The Centers for Medicare and Medicaid Services (CMS) has proposed concerning changes to key pain management questions on an influential survey, called the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Survey, which is used to rate patient satisfaction with their inpatient hospital stay. The survey is important because results are publicly reported on Medicare’s Hospital Compare website and a hospital’s score can affect its CMS payments. CMS has invited the public to comment on the proposal by June 13, and U.S. Pain is asking its members to speak out against the changes.

“U.S. Pain Foundation is deeply concerned that CMS’s proposed replacement questions about pain management on the HCAHPS survey could negatively impact the pain care of millions of Americans who require hospital stays each year,” says Cindy Steinberg, national director of policy and advocacy for U.S. Pain. “Instead of asking hospital patients how well their pain was controlled and if hospital staff did everything they could to help them with pain, CMS is proposing to ask if hospital staff ‘talked to them’ about how much pain they had and ‘talked to them’ about how to treat it.”

The original questions 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?

The proposed change would rewrite the questions to be:

  • During this hospital stay, did you have any pain?
  • During this hospital stay, how often did hospital staff talk with you about how much pain you had?
  • During this hospital stay, how often did hospital staff talk with you about how to treat your pain?

According to Steinberg, it should be a given that health care professionals talk to patients about his or her pain and how to treat it. It’s unacceptable that they would not be encouraged to actually try to treat the pain.

“Of course, we would want hospital staff to discuss the benefits and risks of various options provided to manage their patients’ pain,” says Steinberg. “But if a hospital patient is in distress about the level of his or her pain, shouldn’t the goal be to reduce it or reduce it enough so the patient can function?”

The reason for the change, states CMS, is that the original questions may have created pressure on hospital staff to prescribe more opioids in order to achieve higher scores. In its report, however, CMS noted the survey does not specify any particular type of pain control method, and that there are no scientific studies that support an association between these two questions and opioid prescribing practices.

“We understand concerns about offering only one option to patients to manage their pain,” says Steinberg. “We believe the best way to accomplish CMS’s goal is to simply change the first question now asked so that it is not solely focused on pain medication. The newly proposed question 12 would be a good replacement asking ‘During this hospital stay, did you have any pain?’ And, then keeping the current questions 13 and 14 as is.”

U.S. Pain Foundation encourages members to write to CMS and share their thoughts about the pain management question changes. When submitting comment, please refer to file code CMS-1677-P. To submit electronic comments, go here. Alternatively, the public may mail written comments to the following address: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1677-P, P.O. Box 8011, Baltimore, MD 21244-1850. Comments must be received by 5 pm on June 13, 2017.