Final Report on Assessment Instruments for a Prospective Payment System

This report discusses a design for a prospective payment system (PPS) for inpatient rehabilitation facilities. Such systems pay providers a predetermined, fixed price (per day, per episode, or per case). Since the payment is independent of the amount of service provided, these systems are thought to create an incentive for efficient, cost-conscious care. A new assessment tool has been developed for PPS for rehabilitation facilities--the Minimum Data Set - Post-Acute Care (MDS-PAC)--and it replaces the former measure--the Functional Independence Measure (FIM). The MDS-PAC is a comprehensive data collection tool, with over 300 items, including sociodemographic information, pre-admission history, advance directives, cognitive and communication patterns, mood and behavior patterns, functional status, bladder/bowel management, diagnoses, medical complexities, pain status, oral/nutritional status, procedures/services, functional prognosis, and resources for discharge. To use the MDS-PAC in the new payment system, researchers needed a way to create a FIM-like motor score and a FIM-like cognitive score. A translation was begun, which took several items from the MDS-PAC and converted them into FIM-like items. By summing the "pseudo-FIM" motor items from the MDS-PAC, a motor scale was created. In the same way, "pseudo-FIM" cognitive items were created and summed to form a cognitive scale. The goal of the report was to determine whether the planned substitution of the MDS-PAC for the FIM in the proposed inpatient rehabilitation hospital prospective payment system would adversely affect system performance, patients, or hospitals.