Defining Positive vs. Negative and Eligibility

According to CMS, positive and negative as they pertain to pain assessment documentation are defined as:3

  • Positive – Based on the scoring and interpretation of the specific standardized tool used, and through discussion during the patient visit, the provider should determine if the patient is deemed positive for pain.
  • Negative – Based on the scoring and interpretation of the specific standardized tool used, and through discussion during the patient visit, the provider should determine if the patient is deemed negative for pain.


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Additionally, not all patients will be eligible for follow-up or assessment, even if they are otherwise eligible for the measure. The following criteria are used to determine if a patient is not eligible for follow-up or assessment:3

  • Not eligible for follow-up – A patient may not be eligible for follow-up plan, or it may not be appropriate for a patient to undergo treatment or therapy for pain because such treatments are medically contraindicated.
  • Not eligible for assessment – The patient is not eligible for pain assessment if one or more of the following reasons are documented in the patient’s medical record:
    • Severe mental and/or physical incapacity where the person is unable to express himself/herself in a manner understood by others. For example, cases where pain cannot be accurately assessed through use of nationally recognized standardized pain assessment tools
    • Patient is in an urgent or emergent situation where time is of the essence and to delay treatment would jeopardize the patient’s health status

Justification for any of these findings should be documented in the patient’s medical record.3 

Figure 4 gives an overview of the decision tree users should follow when reporting pain assessment and follow-up data to CROWNWeb. (Image courtesy of the ESRD QIP.)

Figure 4: Pain Assessment and Follow-up Decision Tree.


For more Information

Further information regarding the ESRD QIP can be obtained from http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/ESRDQIP/index.html, which provides a wide variety of information including answers to Frequently Asked Questions, detailed discussions about the rules for each PY, samples of facility’s Performance Score Certificates, and other helpful references. ESRD QIP technical specifications can be accessed at http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/ESRDQIP/061_TechnicalSpecifications.html. Additionally, questions regarding the program can be sent to CMS’s ESRD QIP team at [email protected].

The work on which this publication was performed under Contract Number HHSM-500-2015-00511G, titled “CROWNWeb Outreach, Communications, and Training,” funded by the Centers for Medicare & Medicaid Services, Department of Health and Human Services, Janis Grady, CMS COR. The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. government.

References

  1. Hedayati, S. Susan et. al. A practical approach to the treatment of depression in patients with chronic kidney disease and end-stage renal disease. (2012). Kidney International. Vol. 81, 247 –255. Retrieved February 2, 2016 from http://www.nature.com/ki/journal/v81/n3/full/ki2011358a.html.
  2. Davison, Sarah N. Pain in hemodialysis patients: prevalence, cause, severity, and management. American Journal of Kidney Disease. (2003). Vol. 42, Issue 6, 1239-1247. Retrieved on February 2, 2016, from http://www.ajkd.org/article/S0272-6386(03)01112-0/fulltext.
  3. Centers for Medicare & Medicaid Services. Addressing Depression in Dialysis Patients: A New ESRD QIP Reporting Initiative. (2015). Retrieved February 2, 2016, from https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/ESRDQIP/Downloads/ESRD-QIP-Policy-Update-and-Depression-Screening-CMS-Quality-Conference-v1_5-508.pdf.
  4. Kimmel, Paul L. and Rolf A. Peterson. Depression in Patients with End-Stage Renal Disease Treated with Dialysis: Has the Time to Treat Arrived? (2006). Retrieved on February 2, 2016, from http://cjasn.asnjournals.org/content/1/3/349.full.
  5. Centers for Medicare & Medicaid Services. Final Measure Specifications for the PY 2018 ESRD QIP. (2014). Retrieved February 2, 2016, from http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/ESRDQIP/Downloads/ESRDQIPPY2018finaltechnicalmeasurespecifications-.pdf.
  6. Cohen, S. D., Patel, et al. Pain, sleep disturbance, and quality of life in patients with chronic kidney disease. (2007). Clinical Journal of the American Society of Nephrology, Vol. 2 Number 5, 919-925. Retrieved on February 2, 2016, from http://cjasn.asnjournals.org/content/2/5/919.long.