News | Patient Experience

Oct. 21-26: HCAHPS Changes Coming in Opioid Bill

News | Patient Experience

Oct. 21-26: HCAHPS Changes Coming in Opioid Bill

Oct. 18—Major legislation, which could be signed into law next week, aims to address the opioid crisis and includes changes to Medicare’s hospital patient survey. 

The imminent law will bar Hospital Compare from incorporating responses to pain communication questions on HCAHPS surveys administered in 2018 or 2019.

Oct. 18—Major legislation, which could be signed into law next week, aims to address the opioid crisis and includes changes to Medicare’s hospital patient survey.

In September, Congress cleared the bipartisan Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act, which includes several provisions that affect hospitals. Among them are several changes to the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, which forms a component of some value-based payment programs and factors into publicly available hospital star ratings on Hospital Compare.

The bill would revise HCAHPS measures starting in 2020 by barring questions about pain-related communication by hospital staff with patients “unless such questions take into account whether a patient experiencing pain was informed about the risks of opioids and about non-opioid alternatives for pain management.”

Many clinicians have told the Centers for Medicare & Medicaid Services (CMS) they have felt pressure to overprescribe opioids because scores on the HCAHPS survey’s pain management questions affect Medicare payments to hospitals.

Despite such concerns, a 2017 study found no correlation between pain measurement scores in the survey and postoperative opioid prescribing rates.

In November 2016, CMS removed the pain management questions from the HCAHPS survey. However, the agency maintained that pain management was an important part of patient care and the patient experience.

“CMS continues to believe that pain control is an appropriate part of routine patient care that hospitals should manage, and is an important concern for patients, their families, and their caregivers,” CMS said in a release.

CMS at that time released proposed alternative questions for the Pain Management dimension of HCAHPS but eliminated them from the scoring formula for value-based payment adjustments beginning with FY18. However, questions on pain management remained on the HCAHPS survey and continue to be publicly reported on Hospital Compare.

The imminent law will bar the Hospital Compare website from including “any measures based on the questions appearing on the [HCAHPS] survey in 2018 or 2019 about communication by hospital staff with an individual about such individual’s pain.”

Additionally, the legislation bars Medicare’s value-based purchasing program from including measures based on HCAHPS pain-related responses from 2018 or 2019.

But it is unclear what the full impact of such changes will be.

“There has been such an emphasis on pain and pain management in hospitals that if HCAHPS surveys don’t include the question, it will be interesting to see how many patients start complaining that they are in pain,” said Stephanie Kennan, a senior vice president at McGuireWoods Consulting.

Other provisions that could have direct hospital impacts include the requirement that the U.S. Department of Health and Human Services (HHS) develop guidance on pain management and opioid-use disorder prevention for hospitals paid by Medicare.

HHS also must develop a toolkit by July 1, 2019, that provides best practices to hospitals for reducing opioid use.

The bill also requires a pilot to test “alternative pain management protocols” that limit the use of opioids in hospital emergency departments.

More Provisions

Hospitals in various alternative payment programs also may want to encourage physicians to include in beneficiaries’ “Welcome to Medicare” visits a newly available screening for opioid use, as provided by the forthcoming law. However, patients must opt in to have the physician screen them.

“Some patients you will want to get won’t necessarily want to opt in,” Kennan said in an interview. “Nonetheless, that is a really key provision because the Medicare population is a key group that hasn’t always had a lot of attention paid to it in the epidemic.”

The bill also includes a Medicaid demonstration project in 10 states for three years to figure out ways to expand provider capacity to treat opioid-use disorders.

“That really helps states to figure out how to do different reimbursement or see how they could train others to get into the field of dealing with patients with opioid or other substance abuse,” Kennan said.

Additionally, states can seek waivers under the bill for federal funding to treat substance abuse at institutions for mental disease (IMDs).

“For hospitals, having IMDs available will be helpful, particularly when they are Medicaid patients,” Kennan said.

The bill also will expand the use of telemedicine for substance use treatment in Medicare. That would allow for treatments at a beneficiary’s home, although no facility fee would be provided for such treatment, Kennan noted.

Dropped from the Senate version of the bill was a change to rules to ease provider exchange of information related to patients’ substance use disorders.

The current rules were “something that a number of providers and hospitals had been saying made it harder for them to treat,” Kennan said. “There was a number of people, including hospitals, that were concerned about the way they wanted to fix that. So that’s still hanging out there as an issue for providers.”

Sunday, Oct. 21

HFMA’s annual Revenue Cycle Conference, Denver (through Oct. 23). Learn more.

Monday, Oct. 22

Medicaid Health Plans of America’s MHPA18, Washington, D.C. (through Oct. 23). Learn more.

Event by Calvary Hospital titled “Making Palliative Care a Global Public Health Imperative,” New York City. Learn more.

Summit of the Health Care Payment Learning and Action Network, Vienna, Va. Learn more.

Webcast of the Dr. Lawrence H. and Roberta Cohn Forums event titled “STROKE: Successes and Setbacks with a Notorious Silent Killer.” Learn more.

Podcast by the Federation of American Hospitals on what the facility of the future will look like. Learn more.

Meeting of AMCP Nexus 2018 titled “Preparing for the Next Generation of Care,” Orlando (through Oct. 25). Learn more.

Value-Based Health Care Congress, Alexandria, Va. (through Oct. 23). Learn more.

Tuesday, Oct. 23

Conference Call by CMS titled “Special Open Door Forum: Medicare Documentation Requirement Lookup Service.” Learn more.

Webinar by the American Hospital Association titled “The Modern Hospital Operating Room: Overcoming Obstacles for Organizational Transformation.” Learn more.

Milken Future of Health Summit, Washington, D.C. (through Oct. 24). Learn more.

Webinar by America’s Health Insurance Plans (AHIP) titled “Transforming Price Transparency.” Learn more.

Seventh annual SINAInnovations festival hosted by Icahn School of Medicine at Mount Sinai, New York City (through Oct. 24). Learn more.

Wednesday, Oct. 24

Webinar by CMS “Walking Through the Steps to Successful eCQM Submission for CY 2018 Hospital Reporting.” Learn more.

Webinar by AHIP titled “Effective Strategies to Manage Members with Complex Conditions.” Learn more.

Workshop by the National Academies titled “Artificial Intelligence Applications for Older Adults and People with Disabilities: Balancing Safety and Autonomy,” Washington, D.C. Learn more.

Web conference by the Advisory Board titled “Benchmarking Your Primary Care Access Performance.” Learn more.

Webinar by the American Medical Association (AMA) titled “Prior authorization: Overview of the AMA’s strategy.” Learn more.

Thursday, Oct. 25

Conference by the FBI and others called “Healthcare CyberGard,” Charlotte, N.C. (through Oct. 26). Learn more.

Webinar by AHIP titled “Shattering Legacy IT.” Learn more.

Web conference by the Advisory Board titled “Use Talent Management to Advance Your Desired Culture.” Learn more.

Webinar by athenahealth titled “the 3-step approach to successful patient engagement.” Learn more.

Friday, Oct. 26

Hearing in Washington, D.C., federal district court on a legal challenge, Association for Community Affiliated Plans v. United States, to the Trump administration’s rule on the expansion of short-term health plans.

Comments due on the request for information by the Office of Inspector General at the U.S. Department of Health and Human Services on needed changes to the Anti-Kickback Statute. Learn more.

About the Authors

Rich Daly

is a senior writer/editor in HFMA’s Washington, D.C., office. Follow Rich on Twitter: @rdalyhealthcare

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