HCAHPS Pain Scores Not Associated With Opioid Prescribing After Surgery

A new study in JAMA has found that patient-reported pain satisfaction scores on Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys are not associated with rates of opioid prescribing after surgery.

Despite concerns that patient satisfaction assessments could indirectly encourage clinicians to overprescribe painkillers after surgeries, which may then contribute to the patterns of addiction and diversion fueling the opioid epidemic, a new study has found no correlation between pain measurement scores and postoperative opioid prescribing rates.

Patient-reported satisfaction scores, collected through Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys after discharge, are used to determine hospital reimbursement. The questionnaires include a section on pain management, which has sparked debate about whether collecting such data may incentivize overprescribing of opioids in order to boost the likelihood that patients will be satisfied with clinicians’ efforts to control their pain.

In response to these concerns, CMS declared it would no longer include pain management questions as a factor in its hospital payment calculations beginning in 2018, even though at the time of the announcement in November 2016 little research had been conducted to assess whether a link between pain management satisfaction scores and opioid prescribing actually existed.1

The research recently published in JAMA aims to fill this gap in the literature by reporting the findings of a hospital-level study conducted in 47 Michigan hospitals.2 Researchers measured the mean quantity of opioids measured in oral morphine equivalents (OMEs) filled by surgery patients in the 30 days after discharge, as well as the hospitals’ HCAHPS pain management scores and their pain dimension scores, which provide a comparison of each hospital’s score in relation to national benchmark levels.

Researchers separated the hospitals into quintiles of opioid prescribing, with the 9 lowest-quintile hospitals prescribing less than 356 OMEs and the 9 highest-quintile hospitals prescribing over 465 OMEs. The mean pain management scores, or the proportion of patients reporting their pain was “always” well controlled, were 69.5 for the lowest quintile and 69.1 for the highest quintile. These differences were not significant, nor were the differences in pain dimension scores across quintiles. Statistical analyses also confirmed that the lack of association persisted after controlling for covariates like case mix, comorbidities, and patients’ long-term opioid use prior to the surgery.

The researchers noted that their study population was limited to patients covered by a single insurer, Blue Cross Blue Shield of Michigan, and so the findings may not be generalizable to other populations. Still, they wrote, the lack of correlation between postoperative opioid prescribing and HCAHPS pain measures suggests that “reducing opioid prescriptions may not worsen HCAHPS scores and hospital reimbursement in Michigan.”

They note that efforts to control opioid prescribing after surgery are needed, especially as almost 40% of postsurgical prescriptions are opioids3 and surgeons often prescribe excess opioid pills after operations, as noted in one study where patients took just 28% of the pills prescribed to them.4

“Moreover, these results may also inform policy makers in the current decision to remove pain management from determination of hospital payments,” the JAMA study authors concluded.

REFERENCES

1. Centers for Medicare & Medicaid Services. Medicare program: hospital value-based purchasing (VBP) program. Fed Regist. 2016;81(219):79855-79862.

2. Lee HS, Hu HM, Brummett CM, et al. Postoperative opioid prescribing and the pain scores on Hospital Consumer Assessment of Healthcare Providers and Systems survey. JAMA. 2017;317(19):2013-2015. doi: 10.1001/jama.2017.2827.

3. Levy B, Paulozzi L, Mack KA, Jones CM. Trends in opioid analgesic-prescribing rates by specialty, U.S., 2007-2012. Am J Prev Med. 2015;49(3):409-413. doi: 10.1016/j.amepre.2015.02.020.

4. Hill MV, McMahon ML, Stucke RS, Barth RJ. Wide variation and excessive dosage of opioid prescriptions for common general surgical procedures. Ann Surg. 2017;265(4):709-714. doi: 10.1097/SLA.0000000000001993.