Joint Commission Updates Pain Standards

The moves come as organized medicine, insurers, and policymakers step up their efforts
By Bruce Japsen

THE JOINT COMMISSION, which accredits and certifies more than 21,000 U.S. hospitals, health systems, facilities and programs, is changing the way patients are monitored and cared for when they have pain in U.S. health facilities. The new standards come in the wake of the nation’s opioid crisis and will lead to revising “assessment and management standards” for behavioral health care, home care and nursing care center programs following months of research and consultation with medical experts.

“Effective July 1, 2019, new and revised pain assessment and management standards will be applicable to Joint Commission-accredited behavioral health care, home care and nursing care center programs,” the Joint Commission said in announcing the new standards earlier this year.

“The program-specific standards follow new and revised pain assessment and management requirements for hospitals, ambulatory health care organizations, critical access hospitals and officebased surgery practices that The Joint Commission introduced earlier this year.”

The moves by the Joint Commission come as organized medicine, health insurance companies, policymakers step up their efforts to educate providers and develop new helpful guidelines. The Chicago Medical Society was the first medical organization in Illinois to partner with U.S. Senator Dick Durbin to combat the opioid crisis.

For physicians and other medical care providers, the Joint Commission standards should help while creating a guide for health facilities to better educate staff and spur changes in organizations. One example of new change that could benefit physicians who prescribe is a “requirement that organizations facilitate practitioner access to prescription drug monitoring program databases,” the Joint Commission said.

The Joint Commission said its pain assessment and management standards have been in the making for quite some time and included physician input and research. The Joint Commission said the standards were “developed based on public field review and expert guidance from a technical advisory panel, program-specific expert panels and program-specific standards review panels.”

They are designed to provide contemporary guidance for pain assessment and management, as well as to strengthen organizations’ practices for pain assessment, treatment, education and monitoring,” the Joint Commission said in an announcement. In its new standards for the long-term care setting, for example, the Joint Commission described opioids as “one of the leading causes of preventable adverse drug events in skilled nursing facilities.”

Other new Joint Commission requirements call for healthcare organizations to develop pain treatment strategies that include “nonpharmacologic, pharmacologic, or a combination of approaches.” This is a change from previous standards that said “that treatment ‘may’ provide for such approaches,” the Joint Commission said.

“Inconsistent evaluation of pain treatment effectiveness, including opioid treatment, by prescribers has been identified as an issue by Joint Commission stakeholders and in current literature,” the Joint Commission said in its new “R3” report on pain assessment and management in nursing care centers. “This inconsistency in the quality of care calls for the medical director’s oversight of pain management and responsible opioid prescribing.”

In the last year, health insurance companies have also been changing their standards and practices and looking more closely at physician prescribing habits as part of their monitoring. Cigna, Anthem, UnitedHealth Group and Chicago-based Health Care Service Corp. are closely scrutinizing claims to make sure patients are getting the drugs in the right place, in the right amount and at the right time while making sure patients and their doctors are adhering to recommended dosages established by the Centers for Disease Control and Prevention.

For more information about the Joint Commission’s new guidelines, visit www.jointcommission.org. The “prepublication versions of the standards” are available on the Prepublication Standards Section of the Joint Commission’s website until June 30.

Bruce Japsen is a health care journalist, speaker and author. He can be reached at brucejapsen@ gmail.com.