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Pain questions delinked from hospital reimbursements

Medicare and Medicaid patients will continue to be asked how their pain was treated in the hospital, but their answers no longer will be used as part of a formula to reimburse the hospitals for their care, the Centers for Medicare and Medicaid Services announced last week.

The move was seen as a good first step in addressing concerns that linking pain treatment with hospital reimbursement may put pressure on doctors to overprescribe opioids. The Centers for Disease Control and Prevention has declared an "opioids overdose epidemic." Nearly a quarter of a million people in the United States have died of overdoses from 2000 to 2014, and the CDC says at least half of overdose deaths are related to prescription opioids.

The surveys are given to adult patients after they are discharged from hospitals and cover a range of topics, from how clean their rooms were to how they felt medical staff explained things to them.

But the surveys also include three questions about pain:

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

-- How often was your pain well-controlled?

-- How often did the hospital staff do everything they could to help you with your pain?

These questions will remain in the survey, the Centers for Medicare and Medicaid Services said, but they won't be part of the funding formula.

"Although CMS is not aware of any scientific studies that support an association between scores on the pain management dimension questions and opioid prescribing practices, we are finalizing the removal of the pain management dimension of the ... survey ... in an abundance of caution," the federal agency announced Tuesday.

Lt. Gov. Kathy Hochul, who is the co-chair of the Gov. Andrew M. Cuomo's Heroin and Opioid Task Force, commended the agency's decision.

"This change was a high priority for us and was raised multiple times during our hearings across the state. I shared New York's concerns with Director of White House Office of National Drug Control Policy Michael Botticelli when he was in Albany and again at a meeting with Washington D.C. this summer," she wrote on Facebook. "Hopefully, this can begin changing the practices that led to addiction for thousands of unwitting patients and save lives."

Dr. Nancy H. Nielsen, former president of the American Medical Association, said doctors are pleased.

"Physicians are pleased, but would have preferred that the questions be eliminated, as it still creates unrealistic patient expectations," said Nielsen, who is also the senior associate dean for Health Policy at the University at Buffalo School of Medicine. "We care deeply about our patients, and we address pain concerns with them."

The federal agency said it is "developing and field testing alternative questions related to provider communications and pain in order to remove any potential ambiguity" in the survey.


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