State Health Officials and Medical Experts Want Rollback of Pain Assessment Requirements That Foster Dangerous Overuse of Opioid Pain Medicine

April 13, 2016

State Health Officials and Medical Experts Want Rollback of Pain Assessment Requirements That Foster Dangerous Overuse of Opioid Pain Medicine

WASHINGTON, D.C. – In an effort to reduce over-prescribing of opioid pain relievers, dozens of health care organizations, medical experts and consumer advocacy groups – including Public Citizen – sent a letter today to the Joint Commission, an agency that accredits health care organizations, and a petition to the federal agency that oversees Medicare.

Co-signers include senior health officials from Pennsylvania, Vermont, Alaska and Rhode Island as well as the heads of professional organizations including the American Society of Addiction Medicine. Petition signers are requesting changes to requirements for assessing patients’ pain, which they believe foster dangerous prescribing practices.

“The current requirements for hospitals and other health care organizations to assess patients’ pain encourage unnecessary, unhelpful and unsafe pain treatments that interfere with primary disease management,” said Dr. Michael Carome, director of Public Citizen’s Health Research Group. “While pain management is an important part of patient care, these requirements foster dangerous pain control practices that can lead to disastrous consequences for individuals, families and communities.”

Over the past 20 years, prescriptions for opioid painkillers have soared, leading to an epidemic of opioid addiction, rising heroin use and a record high rate of overdose deaths. Opioid prescriptions increased in response to a multifaceted campaign, which called for pain to be treated as if it was a vital sign – one of several measures of essential bodily function, which include temperature, breathing rate, blood pressure and pulse. In 2001, the Joint Commission introduced pain management standards requiring health care organizations to ask every patient about pain, leading to use of pain patient scales and hospital policies requiring aggressive pain management.

In their letter to the Joint Commission, petitioners wrote that mandatory pain assessment in all patients and in all medical settings is “unwarranted and can lead to overtreatment and overuse of opioid analgesics.” A recent study found that physicians prescribed opioids, often in high doses, in more than half of 1.14 million nonsurgical hospital admissions.

The petition sent to the Centers for Medicare and Medicaid Services (CMS) calls for removal of the pain questions from the Hospital Consumer Assessment of Healthcare Providers and Systems Survey, the agency’s patient satisfaction survey used to determine hospital reimbursement rates. In their letter to CMS, the petitioners wrote, “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 petitioners believe that over-prescribing opioids results from linking hospital reimbursement rates to patient satisfaction with pain treatment.

CMS also is under pressure from Congress to break the link between hospital reimbursements and patient satisfaction with pain management. Recently introduced legislation, the PROP Act, would end the use of pain management questions as a factor in Medicare reimbursement calculations. The PROP Act has bipartisan support in both chambers of Congress and has been endorsed by the American Medical Association and other professional organizations.

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