrease the number of opioid prescriptions given by clinicians, and help curb the country's growing opioid overuse problem.

The pain-related questions currently asked as part of hospital patient surveys are:

  • 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 the pain?

The proposal, included in a series of changes to the Hospital Outpatient Prospective Payment System, would help address concerns that the questions “unduly influence prescribing practices” and put pressure on clinicians to prescribe the drugs, CMS said in a news release. Many healthcare groups have also expressed worries that the questions are worded to imply that medications are the best or only ways to manage pain.

CMS said it would continue to collect and report the results of pain management questions, despite their removal from the VBP program. The agency is also working to develop alternative questions to gauge provider communications and pain to include in the VBP program in future years.

The American Hospital Association pushed CMS to take the pain questions out of the VBP scores in April, calling for redesigned questions to help stop the opioid epidemic.

“We recognize that the undertreatment of pain can have a significant impact on individuals' health and quality of life,” wrote Ashley Thompson, senior vice president of public policy analysis and development for AHA, in a letter to CMS. “However, we also want to ensure that the questions do not create pressure to prescribe opioids or other prescription painkillers or punish providers who, in their best judgment, choose not to prescribe them.”

CMS is accepting comments on the questions' removal, as well as the development of alternative pain questions, until Sept. 6.