Patient Satisfaction News

HHS Proposes Patient Satisfaction Changes for Pain Management

The agency has proposed eliminating pain management questions from the patient satisfaction survey, HCAHPS.

By Sara Heath

- The Department of Health & Human Services (HHS) has proposed revisions to the HCAHPS survey, changing the way in which providers measure patient satisfaction with pain management.


According to an HHS press release, the agency has proposed removing the HCAHPS survey questions regarding pain management from the hospital payment scoring calculation. This is all in an effort to eliminate any perception that hospitals may not receive full Medicare payments because they did not prescribe opioid pain medications to patients.

“Many clinicians report feeling pressure to overprescribe opioids because scores on the HCAHPS survey pain management questions are tied to Medicare payments to hospitals,” the agency explained.

“In order to mitigate even the perception that there is financial pressure to overprescribe opioids, the Centers for Medicare and Medicaid Services (CMS) is proposing to remove the HCAHPS survey pain management questions from the hospital payment scoring calculation,” it continued. “This means that hospitals would continue to use the questions to survey patients about their in-patient pain management experience, but these questions would not affect the level of payment hospitals receive.”

HHS notes that pain management assessments never had a large effect on hospital Medicare payments. However, the agency says it understands how providers may feel the pressure to over-prescribe opioid medications due to these provisions, and therefore has proposed changes to the patient satisfaction survey.

The HCAHPS survey – or the Hospital Consumer Assessment of Healthcare Providers and Systems –targets patient satisfaction and helps hospitals and individual providers measure how patients perceived the quality of their healthcare.

In making changes to how these scores are used, HHS is taking a step in changing what patient satisfaction and engagement truly mean. Instead of measuring patient satisfaction by a patient’s perceived comfort, the agency is prioritizing the long-term health of the patient by preventing potential addiction to a prescribed opioid.

This is all a part of a broader plan from HHS to combat the opioid crisis, says Secretary Sylvia M. Burwell.

“The opioid epidemic is one of the most pressing public health issues in the United States. More Americans now die from drug overdoses than car crashes, and these overdoses have hit families from every walk of life and across our entire nation,” said Secretary Burwell.

“At HHS, we are helping to lead the nationwide effort to address the opioid epidemic by taking a targeted approach focused on prevention, treatment, and intervention. These actions build on this approach.”

Industry stakeholders have already expressed approval for the agency’s move.

According to a press release, the American College of Emergency Physicians (ACEP) says this move represents the agency’s commitment to doing what is best for the patient.

In an official statement, ACEP president Jay Kaplan, MD, FACEP, said the following:

ACEP commends Secretary Burwell's proposal to remove pain management questions from patient satisfaction surveys.  These questions have been used to influence Medicare reimbursement rates and have resulted in unintended consequences in light of the nation's opioid epidemic.  The pursuit of high patient-satisfaction scores can create incentives for medical providers to honor patient requests for unnecessary and even harmful treatments.  The HHS proposal will align federal policies to be consistent with current efforts to reduce opioid use.

ACEP also explained the fine line HHS is toeing, stating that providers must find a way to ensure patient satisfaction and patient-centered care, while taking measures to prevent long-term consequences, such as opioid addiction.

“We need to ensure that patients with pain are cared for in a compassionate way at the same time that we work to decrease the number of patients who become dependent on prescription medications,” Kaplan said.

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