Hospital workers are well aware of the current opioid epidemic in New York and nationwide. Emergency rooms and inpatient units are inundated with patients who have overdosed or who have an opioid-abuse related condition. According to the New York State Department of Health, there were about 37,000 opioid-related emergency department visits in 2014, a 73 percent increase over 2010. More than 75,000 opioid-related hospital admissions were recorded in 2014. As part of government efforts to stem the surge in opioid abuse, the Centers for Medicaid and Medicare (CMS) is proposing to remove the pain management dimension from the hospital Value Based Purchasing (VBP) program beginning with the 2018 fiscal year.


The VBP pain management domain is measured via three questions on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, an instrument that assesses patient experience of care. Scores on the HCAHPS survey are linked to hospital Medicare payments. On the survey, patients are currently asked if they received pain medication during their hospital stay, how often their pain was well controlled and how often staff did “everything that they could” to help them with pain.


According to CMS, stakeholder groups have been concerned about pain management scores being linked to higher hospital payments. Many have reported that hospital staff feels pressure to prescribe opioids to achieve higher scores on the pain dimension of the HCAHPS survey. By removing pain management questions, CMS hopes to “mitigate even the perception that there is financial pressure to overprescribe opioids” through its proposal. A final rule on this matter is still pending. (To read the proposed rule in its entirety, go to and search for CMS-2016-0115-0001.)


Despite this proposal, CMS continues to “believe that pain control is an appropriate part of routine patient care that hospitals should manage and an important concern for patients.” Therefore, the agency plans to work on developing alternative questions for the pain management domain and to research hospitals’ concerns in this area. Once modified questions have been crafted, CMS will release them and allow for stakeholder comment.

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