“Every day in the U.S., more than 650,000 opioid prescriptions are dispensed, and 3,900 people start using prescription opioids for a non-medical purpose. Seventy-eight people die from an opioid-related overdose daily.”1 This creates a struggle for hospitals between patient satisfaction and realistic expectations of pain levels.
In a 2014 survey published in Patient Preference and Adherence, “more than 48% of doctors say they have prescribed inappropriate narcotic pain medication because of patient satisfaction questions”2. Staggering statistics like this have caused concern for those participating in value based reimbursement programs that their financial incentives are tied to an area that may indirectly contribute to a growing epidemic. These conflicting realities are being addressed through new ways of communicating about pain.
Out With the Old, In With the New
The Centers for Medicare & Medicaid Services reviewed the concerns expressed by physicians and hospitals. As a result, for FY2018 the questions related to pain management were removed from the reimbursement scoring formula. Recognizing that pain control is important, the questions remained on the 2017 HCAHPS survey itself for public reporting on Hospital Compare.
Because a patient’s pain experience can impact their overall assessment in their quality of care, CMS updated the questions on pain management shifting the focus from pain management to communication about pain management options. Beginning January 1, 2018, CMS proposed the following questions be used on all future discharges, with public reporting starting in 2019.
- During this hospital stay, did you have any pain?
- During this hospital stay, how often did hospital staff talk with you about how much pain you had?
- During this hospital stay, how often did hospital staff talk with you about how to treat your pain?
Preparing for the Challenge
So how can hospitals be prepared for the transition to the new questions while also being sensitive to the opioid connection? The answer is communication. The overall idea behind the changes to the HCAHPS questions is to eliminate the connection between financial incentives and the stakeholder’s responsibility for managing the pain level. As an alternative, the responsibility falls on communicating with the patient about their pain level and discussing the options available to alleviate the pain.
Studies have proven that what is improving the patient perception of care when it comes to pain management is directly related to the nurse staffing and their communications vs the ability to manage the pain.3 Future education and training on the HCAHPS requirements should be focused on the communication of pain, not the elimination of it. This is a big area of confusion and the right nurse rounding app can direct organizations into standardizing that communication in a safe direction when rounding on patients.
An effective way to keep the messaging consistent for nurses is during the nurse leader rounding process. Ensure your nurse rounding tool has the flexibility to offer scripting to control the phrasing of questions and standardize the organization’s approach to pain management discussions. Implementing hospital rounding software like CLARIFIRE HEALTH, combined with the consulting strategy they employ, will complement your strategy to keep your HCAHPS scores in the top box and improve the Patient Experience.
Sources:
1https://www.beckershospitalreview.com/quality/cms-proposes-eliminating-pain-management-from-hcahps-payment-score.html
2http://www.healthleadersmedia.com/leadership/opioid-epidemic-patient-satisfaction-and-physician-prescribing#
3http://www.npjournal.org/article/S1555-4155(16)30365-8/fulltext
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Lauren Walling
Lauren Walling is a graduate of Emory University with a degree in Industrial Psychology, as well as an MBA from the John Sykes School of Business from The University of Tampa. She currently sits on the Board of Fellows at the University of Tampa, and is a member of the Healthcare Business Women's Association, National Association of Professional Women, and the Morton Plant Skip Cline Society. Lauren works with large Healthcare Systems implementing Patient Experience Solutions that streamline processes, increase patient experience and improve quality and safety.