Rehab prospective pay inches closer to reality
FIM measures included in latest MDS-PAC draft
The Health Care Financing Administration (HCFA) is one step closer this month to having the tools in place to implement a prospective payment system (PPS) for the rehab industry.
The latest draft of the Minimum Data Set-Post Acute Care (MDS-PAC), which will be used as the patient assessment instrument for the prospective payment system, was on schedule to be presented to HCFA by March 31. It likely will contain measures that should appease fans of the Functional Independence Measure (FIM).
As Rehab Continuum Report went to press, officials associated with the MDS-PAC project and the Buffalo, NY-based company that administers FIM — the most widely used assessment measure for inpatient rehab patients — said they had suggested a number of revisions to better incorporate essential elements of the 18-item FIM. Rehab industry groups such as the American Medical Rehabilitation Providers in Washington, DC, had lobbied for the inclusion of FIM data because they are widely used among rehabilitation facilities (about 1,300 across the country) and because there are FIM data for 85% to 90% of Medicare patients.
"With the current draft, we’re comfortable that most of the essential elements [of FIM] are there now," says Anne Deutsch, RN, MS, CRRN, research analyst for the Uniform Data System for Medical Rehabilitation (UDS), which administers the FIM.
UDS officials went through draft seven of the MDS-PAC and used FIM data to identify areas they thought could be improved, Deutsch says. For example, an item originally listed under the category of "bathing" on the MDS-PAC draft instrument now has been broken into two separate items — a "bathing" item and a "tub transfer" item — to mirror the FIM instrument.
In late February, officials at the Research and Training Institute at Hebrew Rehabilitation Center for the Aged in Roslindale, MA, were finalizing work on draft eight of the MDS-PAC. The 127 facilities that served as testing sites for MDS-PAC were scheduled to get all remaining data to Hebrew by the second week in March, says Pauline Belleville-Taylor, RN, MS, CS, project director at The Research and Training Institute at Hebrew Rehabilitation Center.
Belleville-Taylor says it is too early to comment on the feedback received from the test sites. The goal is to shorten the form so it can be completed in one hour. She says therapists at the test sites are becoming more aware of a patient’s functional status based on the patient’s entire activities, not just the activities observed while the patient is in therapy.
"Now that these therapists are involved in an assessment instrument where you have to talk to the nursing staff, . . . they are getting more complex information," she says. "They may find out that on the night shift, a person gets a little bit disoriented and may need physical assistance in ambulation. This type of information makes a therapist look at what a patient can accomplish in the whole 24-hour time frame."
Final report a year away
The Hebrew Rehabilitation Center contract is for developing only the assessment instrument. HCFA will use the data from the MDS-PAC tests to establish patient classification groups for inpatient rehabilitation hospitals.
After receipt of the MDS-PAC instrument, Wash ington, DC-based Muse & Associates and Aspen Systems in Rockville, MD, will begin staff time-measurement studies at a sampling of rehab hospitals and units. This is scheduled to take place in spring 1999. Using the MDS-PAC instrument, the researchers will determine a patient classification system based on resource allocation. Their final report is due to HCFA in April 2000.
The Balanced Budget Act of 1997 mandates that a PPS for rehabilitation hospitals and units go into effect Oct. 1, 2000. The budget for the PPS-based reimbursement system will be 98% of what HCFA paid under the Tax Equity and Fiscal Responsibility Act (TEFRA).
In the first year, providers will receive two-thirds of their TEFRA rate and one-third the national rate. The second year, they will receive one-third of their TEFRA rate and two-thirds of the national rate. The third year, the PPS goes into effect 100%.
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