AMA Wins Pain-Management Rule Change

The Centers for Medicare and Medicaid Services (CMS) has eliminated a requirement that patients be surveyed on whether they got enough pain medication—a well-intentioned question that had the unintended consequence of sometimes making physicians feel pressure to prescribe opioids.

Under the existing system, Medicare rewards physicians and healthcare facilities financially if they score well on measures of quality.

Those questions and criteria are part of the CMS Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System.

At the AMA’s House of Delegates meeting in Chicago, IL in June, 2016, delegates and AMA leaders pressed CMS to change some of those rules. Andy Slavitt, Acting Administrator of CMS attended the meeting and in a speech pledged he would do so.

CMS announced other changes in regulations that met with AMA approval.

The AMA today, in a statement from AMA President Andrew Gurman, MD (photo), said the organization is pleased that it was heard.

“CMS understands that these policies effect how physicians practice medicine and how patients receive treatment,” said AMA President Andrew W. Gurman, MD. “By listening to our concerns, CMS made clear that patient care was the top priority. We look forward to continuing to work with CMS to improve patient health and enhance access to affordable quality care.”

In a news release, the AMA summarized what it likes in the CMS announcements, listing the following “notable policy changes” made by CMS, which will be effective in 2017:

• CMS took steps to level the site of service playing field between physician offices and off-campus provider-based departments formed after November 2015. Work in this area can contribute to the preservation of small, independent practices by eliminating the incentives for hospitals to purchase physicians practices. CMS made this an interim final rule, which gives the AMA an opportunity to continue to work with the agency as it further develops the policy.

• After hearing AMA concerns, CMS removed the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey questions concerning pain management from the Hospital Value Based Purchasing (VBP) program. Over the years, physicians have expressed deep concerns about the unintended consequences pain questions have had on opioid prescribing practices and patient care. Under HCAHPS, there was a link between high scores on the pain questions and higher payments to hospitals. The AMA looks forward to working with CMS as it develops alternative questions related to pain and the patient experience, as well as it develops quality measures related to opioid prescribing to ensure the measures and questions are clinically appropriate.

• CMS allowed physicians to report Meaningful Use for 90 days in 2016. This is a much-needed reform of the earlier proposal requiring a full year of reporting. Additionally, CMS developed a hardship exception that allows first time Meaningful Use participants to report once in 2017 to satisfy both Meaningful Use and the Advanced Care Information performance category in MIPS.

The OPPS /ASC Final Rule and IFC are available on the Federal Register . The CMS newsroom has a fact sheet on the final rule..

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