​Prescribing of opioids after surgery was not associated with performance on Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) pain measures, according to a research letter published in the May 16, 2017, Journal of the American Medical Association. Patients often take HCAHPS surveys, which are sent 48 hours to six weeks after discharge, at a time when they may have prescriptions for postoperative opioids. As the authors note, "this timing has raised concerns that HCAHPS measures could inadvertently incentivize clinicians to overprescribe opioids after discharge to ensure satisfactory ratings and reimbursement." The Centers for Medicare and Medicaid Services has stated that it plans to remove the pain management dimension from the Hospital Value-Based Purchasing Program starting in fiscal year 2018. The data set included insurance and pharmacy claims for more than 31,000 patients who underwent a variety of surgical procedures at 47 hospitals in one state. The HCAHPS measures studied were the pain management score, which indicates the percentage of patients who reported that their pain was "always" well controlled, and the pain dimension score, which reflects a hospital's pain management score in comparison with national benchmarks. The researchers adjusted for "hospital-level aggregates" of patient variables, such as comorbidities, case mix, and long-term preoperative opioid use. Neither pain measure was associated with postoperative opioid prescribing, in unadjusted or in mixed linear models. The authors suggest that at least in the state studied, "these findings suggest reducing opioid prescriptions may not worsen HCAHPS scores and hospital reimbursement." The authors further note that the results "may also inform policy makers in the current decision to remove pain management from determination of hospital payments."

HRC Recommends: Patients should receive an individualized plan for the management of postoperative pain, including pain that may persist after discharge. This begins with a comprehensive assessment of the patient and discussion of goals and expectations before planned surgery. Clinicians should consider multimodal pain management, which may include nonpharmacologic modalities, nonopioid pain medications, or opioid-sparing techniques, whenever appropriate. Care coordination among surgeons, anesthesia professionals, hospital-based providers, and primary care physicians may be necessary, and consultation with pain management specialists should be considered in complex cases (e.g., patients taking long-term opioids before surgery, patients with kidney or liver disease).