Press Room

Leading Nursing Association Calls for CMS Reforms to Better Address Opioid Misuse, Pain Management, Malnutrition and More

Philadelphia, Pa. – This week, in a letter to Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma, MPH, the National Association of Clinical Nurse Specialists (NACNS) noted its support for CMS’s proposal to include safe use of opioids and malnutrition assessment in electronic clinical quality measures (eCQMs). CMS is considering including these two eCQMs in the Hospital Inpatient Quality Reporting (IQR) and Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs as part of CMS’s FY 2018 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long Term Acute Care Hospital Prospective Payment System Proposed Rule and Request for Information.

The letter says: “Measures are needed that assess opioid follow‐up, prescription and appropriate prescribing, even as there are times when concurrent prescriptions of opioids and benzodiazepines are appropriate. In a growing number of healthcare systems, the clinical nurse specialist (CNS) leads efforts to modify the use of opioids for pain relief, implements system‐level protocols that call for alternate pain relief measures and provides individualized patient consultation to improve the appropriate use and prescribing of these medications. NACNS supports the use of opioids and/or benzodiazepines in certain clinical situations and is exploring the optimal ways the CNS can contribute to reducing the opioid crisis. In 2016 NACNS appointed an Opioid/Pain Management Task Force that is currently developing tools and resources to assist the CNS to improve the management of pain and enhance the correct use of opioids and other pain management options.”

It continues, “Our nation is facing two interrelated public health epidemics – chronic pain and opioid misuse and overdose… NACNS believes that a long‐term solution to the opioid epidemic will not be achieved without addressing the challenge of chronic pain and investing in research on effective pain relief alternatives. Better acute and chronic pain treatment will improve the lives of millions of Americans, save billions of dollars and reduce opioid misuse.”

NACNS is also encouraging CMS to support immediate adoption of malnutrition eCQMs into the Hospital IQR Program and adoption of a malnutrition composite eCQM as soon as feasible. In regards to malnutrition the letter states:  “In February 2017, NACNS issued the report, Malnutrition in Hospitalized Adult Patients: The Role of the Clinical Nurse Specialist, produced by the NACNS Malnutrition Task Force and sponsored by a grant from the Abbott Nutrition Health Institute. Our report found that an estimated 20% to 50% of hospitalized adult patients are malnourished and that treatment costs associated with malnutrition are estimated to be greater than $11 billion annually. The costs are related not only to the treatment of malnutrition and its underlying cause, but also to the sequelae of malnutrition, including muscle wasting, loss of functional ability, and hospital‐acquired conditions (e.g., falls, pressure injuries, and infections). These sequelae also can lead to increased morbidity and mortality, longer lengths of stay, and higher readmission rates.”

“NACNS recognizes that hospitals and providers are concerned with measure reporting burden, yet we also contend that these malnutrition eCQMs ultimately will reduce the economic burden incurred by them,” the letter says. “Adopting the patient‐centered measures comprising the malnutrition measure set and encouraging the use of interprofessional approaches to achieving these goals is imperative to improve patient outcomes and care coordination, and to decrease costs to the system.”

Other areas NACNS asks CMS to support include:

  • Continued implementation and expansion of care coordination models;
  • Adopting a Falls with Injury measure in the IQR Program to support the Hospital Acquired Condition Reduction Program;
  • Establish EHR provisions that collect data specific to the interventions for all providers, especially CNSs and advance practice registered nurses (APRNs);
  • Allowing at-risk beneficiaries for prescription drug abuse access to CNSs; and
  • Inclusion of two NQF-endorsed nurse staffing measures in the final hospital payment rule.

Clinical nurse specialists are licensed APRNs who have graduate preparation (master’s or doctorate) in nursing as a clinical nurse specialist. They have unique and advanced level competencies that meet the increased needs of improving quality and reducing costs in today’s health care system. CNSs are leaders of change in health organizations, and they work across the spectrum of care—providing direct patient care, developing scientific evidence-based programs to prevent avoidable complications, coach those with chronic diseases to prevent hospital readmissions and facilitate interprofessional teams that improve care quality and safety. There are more than 72,000 clinical nurse specialists.

Read the complete letter to CMS Administrator Verma here.

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