Testing has begun on patient assessment tool for rehab PPS
Instrument includes elements of the FIM, MDS for nursing homes
Field testing has begun on the Minimum Data Set for Post Acute Care (MDS-PAC) intended to be used as the patient assessment instrument for Medicare's prospective payment system for post-acute care. The new assessment system is being developed and tested at the Research and Training Institute at Hebrew Rehabil ita tion Center for the Aged (HRCA) in Roslindale, MA, through a contract with the federal Health Care Financing Administration (HCFA) in Baltimore.
The HRCA 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. Other projects will establish payment rates for the patients within each classification. (For details on other developments in the PPS process, see story, p. 103.) The HRCA report on the assessment instrument is due to HCFA Feb. 1, 1999, according to Pauline Belleville-Taylor, RN, MS, CS, project director.
The new MDS-PAC is a hybrid instrument that includes features of the lengthy MDS 2.0, used as a patient assessment tool in skilled nursing homes, and the 18-item Functional Independence Measure (FIM, administered by the Buffalo, NY-based Uniform Data System for Medical Rehabilitation), the most widely used assessment measure for inpatient rehab patients.
Representatives from nursing homes with subacute units have told HCFA the MDS for skilled nursing facilities (SNFs) doesn't work for short-stay beds. Rehab providers have complained that the MDS for SNFs is too lengthy, and the assessments, which begin on day five and set the reimbursement rate for the first 14 days of treatment, take place too far into the rehab stay to be useful in rating rehab patients, many of whom are discharged after only a few days in inpatient rehab.
"Our goal is for a system that is clinically useful and practical. If it takes two hours to administer, it's not going to work. We realize some patients leave in five days," Belleville-Taylor explains.
The MDS-PAC has been developed with the input of professionals throughout the post-acute continuum of care. HRCA research staff are working on draft seven of the instrument. Their final report will be based on field testing of draft 10.
Representatives from subacute facilities, skilled nursing facilities, and rehab hospitals and units were asked for input into the study in 1997 and had an opportunity to suggest changes in draft six of the new assessment tool in the spring of this year. Members of the American Medical Rehabilitation Providers Association's (AMRPA, in Washington, DC) prospective payment task force made many suggestions for change in the assessment tool.
HRCA held a focus group for skilled nursing facilities and a second focus group for rehab and long-term care providers. Also, a technical experts panel of representatives from provider and professional organizations has been asked to give feedback at each step of development, she says.
Team approach to data collection
In all except the baseline data collection test, which is being administered only by RNs, providers are asked to assign one registered nurse and either a physical or occupational therapist to do the assessments. "We are asking them to work together on it and give us feedback," Belleville-Taylor says.
When the tests are completed, HRCA staff will conduct a conference call with assessors at each facility and go through an extensive questionnaire to get their input on what works best, which items should be kept, and which should be dropped.
"It's very important that we get direct information from the people at the bedside. I worked on the nursing home MDS 2.0 test, and we really listened to the people who administered the instrument. We all thought of the nurses as the voice of reality," she adds.
The final instrument will be an amalgam of ideas from people throughout the post-acute continuum, and it will be based on their input and what works well in the field tests, Belleville-Taylor says.
For instance, some people have indicated it is important for the assessment to include psychosocial items, while others feel those measures are unimportant. "We want to keep it to what is absolutely necessary. That's what's good about field testing," she says.
Most of the participants in the testing will be selected from a database of 900 facilities that volunteered to test the new instrument. In addition, because of a mandate from the federal Office of Management and Budget, some of the participants will be chosen from a list of rehab and long-term care units based on HCFA's geographical areas.
HRCA will provide training materials and a video for each testing facility and will be available to answer questions after the staff have gone through the training. A toll-free number will be provided for telephone support.
Belleville-Taylor suggests rehab providers who have concerns about the new assessment instrument work with their professional organizations to make sure their views are expressed. "Being involved with an organization is the best way to make an impact. You don't have much effect with input from just one facility," she adds.
[For more on the latest version of the MDS-PAC, contact the American Medical Rehabilitation Providers Association at (888) 346-4624. Its new information line is (888) 802-5712. The fax information number is (888) 632-8023.]
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