Controversy erupts over using PPS data tool for benchmarking
UDSmr and AMRPA square off in center ring
The rehab industry exhaled a collective sigh of relief last year when the Centers for Medicaid and Medicare Services (CMS) issued its final rule for the inpatient rehabilitation prospective payment system (PPS). The industry was relieved largely because CMS had decided to use a tool that was based on one already used by most rehab facilities.
Now it appears that the industry’s relief was premature. While the federal government still will be using the new system, the Inpatient Rehabilitation Facilities Patient Assessment Instrument (IRF-PAI), there is a big question about whether rehab facilities will have as much choice in vendors as they’d like when using IRF-PAI data for benchmarking purposes.
Who holds copyright on FIM?
The controversy basically comes down to this: UDSmr, a division of UB Foundation Activities Inc., a nonprofit corporation supported by SUNY-Buffalo, says the IRF-PAI is based on its functional independence measure (FIM) system, which UDSmr claims is copyrighted material. Therefore, rehab facilities that use vendors other than UDSmr and its contracted vendors for benchmarking purposes may be in violation of the company’s copyright, according to UDSmr, in a statement issued in November 2001 on the company’s web site (www.udsmr.org).
Specifically, UDSmr says, "Facilities who subscribe to UDSmr need not worry about ownership issues. The same cannot be said with respect to services offered by AMRPA."
UDSmr is referring to the American Medical Rehabilitation Providers Association (AMRPA) in Washington, DC which has its own IRF-PAI, called eRehabData. AMRPA has argued that UDSmr does not possess the exclusive right to use the tool for benchmarking purposes.
AMRPA has issued two statements about the controversy, and in both cases asserts that UDSmr’s copyright claims are questionable.
"Neither SUNY-Buffalo nor the Research Foundation created the FIM," the AMRPA statement says. "The original components of the FIM were developed by a joint task force composed of representatives of various organizations in the rehabilitation field."
UDSmr says the company currently licenses numerous vendors to incorporate copyrighted elements of the FIM System in products that the vendors offer to rehab providers. "UDSmr has signed agreements with various vendors and continues to discuss and respond to the needs and requests of additional vendors," UDSmr says in its statement.
The AMRPA statement responds, "In AMRPA’s view, no license from UDSmr is needed to use the IRF-PAI published by CMS, or to collect and analyze the data supplied by facilities."
Facilities fear litigation
Regardless of whether the dispute is settled in or out of court, it appears to be having a dampening effect on the rehab industry. According to AMRPA, there have been reports from rehab facilities that they fear being sued if they use benchmarking services from AMRPA or vendors other than those affiliated with UDSmr.
"UDSmr has always maintained that each of its subscribing facilities owns its own raw data and has never restricted the sharing of such data with any party that a facility deems appropriate," says the UDSmr statement. "In fact, AMRPA itself has benefited from the ability of facilities to share their data because, to date, the majority of data on which AMRPA has performed financial analysis has been derived from rehabilitation facilities that collected data using UDSmr’s FIMware software."
UDSmr says it has sent contract renewal packages to existing subscribers and as a service to them has sent them UDSmr’s new UDS-PRO software for outcomes systems.
The controversy is unfortunate and unproductive, and it needs to be resolved fairly, says Ken Aitchison, chief executive officer of Kessler Rehab Corp. in West Orange, NJ. Aitchison is the chairman of the PPS committee of the AMRPA.
"If in fact UDSmr has what they assert they have, then show it," Aitchison says. "Then obviously, with that in hand, let’s come to a resolution."
UDSmr needs to recognize the AMRPA’s role as an advocacy group for the field of rehabilitation, Aitchison says. "Advocacy doesn’t just take the context of going down the halls of Washington — it’s data-based."
Distinguishing between AMRPA’s two roles
The UDSmr statement says, "First and foremost, we urge you to distinguish between AMRPA’s role as a trade association representing numerous rehabilitation facilities in Washington and its new, proposed role as a commercial vendor providing data transmission and data analytic services to the rehabilitation field."
The statement concludes, "Both UDSmr and AMRPA have made significant contributions to the medical rehabilitation field. We believe that both of us can continue to best serve the field by utilizing our existing areas of expertise for the ultimate benefit of the rehabilitation community."
AMRPA’s eRehabData project was designed, at the request of rehab facilities, to enable facilities to model PPS reimbursement prior to implementation, the AMRPA statement says.
"AMRPA also responded to industry requests to incorporate cost data into the model and to provide real-time information," the AMRPA statement reads. "These innovations help rehabilitation providers to review their actual and projected costs and outcomes, and to prepare for new government regulations, without having to wait months to receive their own information and benchmark information."
The dispute over the use of the IRF-PAI and its FIM data is not without irony.
When CMS first proposed using the Minimum Data Set for Post Acute Care (MDS-PAC) as a data collection tool, AMRPA joined rehab facilities in objecting to what they saw to be a burdensome, time-consuming tool.
"I and many people at AMRPA were very active in seeking HCFA to move away from the MDS-PAC idea," Aitchison says. "So we were moving quite aggressively to support moving over to the FIM-based model, and were obviously successful."
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