Cover: Final Report on Assessment Instruments for a Prospective Payment System

Final Report on Assessment Instruments for a Prospective Payment System

Published 2004

by Joan L. Buchanan, Patricia Andres, Stephen M. Haley, Susan M. Paddock, David Young, Alan M. Zaslavsky


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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.

The research described in this report was sponsoredby the Centers for Medicare and Medicaid Services (formerly the Health Care Financing Administration). The research was conducted through a subcontract from RAND to Harvard University and represents a collaborative effort involving faculty from the department of Health Care Policy at Harvard Medical School, Sargent College of Health and Rehabilitation Sciences at Boston University and RAND Health.

This report is part of the RAND monograph report series. The monograph/report was a product of RAND from 1993 to 2003. RAND monograph/reports presented major research findings that addressed the challenges facing the public and private sectors. They included executive summaries, technical documentation, and synthesis pieces.

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