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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These appendices accompany a report that evaluates alternative assessment tools for use in a prospective payment system (PPS) for inpatient rehabilitation facilities. They include samples of study forms and instructions; descriptions of measures; recruitment and participation letters; characteristics of participating facilities; sample study newsletters; and sampling protocols. The PPS was designed for use with the Functional Independence Measure. Policymakers hoped to substitute a new, more comprehensive, multipurpose assessment instrument, the Minimum Data Set-Post-Acute Care (MDS-PAC). This study compares the potential effects of this substitution. 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 proposed translation was refined and evaluated. 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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