Support mounts for FIM-FRG system
August 1, 1999 3 minutes read
Support mounts for FIM-FRG system
Hospitals wait and wait and wait some more
The summer doldrums have set in for rehab hospitals as they wait for the Health Care Finan cing Administration (HCFA) to iron out the last details of the industry’s prospective payment system (PPS). In the meantime, Rep. Bill Thomas (R-CA), who helped write the Balanced Budget Act (BBA) of 1997, has lent his voice to the rehab industry in asking HCFA to drop its per diem proposal and use a per-case patient classification system instead. The American Medical Rehabilitation Provid ers Association (AMRPA) supports the use of the Functional Independence Measure-Function Related Groups (FIM-FRGs) for patient classification.
HCFA officials still had not decided on the proposed reimbursement methodology as Rehab Continuum Report went to press, but they say the proposals should be announced soon.
Some officials with rehabilitation hospitals say they also support the FIM-FRG system and hope that’s what HCFA will select. "I would prefer the FRG system because it gives the country an incentive to become more efficient, and with either system you still want the outcomes to be as good or better than they are today," says Bill Munley, MHSA, CRA, administrator of rehabilitation, neurology, and orthopedics at St. Francis Hospital in Greenville, SC.
Despite the rehab industry’s support of a per-case payment system, some say they believe HCFA will stick with the per diem approach. "HCFA has spent a lot of money and time developing the MDS [Minimum Data Set-Post Acute Care] system and the Resource Utilization Group, and they’re not going to abandon that," predicts Lynn Rosenblatt, CRRN, director of utilization review for Healthsouth Sea Pines in Melbourne, FL.
Have any rehab hospitals taken the plunge in the chilly waters and made changes in anticipation of PPS? Several officials told Rehab Contin uum Report it’s too risky to make changes based on their own predictions of how HCFA will act.
"It’s really been very confusing as to which way the pendulum is going to fall," says Marggi Diercks, MA, CCC, SLP, director of inpatient rehabilitation at Pinecrest Rehabilitation Hospital in Delray Beach, FL. Pinecrest is part of Tenet South Florida System, which is part of Dallas-based Tenet Health Systems.
"We can only do our best in re-engineering our hospital for better cost-effectiveness, and we’ve been doing that all along," Diercks says.
After what happened this past year, when part of the changes resulting from the BBA cost rehabilitation hospital hundreds of thousands of dollars, it’s little wonder that no one is clamoring to be at the front of the PPS line.
TEFRA has forced cost-cutting measures
The BBA’s new limits on the Tax Equity and Fiscal Responsibility Act (TEFRA) cost St. Francis Hospital in Greenville more than $250,000. The hospital, which opened in 1990, had a cost limit of $26,000 and had kept actual costs to less than $10,000 per case. This enabled the hospital to receive a TEFRA bonus of $1,400 per case, Munley says. Now the hospital receives a maximum bonus of $385 per case. "So we’ve already tightened the purse strings, trying to shorten our length of stay to enable us to take on more cases," he adds.
Pinecrest Rehabilitation Hospital also was hit hard by TEFRA, Diercks says. "We’re trying to meet cost goals and meet our budget, but we’re not overreacting to the government’s decisions at this point."
The hospital also has implemented staff cross-training and a skills mix strategy, along with having employees share job responsibilities. "We’re also looking at different service delivery models, such as group therapy," Diercks explains.
But before hospitals can make more changes than these, they’ll need to know whether HCFA has decided to stay with a per diem model. And then they need to know how long it will take the government to cut rehabilitation daily reimbursement to very low levels, as has happened to nursing homes and skilled nursing facilities.
"I don’t think the home health and skilled nursing home industries were prepared and knew that the BBA and PPS would be so restrictive," Rosenblatt says. "If they cut the rehab per diem payment by huge amounts, then we will have to look at how much therapy these patients can handle and what to do with them."
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