Evaluating the planned substitution of the minimum data set-post acute care for use in the rehabilitation hospital prospective payment system

TitleEvaluating the planned substitution of the minimum data set-post acute care for use in the rehabilitation hospital prospective payment system
Publication TypeJournal Article
Year of Publication2004
AuthorsBuchanan J.L, Andres P.L, Haley S.M, Paddock S.M, Zaslavsky A.M
JournalMedical Care
Date PublishedFeb
Type of ArticleComparative Study<br/>Evaluation Studies<br/>Research Support, Non-U.S. Gov't
ISBN Number0025-7079 (Print)<br/>0025-7079 (Linking)
Accession Number14734953
Keywords*Prospective Payment System, Cross-Sectional Studies, Health Services Research, Humans, Medicare/economics, Prospective Studies, Regression Analysis, Rehabilitation Centers/*economics/utilization, Subacute Care/*classification/*economics, United States

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. RESEARCH DESIGN: We used a prospective cross-sectional design using consecutive sampling. SUBJECTS: 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. MEASUREMENTS AND 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%. CONCLUSION: 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.



Short TitleMedical careMedical care
Alternate JournalMed Care