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Amid a national spike in overdose deaths, a coalition of state health officials, medical experts and advocacy groups is calling for the reevaluation of systems and guidelines for managing pain.
Doctors in the United States are now writing so many opioid painkiller prescriptions that every American adult could have his or her own.
At the same time, prescription painkiller overdoses killed 14,000 Americans in 2014, a number that has quadrupled since 1999.
The role pain management standards play in the behavior of doctors and patients with regard to opioid painkillers, and the financial incentivization of pain management, form the subject of two petitions sent Tuesday to the federal Centers for Medicare and Medicaid Services and the Joint Commission, an independent and non-profit organization that accredits and certifies U.S. health care organizations and programs.
These letters—spearheaded by Physicians for Responsible Opioid Prescribing and signed by health care organizations, medical experts, advocacy groups, including Shatterproof, as well as top health officials from Vermont, Pennsylvania, Alaska and Rhode Island—assert that pain management practices inadvertently encourage excessive prescribing practices on the part of doctors, and spark more aggressive opioid use by hospitalized patients following discharge.
The Pain Management Standards introduced in 2001 by the Joint Commission required these organizations to ask every patient about pain. This in turn, the petition charges, has led to pain being treated as a vital sign—along with blood pressure, heart rate, respiratory rate and temperature.
The difference, the letter to the Joint Commission asserts, is that, unlike the vital signs, pain cannot be measured, and that routine pain assessment mandates have lead to overtreatment.
Although the Joint Commission has clarified one of its standards in question to emphasize that smart pain management includes non-pharmacological approaches, the signees of this petition “believe the Pain Management Standards continue to encourage unnecessary, unhelpful and unsafe pain treatments that interfere with primary disease management.”
The petition sent to the Centers for Medicare and Medicaid Services seeks to strike three questions regarding pain from the CMS’s patient satisfaction survey, known as HCAHPS.
- 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?
This survey comes loaded with financial implications for hospitals—reimbursal rates determined by CMS may be jeopardized by a low score.
The signees of the petition to CMS say that including the questions on the survey links hospital reimbursements to patient pain management satisfaction in a way that incentivizes the overprescription of pain drugs.
“Aggressive management of pain should not be equated with quality healthcare as it can result in unhelpful and unsafe treatment, the end point of which is often the inappropriate provision of opioids,” the letter reads.
The issue of the link between CMS patient satisfaction and pain management also featured heavily in discussions at the recent convening of the National City-County Task Force on the Opioid Epidemic in Washington, D.C. Task force members, including Dr. Vidya Kora, a LaPorte County, Indiana, commissioner and practicing physician mentioned these three questions as a point of major concern.
Quinn Libson writes for Government Executive’s Route Fifty.
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