It’s official: Pain Management no longer part of VBP incentive calculation


Multiple sources within The Centers for Medicare & Medicaid Services (CMS) have confirmed that the Pain Management dimension will NOT figure into the calculation of incentives for the Hospital Value-Based Purchasing program (VBP) over the next two federal fiscal years, 2018 and 2019. The decision addresses concerns expressed by physicians and other healthcare providers who contend that linking survey questions covering pain management to the Hospital VBP program creates undue pressure on hospital staff to prescribe opioids simply to raise scores and increase incentive payments.

This announcement is embedded in the Outpatient Prospective Payment System (OPPS) final rule, which is scheduled to be published on Monday, November 14. The final rule returns the model to eight scored dimensions. Remember: FFY 2018 is the first year that the Care Transition dimension will factor into VBP reimbursements.

Although there is no empirical evidence that the Pain Management questions have actually affected prescribing practices, CMS wants to eliminate any perceived financial pressure clinicians may feel to overprescribe pain medications.

Pain Management questions will still be asked on every HCAHPS survey and the results will continue to be submitted for public reporting on Hospital Compare. CMS has clearly communicated its belief that patients’ perceptions of pain management are an important aspect of healthcare to measure, so it has already initiated research into the design of new questions. There is no prediction for when questions may be discontinued or added within the HCAHPS core survey.

The Final Rule may be accessed here. The published version will be available after November 14.