In the 80s we wanted our MTV; now in 2019, QAPI program managers want their pain quality measures.
By Janine Savage, RN, RAC-CT, CHC
The Centers for Medicare & Medicaid Services (CMS) announced in October that it has removed the Short-Stay Pain and Long-Stay Pain Quality Measures from the Five-Star program and from being reported on the Nursing Home Compare (NHC) website altogether. These measures identified the percentage of residents who self-report moderate to severe pain.
Why did CMS remove these pain measures?
CMS began its rollout of its pain management initiatives earlier in 2019, outlined in a three-part approach that addresses new issues in opioid abuse, ongoing dependence, and the usage of data for management and prevention. CMS cited the ongoing battle with opioid abuse as the driver behind these changes.
Impact on Five-Star Ratings
In the announcement on October 7, CMS discussed the details of the changes and outlined the potential impact of the increasing quality measure (QM) thresholds going into effect April 2020.
“As CMS changes the QM thresholds, some nursing homes will see a decline in their rating in these areas until they make further improvements. Also, because the QM ratings are also used as part of the overall rating, some nursing homes will see a decline in their overall five star rating.”
What about my QAPI program?
Many Skilled Nursing Facilities have incorporated these measures into their Quality Assurance and Performance Improvement (QAPI) programs. They understand that pain is a quality of care consideration and can have a major impact on residents’ quality of life. Pain is a subjective experience and unrelieved pain can have many negative effects – including insomnia, depression, anxiety, loss of appetite, change in activity or functional status, and overall decreased quality of life. In addition, it can affect the resident’s (and family’s) level of satisfaction with their care.
The PointRight Pain Quality Measures are NOT going away!
PointRight has you covered. Our clients have made it clear that they still want and need the pain measures that CMS has removed from NHC. We will continue to provide both the Short-Stay and Long-Stay pain quality measures, calculated from MDS data in near real-time, so there is no interruption in your clinical and quality program initiatives.
Janine Savage, RN, RAC-CT, CHC
Vice President, Product Management, PointRight
Janine is Certified in Healthcare Compliance (CHC) and leverages her knowledge of relevant regulations and expertise in compliance processes to assist organizations in promoting organizational integrity through the operation of effective compliance programs.