Pain Management Survey Questions Will No Longer Impact Inpatient CMS Hospital Reimbursement Rates

Clarice Miller, OTS; Fieldwork Student with AOTA Federal Affairs

On October 1, 2017, the Centers for Medicare & Medicaid Services (CMS) announced they will no longer use results from the pain management portion of the Hospital Consumer Assessment of Health Providers and Systems (HCAHPS) survey to impact reimbursement rates from the Hospital Value-Based Purchasing (VBP) program*. The Department of Health and Human Services (HHS) determined pain management questions may financially incentivize inpatient hospitals to over prescribe opioids in an effort to eliminate pain and improve survey results.

Hospital DischargeHHS intends to replace the current questions with questions targeted toward pain management communication similar to those in the Outpatient and Ambulatory Surgery (OAS) CAHPS. HHS will have public comment periods available during development and prior to implementation of the new pain management questions for the HCAHPS. The President’s Commission on Combating Drug Addiction and the Opioid Crisis supported this decision as part of their 56 recommendations released on October 31, 2017.

Going forward, HHS emphasizes that “appropriate pain management includes communication with patients about pain-related issues, setting expectations about pain, shared decision making, and proper prescription practices.” HHS estimates that 25 million Americans have daily pain and that their pain often interferes “with their physical and mental health, work productivity, and ability to engage in social activities.”

Occupational therapy practitioners play an important role as part of the interdisciplinary care team to communicate with their patients about pain management techniques and appropriate pain expectations, and to develop client-centered interventions that improve overall health and societal engagement for individuals with acute and chronic pain. Improving pain management and communication surrounding pain is a goal for HHS and CMS across the care continuum. In the spring of 2017, the AOTA Representative Assembly adopted a motion to create an Ad Hoc Committee on Opioid Drug Abuse.

*For now, the pain management questions will continue to remain a part of the survey sent to patients and will be used when determining scores for the Hospital IQR program, HCAHPS star ratings, and Hospital Compare overall ratings. However, the scores will not impact reimbursements through the VBP program.

Pain Management Resources for Occupational Therapy Practitioners:

Breaking the Cycle: Occupational Therapy’s Role in Chronic Pain Management

AOTA Fact Sheet: Occupational Therapy and Pain Rehabilitation

Report of the Ad Hoc Committee on Drug Opioid Abuse


HHS: Advancing the Practice of Pain Management HHS Opioid Strategy

National Pain Strategy Implementation: A Listening Session May 11, 2017

HHS and CMS Hospital Value-Based Purchasing (VBP) Program Rule Announcement

The President’s Commission on Combating Drug Addiction and the Opioid Crisis