Opioid Critics Take Aim at Pain Standards and Hospital Patient Surveys

New York advocacy group petitions CMS and Joint Commission

More than 60 nonprofit groups and medical experts have sent a letter to the Joint Commission, a nonprofit agency that accredits U.S. hospitals, asking it to revisit its standards for pain management. Only hospitals that have been accredited can receive payments from government plans, such as Medicare and Medicaid, making the group’s standards highly influential.

The letter, issued by a New York-based advocacy group called Physicians for Responsible Opioid Prescribing (PROP), specifically criticized the Joint Commission’s pain management standards, which “encourage unnecessary, unhelpful, and unsafe pain treatments that interfere with primary disease management.”

Pain is not a single entity that warrants a formulaic “titrate to effect” approach in response to a patient’s reported pain score, the letter said. Therefore, mandating routine pain assessments for all patients in all settings is unwarranted and can lead to overtreatment and overuse of opioid analgesics.

PROP requested that the Joint Commission re-examine its pain management standards “immediately.”

The United States experienced a sharp rise in prescriptions for opioid analgesics after the standards were introduced 15 years ago, according to PROP. During that period, more than 200,000 Americans have died from accidental overdoses involving prescription opioids.

In a second letter, PROP has asked the Centers for Medicare and Medicaid Services (CMS) to remove questions pertaining to pain treatment from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. According to the group, the questions pertaining to the treatment of pain have had the unintended consequence of encouraging aggressive opioid use in hospitalized patients and upon discharge.

“Aggressive management of pain should not be equated with quality health care as it can result in unhelpful and unsafe treatment, the end point of which is often the inappropriate provision of opioids,” the letter stated.

Specifically, the letter requested that the following questions be removed from the HCAHPS survey:

  • 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?

A recent study found that physicians prescribed opioids, often in high doses, in more than half of 1.14 million nonsurgical hospital admissions, PROP pointed out. In addition, overprescribing of opioids has led to an epidemic of opioid addiction and overdose deaths, according to the Centers for Diseases Control and Prevention.

Sources: Charlotte Observer; April 13, 2016; Joint Commission Letter; April 13, 2016; and CMS Letter; April 13, 2016.