Harmony Healthcare Blog

Quality Measures Related to Pain:  Understanding the Intent of the Pain Assessment

Posted by Melissa Fox on Tue, Sep 06, 2016


Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency

PainAssessment.jpgMany facilities become concerned when they note that their long and short stay Quality Measures for Patients Who Self-Report Moderate to Severe Pain is elevated above facility benchmarks or national averages.  This concern is justified and opens an excellent opportunity to investigate current facility practices for pain control.

5 STEPS to Better Understand the INTENT of PAIN 

  1. Root Cause Analysis
    The first step in drilling down to the root cause of this Quality Measure is to understand how the measure is calculated. 
    1. Both the long and short stay measures pull data from the resident interview for pain in Sections J0300-0600.
    2. Residents included in the numerator of the calculation are those who reported almost constant or frequent moderate to severe pain in the last five days, or very severe/horrible pain of any frequency in the last five days. 
  1. Understanding the Defined Criterion
    Providers should be familiar with the MDS 3.0 Quality Measure User’s Manual and the specific definitions associated with coding Pain.
    1. Providers who wish to investigate potential causes for a higher result for these QMs should first consider interviewing techniques and practices.
    2. The RAI User’s Manual instructs the assessor to attempt the patient interviews for pain on all residents who are at least sometimes understood.
    3. This is determined based on coding in Section B0700 (Makes Self Understood). All residents coded as a 0, 1, or 2 should be attempted to be interviewed, per RAI User’s Manual instructions.  Residents coded as a 3 (rarely/never understood) should NOT be interviewed, and the assessor should proceed to the staff assessment. 
MDS 3.0 RAI Manual
  1. Consistent Interviewing Techniques and Practices
    As outlined in the RAI User’s Manual, consistent interviewing techniques and practcies are critical in assuring that patients are not unnecessarily “screened out” of the resident interview process. 
    1. The long and short stays QMs for pain are based on resident self-report, as coded in Sections J0300-0600.
    2. Screening out patients who were appropriate for this QM inappropriately could lead to a decreased number of patients in the numerator of the calculation, and potentially will influence the overall facility performance in these QMs. Inappropriate use of dashes in Sections J0300-0600 may have a similar effect. 
  1. Understand the Covariate
    The long stay measure has a covariate applied.  Covariates are applied after the QM has been calculated, to take into consideration facility-specific characteristics and level the playing field for facilities that may have a unique resident demographic. 
    1. The covariate for the long stay measure is based on independence or modified independence in daily decision making on the prior assessment, which are assessed during the BIMS interview and in Section C1000.
  1. Care Planning Pain Control
    Facilities should also examine their current pain control practices.
    1. This process would make an excellent Continuous Quality Improvement (CQI) project or Performance Improvement Project (PIP) for the Quality Assurance team. Outcomes of the CQI/PIP could include patient reports of overall satisfaction with their stay and positive perception of their SNF/LTC experience.
    2. Facilities should also be aware that Quality Measure reports are “old” data. Proactive management of pain control issues is the best way to ensure patients have a positive and pain-free stay. 

Harmony Healthcare International (HHI) is available to provide onsite analysis and associated medical record reviews to help you improve your Quality Measure Scores.  Please contact Harmony Healthcare International by clicking here or calling our office at 1.800.530.4413.  

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Topics: Pain Assessment, Quality Measures, MDS 3.0 RAI Manual

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