Should pain management be considered for federal funding?

On February 9, 26 senators from 17 states sent a letter to the Secretary of the U.S. Department of Health and Human Services, Sylvia Burwell. The senators asked for a review of the pain management section of CMS’s Hospital Value-Based Purchasing Program (HVBPP), stating that it puts pressure on physicians to excessively prescribe opioids.

The HVBPP survey is to determine federal funding for hospitals, with the potential of 1.75% of a facility’s base operating diagnosis-related group payments being withheld for a bad review. The patient experience section, which contains questions on pain management, is worth 25% of the survey’s total score. Senators argue that if a patient is denied opioids for any reason, they may give the hospital a worse review. Since HVBPP helps determine hospital funding, physicians and staff may feel pressured to prescribe opioids when requested.

“As we take steps to reward high quality care in the Medicare program, it is critical that we correctly measure the quality we are rewarding,” said the letter. “Currently, there is no objective diagnostic method that can validate or quantify pain…We are concerned that the current evaluation system may inappropriately penalize hospitals and pressure physicians who, in the exercise of medical judgment, opt to limit opioid pain relievers to certain patients and instead reward those who prescribe opioids more frequently.”

Senators urged Burwell to conduct a “robust examination” of the pain management section and the wording of questions like, “During this hospital stay, how often was your pain well-controlled?” and “During this hospital stay, how often did the hospital staff do everything they could to help you with your pain?”

The U.S. consumes more opioids than any other nation, with twice as many opioids per capita as Canada. One study by the National Council on Drug and Alcohol Abuse found that four of five new heroin users were first addicted to prescription opioids.