HCFA to use historical FIM data to develop rehab PPS
Data being transferred from UDS, Medirisk
The Health Care Financing Administration (HCFA) has agreed to use historical Func tional Independence Measure (FIM) data as part of the development of the prospective payment system (PPS) for rehab providers.
Work is under way to transfer 1997 FIM data from the databases of the Uniform Data System for Medical Rehabilitation (UDSMR) in Buffalo, NY, and Chicago-based Medirisk. The two databases contain FIM data for about 85% to 90% of Medicare patients.
Carolyn Zollar, JD, general counsel for the American Medical Rehabilitation Providers Association (AMRPA) in Washington, DC, is coordinating transfer of the data.
HCFA's decision to use the FIM data is a positive development, explains Kenneth W. Atchison, chairman of the AMRPA PPS task force.
"Use of FIM data by HCFA means that the door stays open as to whether the ultimate form of a payment system is per-diem or per-discharge. Even if a per-diem system is adopted, having it based on FIM scores will be a plus because the effect is likely to be more accurate case weights," he says.
HCFA officials still intend to base the reimbursement on a per-diem system, but AMRPA continues to pursue a per-discharge reimbursement system, says Sam Fleming of the Washing ton, DC-based financial consulting firm, Fleming- AOD Inc., a consultant to the AMRPA. "Right now, we're concentrating on getting them to use historical data from the FIM, and we will work on the details, such as whether reimbursement is per-discharge or per-diem, later," he says.
AMRPA officials have recommended a per- discharge system of reimbursement for rehab patients because payment of a fixed amount would allow facilities more flexibility in determining the proper intensity and duration of services. They also have expressed concerns that a per-diem system would produce longer stays and greater spending, which eventually would lead to a decrease in reimbursement rates.
After the patient assessment instrument, the Minimum Data Set for Post Acute Care (MDS-PAC), is tested in the field, the data the test generates will be used to establish inpatient rehab hospital patient classification groups. Appropri ate case-mix weights will be assigned to each classification group reflecting the resources used for patients within a group, compared with patients classified within other groups.
HCFA then will determine a payment rate for patients in each classification group. The FIM data are expected to be used in determining the average case mix of each inpatient rehab hospital and unit in the HCFA database. "If they base their new payment system on the FIM, we can expect relative weights close to those contained in the RAND report," Fleming says.
In 1995, HCFA awarded a contract to the RAND Corp. in Santa Monica, CA, to develop a prospective payment model for rehabilitation based on the functional related groups. However, Thomas Hoyer, director of the chronic care purchasing policy group, which is part of HCFA's Center for Health Plans and Providers, has announced he favors a single reimbursement system for post-acute care. Hoyer has gone forward with development of a post-acute reimbursement system based on a modified version of the MDS and the Resource Utilization Groups (RUGs) case-mix classification system, currently used in nursing homes.
Rehab providers have expressed concern that the current RUGs system for determining case weights is primarily concerned with nursing and therapy time and doesn't consider the intensity of rehab services and other expenses incurred by providers, such as medical supplies, psychology, and social services. They have urged HCFA to use the RAND analysis to develop case weights.
There is some indication HCFA will contract with the RAND Corp. to analyze the UDSMR and Medirisk data, which would be advantageous to rehab providers because the RAND staff are familiar with rehab services.
[Editor's note: For more information on the PPS for rehab, contact the American Medical Rehabilitation Providers Association at (888) 346-4624.]
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