CMS: Patients should get pain management info

A statement from the Centers for Medicare and Medicaid Services (CMS, formerly the Health Care Financing Administration) is adding more pressure on health care providers to improve their pain management programs. Health care facilities already were facing pressure from the Joint Commission on Accreditation of Healthcare Organizations’ new pain management standards.

CMS’ action is not new, but the agency recently released an opinion underscoring what it has expected from health care providers all along. The CMS opinion stated that information about pain management must be conveyed to patients. The opinion came as an answer to a petition to CMS from a coalition of patient advocacy groups.

In response, CMS sent a letter that clarifies its position on pain management. Jeffrey L. Kang, MD, MPH, director of the Office for Clinical Standards and Quality at CMS, wrote that patients have a right to be informed of all aspects of their medical care, including pain management. Not only is pain management included under medical care, he said, but it is a "critical aspect of care."

Kang says the agency’s surveyors will discuss pain management as part of their survey to assess compliance with state and federal laws. The petition came from a coalition that includes Americans for Better Care of the Dying, the American Academy of Pain Management, the American Pain Foundation, Compassion in Dying, the Medicare Rights Center, and Partnership for Caring (formerly Choice in Dying).

The coalition petitioned CMS to amend its Patient’s Rights Conditions of Participation to require Medicare and Medicaid providers to:

  • inform patients of their pain management rights;
  • identify pain management as a critical aspect of medical care;
  • explicitly acknowledge that patients have the right to make informed pain management decisions;
  • inform patients of any pain management rights they may have under state law.

CMS denied the requests made in the petition but made clear that it supports efforts to improve pain management. The only reason CMS rejected the petition, Kang wrote, was that CMS already considers pain management "a critical aspect of care." No change in policy is necessary, he wrote.

Kathryn Tucker, JD, director of legal affairs with the Compassion in Dying Federation in Seattle, says the CMS letter means that all U.S. health care providers who participate in Medicaid or Medicare are operating under equivalent pain management requirements. Prior to CMS’ clarification, the coalition was concerned that some facilities not accredited by the Joint Commission would not be held to the same pain management standards.

Tucker says the CMS clarification should urge all health providers to manage pain effectively. Joint Commission-accredited organizations risk losing their accreditation by not complying, and others that are not accredited risk losing their Medicare and Medicaid financing by not complying with CMS’ expectations.

Kang wrote in his letter that the Hospital Interpretive Guidelines (issued June 2000) explicitly direct the surveyor to ask if the patient has been notified of his or her right to be informed of his or her health status; has been informed of his or her prognosis; has been involved in care planning and treatment, including pain management; and has been given the opportunity to request or refuse treatment.

"We believe that pain management is included under medical care as it involves the mitigation and treatment of pain, and that by including it in our interpretive guidelines, we have identified its as a critical aspect of care," he added.

When surveyors look at whether facilities meet the requirements of applicable state and federal laws, including the Patient Self-Determination Act (PSDA), "pain management should be discussed. We also believe that it is the clear intention of the PSDA to allow each individual state the flexibility to determine the most effective manner to comply with its own laws regarding the right of each patient to request or reject the use of effective pain management," he wrote.