On April 28, 2017, CMS (the Centers for Medicare and Medicaid Services) published the next proposed rule for the Hospital Inpatient Prospective Payment System to address Federal Fiscal Year 2020. As expected, many of the proposals for the next payment year/performance period are consistent with existing program features.
- Person and Community Engagement (HCAHPS) will continue to make up 25% of the Total Performance Score. The other three domains — Safety, Clinical Care, and Efficiency — will also be weighted at 25% each, as they are currently.
- For the Achievement Threshold and Benchmark values, the proposal suggests that there will not be dramatic changes to either set of values. Most of the changes for both of sets of values are within two- or three-tenths of a point. The greatest change is for the 0-10 Overall Hospital Rating, where the Achievement Threshold is proposed as 71.35, an increase of 0.5.
But the “news of note” emerging from this proposed rule is CMS’s recommendation for new questions regarding pain, to be implemented with January 2018 patients. As you may recall, toward the end of 2016, CMS made the decision to discontinue use of the Pain Management dimension as part of the calculations for Value-Based Purchasing (VBP). At that time, CMS said it would retain the pain-related questions in the survey and would continue to publicly report them while it worked to develop new questions to address this important aspect of the patient experience. The goal was to develop new questions that would eliminate any perceived financial pressure clinicians may feel to over-prescribe pain medications.
The new questions proposed to create a new Communication about Pain dimension are:
- During this hospital stay, did you have any pain? Yes/No
- (If Yes) During this hospital stay, how often did hospital staff talk with you about how much pain you had? Never/Sometimes/Usually/Always
- During this hospital stay, how often did hospital staff talk with you about how to treat your pain? Never/Sometimes/Usually/Always
This proposal is open for public comment through Tuesday, June 13, 2017. Individuals and organizations interested in making official comments about the proposed questions may use the link toward the top of the Federal Register page.
The Final Rule formalizing all of these proposals, including the new questions for pain, is expected in November. If you have any questions about the proposed rule or the proposed questions that could make up the Communication about Pain dimension, please contact us.