Support for a Roll Back of Aggressive Pain Management Rules

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In an effort to reduce overprescribing of opioid pain relievers, the Pennsylvania Department of Health joined dozens of health care organizations, medical experts and consumer advocacy groups in signing petitions requesting changes to federal pain management requirements that are believed to foster dangerous prescribing practices.

The petitions were sent earlier this month to the Joint Commission, an agency that accredits health care organizations, and to the Centers for Medicare and Medicaid Services (CMS), according to a press release from the Pennsylvania Department of Health. Co-signers include senior health officials from Vermont, Alaska, and Rhode Island, as well as heads of professional organizations including the American Society of Addiction Medicine.

“As health professionals we have a duty to relieve pain and suffering, but these existing pain management rules are ultimately causing harm to patients and fueling an addiction epidemic,” said Secretary of Health Dr. Karen Murphy. “Prescriptions for opioid painkillers have risen dramatically over the past 20 years, leading to an epidemic of opioid addiction, rising heroin use, and a record high rate of overdose deaths. I am joining my colleagues in signing these petitions in an effort to spur changes that will help combat the public health crisis caused by opioid overdose in Pennsylvania.”

Opioid prescribing has increased in response to a multifaceted campaign that called for pain to be treated as if it was a vital sign, a measure of essential bodily function, which includes temperature, breathing rate, blood pressure and pulse.

In 2001, the Joint Commission introduced pain management standards requiring health care organizations to ask every patient about pain, leading to use of pain patient scales and hospital policies requiring aggressive pain management. In the letter to the Joint Commission, petitioners wrote that mandatory pain assessment in all patients and in all medical settings is “unwarranted and can lead to overtreatment and overuse of opioid analgesics.” A recent study found that physicians prescribed opioids, often in high doses, in more than half of 1.14 million nonsurgical hospital admissions.

According to the release, the petition sent to CMS calls for removal of the pain questions from the agency’s patient satisfaction survey used for determining hospital reimbursement rates. In their letter to CMS, petitioners wrote “Aggressive management of pain should not be equated with quality health care as it can result in unhelpful and unsafe treatment, the end point of which is often the inappropriate provision of opioids.” The petitioners believe that linking hospital reimbursement to patient satisfaction with pain treatment results in overprescribing of opioids.”

CMS is also under pressure from Congress to de-link hospital reimbursement from patient satisfaction with pain management. A recently introduced bill called the PROP Act would end use of pain management questions from factoring into Medicare reimbursement calculations. The PROP Act is receiving bipartisan support in the House and Senate and has been endorsed by the American Medical Association and other organizations.

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