The CMS is looking for consultants to help finalize and launch a national survey to track the quality of care patients receive in emergency rooms.
The survey could be critical in improving that care and lowering costs, since ERs handle 28% of all acute-care visits in the U.S. Half of those visits serve Medicaid and Children's Health Insurance Program beneficiaries, and nearly two-thirds of ER visits are made by uninsured individuals, according to the CMS.
But industry stakeholders have responded to the survey with concern, saying it could aggravate the nation's opioid abuse crisis if emergency care patients do not feel ERs do enough to ease their pain.
The Affordable Care Act mandated a national quality strategy that included surveying patients and caregivers.
The CMS already surveys Medicare, Medicare Advantage and Part D prescription drug beneficiaries, as well as inpatients, home health agencies, in-center hemodialysis facilities, hospices, accountable care organizations and physician practices.
An ER survey has been the hold out.
The CMS has been working on the survey since 2012, and has tested a version in select markets. The agency has given no explanation for the delay, or designated a time frame for its release. But in a recent notice, the agency said it is gauging how many companies have experience in developing this type of survey. The agency is also asking for expertise in ER protocols and Health Insurance Portability and Accountability Act requirements. Depending on the responses it receives, a formal request for proposal will be released. Responses to its inquiries are due April 6.
Gregg Loughman, general manager and vice president of patient experience solutions at HealthStream, a patient survey vendor, said this type of survey could take as long as five years to launch. "It just comes down to when measuring patient experience in the emergency room will become a priority at the CMS,” he said.
The RAND Corp., a research consultancy, developed an early version of the survey that was tested in 12 hospitals in late 2013 and early 2014, and analyzed the resulting data from 4,101 ER patients. Additional preliminary tests were expected in the first quarter of the year.
The draft survey has troubled industry stakeholders.
The Emergency Nurses Association said in a January letter to the CMS (PDF) that it was concerned that survey questions related to pain management during an ER visit would inappropriately prompt ER nurses to administer pain medication “in excess of clinical guidelines and safe practice.”
One question asks: “During this emergency room visit, did the doctors and nurses do everything they could to help you with your pain?”
The question implies that ER practitioners should reduce a patient's pain without consideration for clinical guidelines or appropriate protocols, the trade group said.
“It also contradicts other efforts by [HHS] to address a growing epidemic of opioid abuse through improved prescribing practices, among other things,” the group stated.
President Barack Obama addressed the epidemic this week, saying he didn't think the public "appreciated the scope of the problem."
Congress is attempting to allocate more resources to confront the epidemic, one of only a few areas where bipartisan agreement may be reached during the election year.
But the White House is critical of a related Senate bill, which it says lacks critical funding. Obama is seeking $1.1 billion in new funds to expand treatment for opioid addiction, which is about triple current funding levels.
In 2013, nearly 2 million Americans abused prescription painkillers, and each day, nearly 7,000 people receive ER care for misusing the drugs, according to federal data.
