Veterans Health Administration Pain Management Quality Improvement in a Post-Commission on Accreditation for Rehabilitation Facilities Era.

Tertiary interdisciplinary pain rehabilitation programs (IPRPs) provide integrated, comprehensive pain rehabilitation using an evidence-based biopsychosocial approach delivered by teams offering multi-modal care. A 2009 Veterans Health Administration (VHA) Directive mandated implementation of Commission on Accreditation for Rehabilitation Facilities (CARF) accredited IPRPs in each Department of Veterans Affairs (VA) service network. Commission on Accreditation for Rehabilitation Facilities accreditation included regular program surveys to reinforce continuous quality and improvement standards. IPRPs are integral to the VHA's capacity to provide a stepped-care model including advanced pain diagnostics and functional rehabilitation to best meet the needs of veterans with complex chronic pain. Recently, VHA ended its enterprise-wide contract with CARF International for accreditation across all programs. The absence of a formal external accreditation process created a gap in sustaining quality oversight and may put VA IPRPs at risk for closure or losing their relevance as tertiary pain care centers. As such, the VA national Pain Management, Opioid Safety, and Prescription Drug Monitoring Program (PMOP) is launching an initiative to ensure governance, sustainability, and alignment with VHA and PMOP strategic priorities. PMOP's provision of oversight, support, and strategic direction is critical as the VA continues to sustain the highest quality standard for pain management and rehabilitation in the post-CARF era. This commentary will discuss current PMOP initiatives for VA IPRPs to address gaps left by the absence of the CARF accreditation framework.