Function-based payment model for inpatient medical rehabilitation: an evaluation.
OBJECTIVE
To describe the components of a function-based prospective payment model for inpatient medical rehabilitation that parallels diagnosis-related groups (DRGs), to evaluate this model in relation to stakeholder objectives, and to detail the components of a quality of care incentive program that, when combined with this payment model, creates an incentive for provides to maximize functional outcomes.


METHODS
This article describes a conceptual model, involving no data collection or data synthesis.


RESULTS
The basic payment model described parallels DRGs. Information on the potential impact of this model on medical rehabilitation is gleaned from the literature evaluating the impact of DRGs. The conceptual model described is evaluated against the results of a Delphi Survey of rehabilitation providers, consumers, policymakers, and researchers previously conducted by members of the research team.


CONCLUSIONS
The major shortcoming of a function-based prospective payment model for inpatient medical rehabilitation is that it contains no inherent incentive to maximize functional outcomes. Linkage of reimbursement to outcomes, however, by withholding a fixed proportion of the standard FRG payment amount, placing that amount in a "quality of care" pool, and distributing that pool annually among providers whose predesignated, facility-level, case-mix-adjusted outcomes are attained, may be one strategy for maximizing outcome goals.
Sutton
J P
JP
National Rehabilitation Hospital Research Center, Medlantic Research Institute, Washington, DC 20010, USA.
DeJong
G
G
Wilkerson
D
D
D000203:Activities of Daily Living; D014487:Centers for Medicare and Medicaid Services, U.S.; D003697:Delphi Technique; D003953:Diagnosis-Related Groups / Q000145:classification / Q000191:economics*; D006302:Health Services Research; D006801:Humans; D015271:Insurance Pools; D018803:Models, Economic; D010816:Physician Incentive Plans; D011445:Prospective Payment System / Q000458:organization & administration*; D011785:Quality Assurance, Health Care / Q000191:economics / Q000458:organization & administration*; D012047:Rehabilitation Centers / Q000191:economics* / Q000592:standards; D013659:Tax Equity and Fiscal Responsibility Act; D016896:Treatment Outcome; D014481:United States