Vital Times 2017 - 66

Pain during Stay Domain
*
*

*
*
*

During this hospital stay, did you have any
pain?
During this hospital stay, how often did hospital
staff talk with you about how much pain you
had?
During this hospital stay, how often did hospital
staff talk with you about how to treat your pain?
During this hospital stay, did you get medicine
for pain?
Before giving you pain medicine, did hospital
staff describe possible side effects in a way you
could understand?

Treating Pain Post Discharge Domain
*

*

*

Before you left the hospital, did someone talk
with you about how to treat pain after you got
home?
Before you left the hospital, did hospital staff
give you a prescription for medicine to treat
pain?
Before giving you the prescription for pain
medicine, did hospital staff describe possible
side effects in a way you could understand?

CMS plans to gather addition feedback about these
questions with focus groups and hospital staff. No
timing for a transition to new pain questions has been
announced. Press Ganey expects additional information
will be released in early 2017.
3. PRIME (The Public Hospital Redesign and
Incentives in Medi-Cal): The Public Hospital
Redesign and Incentives in Medi-Cal (PRIME)
program will build upon the foundational delivery
system transformation work, expansion of coverage, and
increased access to coordinated primary care achieved
through the prior California Section 1115 Bridge to
Reform demonstration. Activities supported by the
PRIME program are designed to accelerate efforts by

66 		|	 	 CSA	Vital	Times

participating PRIME entities to change care delivery to
maximize health care value and strengthen their ability
to successfully perform under risk-based alternative
payment models (APMs) in the long term, consistent
with CMS and Medi-Cal 2020 goals. The PRIME
program is intentionally designed to be ambitious in
scope and time-limited. Using evidence-based, quality
improvement methods, the initial work will require
the establishment of performance baselines followed
by target setting and the implementation and ongoing
evaluation of quality improvement interventions.
Participating PRIME entities will consist of two types of
entities: Designated Public Hospital (DPH) systems and
the District/Municipal Public Hospitals (DMPH).
While each hospital may chose their own quality metrics
on which to report, some important pain-related metrics
include: (a) Alcohol and Drug Mis-use screening (b)
Opioid management via UTOX within last 12 months
and a pain contract in place if prescribing opioids (c)
CURES check on patients with >90 days of opioid use
(d) Screening for clinical depression (e) Non opioid
modalities offered prior to opioid treatment. While
anesthesiologists and pain physicians may already
be meeting these quality metrics, keep in mind these
metrics apply not only to pain management physicians
but also primary care. Likely, the role of the Institutional
Pain leadership will include monitoring compliance from
primary care physicians.
In conclusion, the opioid epidemic has dramatically
impacted the practice of medicine as it relates to pain
management. So rarely in medicine do we see an entire
culture change as we have now. As a result, regulatory
bodies ( Joint Commission), patient satisfaction
surveyors (Press Ganey and HCAHPS), and state
funded health plan reimbursement (Medi-Cal) will see a
dramatic shift in 2018 for the tracking and management
of pain. In these winds of change, it is vitally important
to have anesthesiologists in leadership roles in hospitals,
and other institutions' pain committees, and to step up to
guide these committees to optimize quality.



Table of Contents for the Digital Edition of Vital Times 2017

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