No correlation between HCAHPS pain scores, opioid prescribing rates, study finds

A recent study in JAMA found no relationship between postoperative opioid prescription rates and HCAHPS pain measurement scores.

The HCAHPS survey collects post-discharge patient satisfaction information  — including questions on pain management — which is used to determine provider reimbursement. However, in light of the opioid epidemic, individuals have questioned whether efforts to increase patient satisfaction has incentivized the overprescription of opioids, according to an AJMC report. Last year CMS proposed removing the HCAHPS survey's  pain management-related questions for the hospital payment scoring calculation, beginning in 2018.

To evaluate the correlation between HCAHPS pain management scores and opioid overprescription, researchers led by Jay Lee, MD, of the department of surgery at Ann Arbor-based University of Michigan, conducted a hospital-level study of 47 Michigan hospitals.

Study authors split hospitals into five groups based on the mean quantity of opioids filled 30 days post-discharge. Nine hospitals in the lowest group prescribed fewer than 356 OMEs, while hospitals in the highest group prescribed more than 465 OMEs.

When compared with mean pain management scores, there was not a significant difference across the groups, AJMC states. The portion of patients reporting their pain was "always" well controlled was 69.5 for the lowest group and 69.1 for the highest group. Researchers said this conclusion was also true when controlling for case mix, comordities and patients' long-term opoid use, AJMC reports.

The authors concluded a lack of correlation between HCAHPS pain measurements and post-discharge opioid prescribing suggests "reducing opioid prescriptions may not worsen HCAHPS scores and hospital reimbursement in Michigan," according to the report. However, study authors also said the analysis may not be generalizable to other populations, as it was limited to patients with Blue Cross Blue Shield of Michigan health plans. 

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