Final Report on Assessment Instruments for a Prospective Payment System

Final Report on Assessment Instruments for a Prospective Payment System

Joan L. Buchanan
Patricia Andres
Stephen M. Haley
Susan M. Paddock
David C. Young
Alan Zaslavsky
Copyright Date: 2004
Published by: RAND Corporation
Pages: 130
  • Cite this Item
  • Book Info
    Final Report on Assessment Instruments for a Prospective Payment System
    Book Description:

    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 and this study provides an evaluation of it.

    eISBN: 978-0-8330-5993-2
    Subjects: Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-ii)
  2. Preface
    (pp. iii-iv)
  3. Table of Contents
    (pp. v-vi)
  4. Figures
    (pp. vii-viii)
  5. Tables
    (pp. ix-x)
  6. Summary
    (pp. xi-xx)
  7. Acknowledgments
    (pp. xxi-xxii)
  8. Acronyms
    (pp. xxiii-xxiv)
  9. 1. Introduction
    (pp. 1-6)

    Inpatient rehabilitation was exempted from the Medicare Prospective Payment System (PPS) for hospital payment at its introduction in 1984. Before that time, hospitals were paid by Medicare on the basis of their historical costs, but as costs continued to increase, policymakers sought ways to limit cost growth. A PPS creates an incentive for cost containment by setting case mix adjusted prices in advance and limiting the amount of growth in future prices. The case mix adjusted prices are based on theexpected costsof care for patients in each case mix class rather than on theactual costsof care...

  10. 2. Study Design and Implementation
    (pp. 7-15)

    This section of the report describes the study design, implementation procedures including facility recruitment and selection, and the data collection training and oversight methods.

    This study was designed to address the following questions:

    1. How accurate is the MDS-PAC for use in classifying cases into CMGs for the proposed inpatient rehabilitation prospective payment system?

    2. How do the validity, reliability, and consistency of the FIM and the MDSPAC compare?

    3. What are the time costs associated with data collection on each instrument?

    We use a two-tiered study design. The first tier provides our primary analytic samples, and the second tier...

  11. 3. Translating the MDS-PAC into FIM Motor and Cognitive Scale Items
    (pp. 16-45)

    To understand the implications of substituting the MDS-PAC for the FIM—a method for using information from the MDS-PAC to classify patients into CMGs—the patient classification system for rehabilitation hospitals was needed. The CMG classification system placed patients into a rehabilitation impairment category (e.g., stroke, traumatic brain injury, or spinal cord injury), gave the underlying reason the patient is in a rehabilitation hospital, and then placed the patient into a class within the selected rehabilitation impairment category on the basis of patient age, FIM motor scale score, and FIM cognitive scale score.

    The FIM motor scale score is the...

  12. 4. Conclusions
    (pp. 46-74)

    This section presents some basic characteristics of the two instruments. Our focus is often limited to the items that will be used in the new payment system. The first and perhaps most fundamental piece of information needed is the reason for the admission to inpatient rehabilitation, so we begin by looking at the completeness and quality of these data. Information on form completeness and data entry for other payment items follows. Analyses then compare inter-team rescoring reliability on each instrument. Factor analysis is used to compare whether the MDS-PAC and the FIM are measuring the same concepts and to evaluate...

  13. 5. Accuracy of the MDS-PAC Translation into Pseudo-FIM Items
    (pp. 75-86)

    To evaluate the effect of the new motor item translations, we recomputed scale and item-level means and these are shown in Table 5.1. This was done for both the institutional assessments (~3,200 cases) and the calibration team assessments (~200 cases). The new translations cut the mean motor scale difference in half, reducing it to around 2.4 points for the institutional team comparisons. The scoring difference in the motor scale was smaller for the calibration team comparisons—only one point—and interestingly, in contrast to the institutional teams, the FIM score was larger for the calibration teams. One reason for the...

  14. 6. Mapping Pseudo-FIM Motor and Cognitive Scores into CMGs
    (pp. 87-100)

    In this section, we consider several methods of transforming the pseudo-FIM items and scales (from the translation described in Section 3) to reduce the remaining differences with the actual FIM item and scale scores. To clarify the process, we first provide background information on the structure of CMGs and how they were created. Then, we describe the different transformations that we considered. Next, we use the transformed motor and cognitive scores and compare how often these map into the same case mix group that the actual FIM scores would have mapped into. Since each case mix group has an associated...

  15. References
    (pp. 101-104)
  16. Back Matter
    (pp. 105-105)