Evaluating the planned substitution of the minimum data set-post acute care for use in the rehabilitation hospital prospective payment system.
OBJECTIVE
The objective of this study was to evaluate the payment implications of substituting the Minimum Data Set-Post Acute Care (MDS-PAC) for the FIM trade mark instrument for use in the planned prospective payment system (PPS) for inpatient rehabilitation hospitals. FIM trade mark is a trademark of the Uniform Data System for Medical Rehabilitation, a division of UB Foundation Activites, Inc.


METHODS
We used a prospective cross-sectional design using consecutive sampling.


METHODS
We studied all Medicare admissions with stays of 3 days or more over a 2-month period to 50 inpatient rehabilitation hospitals in 22 states.


METHODS
Each participating institution completed both the FIM and the MDS-PAC assessments on all participants. Items from the MDS-PAC were combined and translated to create "FIM-like" items. We assessed agreement of classification into prospective payment cells using FIM assessment data and also using MDS-PAC data. Statistical adjustments were applied to improve the level of agreement.


RESULTS
The mean differences between the FIM motor and cognitive scales and their MDS-PAC translations were 2.4 (mean = 45) and 0.0 (mean = 28), respectively, with scale correlations of.85 and.84. Weighted kappas on individual items ranged from.32 to.64. There were substantial hospital-specific differences in scoring. Payment cell classification using FIM data agreed with that using MDS-PAC data only 56% of the time. Twenty percent of the facilities experienced revenue shifts larger than 10%.


CONCLUSIONS
Despite better item-level agreement than previously observed, poor payment cell agreement and substantial revenue shifts indicated that the MDS-PAC should not be substituted for the FIM trade mark instrument in the rehabilitation hospital PPS.
Buchanan
Joan L
JL
Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts 02115, USA. buchanan@hcp.med.harvard.edu
Andres
Patricia L
PL
Haley
Stephen M
SM
Paddock
Susan M
SM
Zaslavsky
Alan M
AM
D003430:Cross-Sectional Studies; D006302:Health Services Research; D006801:Humans; D006278:Medicare / Q000191:economics; D011445:Prospective Payment System; D011446:Prospective Studies; D012044:Regression Analysis; D012047:Rehabilitation Centers / Q000191:economics* / Q000706:statistics & numerical data; D019467:Subacute Care / Q000145:classification* / Q000191:economics*; D014481:United States