Several physicians pointed out that it makes more sense to measure functional status than pain. Can a patient work, walk, or take a bath without any assistance? One speaker recommended the Physical Functional Ability Questionnaire (FAQ5) as a measurement tool.


Cries of Pain Are Getting Some Results

The AAFP is not the first medical society to take a stance against the fifth vital sign. The House of Delegates of the American Medical Association did so a few months ago.

Cries of pain from organized medicine appear to be getting results. Consider, for example, the 32-question Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), which is a controversialpatient-satisfaction survey from the Centers for Medicare & Medicaid Services (CMS). HCAHPS is completed by patients after a hospital discharge. The first of three questions on pain management asks patients if they needed medicine for their pain. Critics of the HCAHPS argue that this wrongly equates pain management with the prescription of a painkiller.

The HCAHPS score is factored in when the CMS, using its hospital value-based purchasing (VBP) program, determines how much it should pay a hospital. This means there is a financial incentive for hospitals to achieve high marks from patients on the pain questions.

New and improved pain-management questions in development will “remove any potential ambiguity” about the survey, CMS reported in July. And to eliminate the financial pressure to overprescribe pain meds, the current pain questions will cease to be part of VBP calculations in 2018.

CMS has issued a warning to hospitals not to misuse HCAHPS data to evaluate or pay individual clinicians, on the basis of what it has heard from the field. Those practices are some of the very things that spurred AAFP delegates to vote for the end of the fifth vital sign.