Advocates are urging the Joint Commission and CMS to scrap policies that they say can lead to opioid overprescribing.
In separate letters to both groups, signees asked the Joint Commission to re-examine its Pain Management Standards -- which once helped push the idea of pain as the "fifth vital sign" -- and asked CMS to strike patient satisfaction questions about pain from its reimbursement procedures.
The letters, sent by Physicians for Responsible Opioid Prescribing (PROP), had the support of senior health officials from Pennsylvania, Vermont, Alaska, and Rhode Island, as well as other physicians, medical organizations, and consumer groups.
In 2001, the Joint Commission rolled out its Pain Management Standards, which helped grow the idea of pain as a "fifth vital sign." It required healthcare providers to ask every patient about their pain, given the perception at the time was that pain was undertreated.
Since that time, the U.S. has experienced a surge in opioid prescriptions -- and, subsequently, an increase in overdoses and deaths tied to these painkillers.
In a letter to Mark Chassin, MD, MPH, president and CEO of the Joint Commission, advocates ask the organization to re-examine those standards, which lead to overtreatment and overuse of opioids, the group said.
"Pain is a symptom, not a vital sign," the letter states, noting that vital signs such as blood pressure, heart rate, respiratory rate, and temperature can be measured objectively.
In a letter to acting CMS administrator Andy Slavitt, they ask for removal of the pain-related questions from HCAHPS, the patient satisfaction survey used to determine hospital reimbursement rates.
The letter focuses on three specific questions: whether patients needed medications for pain, if their pain was well controlled during their stay, and if hospital staff did "everything they could" to help with pain.
Linking reimbursements to patient satisfaction with pain treatment results in opioid overprescribing, the groups said.
"Aggressive management of pain should not be equated with quality healthcare as it can result in unhelpful and unsafe treatment, the endpoint of which is often the inappropriate provision of opioids," they wrote.
In a statement, Joint Commission vice president David Baker, MD, MPH, said his agency’s pain standards often take the blame for the current prescription opioid epidemic.
“The Joint Commission’s standards require that patients be assessed for pain, and if they are experiencing pain, then it should be managed,” Baker said. “The standards do not require the use of drugs to manage a patient’s pain; and when a drug is appropriate, the standards to not specify which drug should be prescribed.”
A spokesperson for CMS said the agency is "committed to using measures of hospital quality that improve the overall quality of hospital care."
"As announced previously, CMS is reviewing how pain management is evaluated by patient satisfaction surveys used by hospitals and other health care providers, including review of how the questions these surveys use to assess pain management may relate to pain management practices and opioid prescribing," the spokesperson said.
The letters parallel Congressional efforts to strike the pain management patient satisfaction questions from CMS reimbursements, which are included in the bipartisan Promoting Responsible Opioid Prescribing (PROP) Act in the Senate.
Getting rid of those questions would take the pressure off physicians and hospitals to prescribe narcotics for pain, thereby reducing the risk of addiction by diminishing the number of opioid scripts, according to a press release about the legislation.
The Senate bill is the companion to House bill 4499, which has been endorsed by the American Medical Association, American Hospital Association, American Society of Addiction Medicine, American Academy of Neurology, American Osteopathic Association, Physicians for Responsible Opioid Prescribing, Hazelden Betty Ford Foundation, Friends of NIDA, and American Association of Orthopedic Surgeons.