The federal agency responsible for setting medical reimbursement policy
for Medicaid and Medicare programs has designated an assessment survey
developed at UB as the national standard for determining payment for
inpatient medical rehabilitation.
The federal Centers for Medicare and Medicaid Services (CMS), formerly
called the Health Care Financing Administration, has elected to use
UB's Functional Independence Measure, or FIM instrument, on which
to base its new system of prospective payment for rehabilitation treatment
provided in hospitals.
In the past, rehabilitation hospitals have been reimbursed based on
a facility-specific rate per discharge, regardless of the number of
days a patient remained in the hospital and the level of care the patient
required. Under the new system, payment will be linked to the severity
of each patient's disability when admitted.
"This is a totally new approach," said Carl Granger, professor and
chair of the UB Department of Rehabilitation Medicine and one of the
developers of the FIM instrument. "It will change rehabilitation care
as we all know it."
For rehabilitation hospitals, the new system means more equitable
payment for facilities that take the most severe cases. For UB, the
ruling brings additional international recognition for its work in rehabilitation
science.
"We are now seen as the experts," said Granger. "Our phone has been
ringing off the hook since April, when it appeared the new system would
be based on the FIM instrument. Everyone wants to talk to us. It's
an affirmation of the work that has been accomplished at UB."
Michael E. Bernardino, vice president of health affairs and dean of
the School of Medicine and Biomedical Sciences, praised Granger and
others who have worked on development of the FIM instrument for their
accomplishments and the national atttention they have brought to the
university.
"The selection of the FIM by CMS is a testament to the many years
of hard work by Dr. Granger and his group," Bernardino said. "We all
take pride in their accomplishment."
The new payment system is expected to take effect early in 2002.
The FIM instrument is an easy-to-use assessment tool that allows
trained personnel to assign a numerical value—the FIM rating—to a patient's
ability to function, based on performance of 18 physical and mental
tasks that represent a basic daily routine of personal-care activities.
The FIM instrument was developed at UB 15 years ago through a three-year
grant to researchers in rehabilitation medicine from the National Institute
for Disability and Rehabilitation Research. Their mandate was to develop
a standard for documenting the level of disability and outcomes of medical
rehabilitation.
The effort was spurred by Medicare's decision in 1983 to use diagnosis-related
groups (DRGs) as the basis for reimbursement for care provided in acute
care hospitals. DRG reimbursement was not appropriate for payment for
rehabilitation, however, because patients are treated based on level
of disability as well as on diagnosis. Lacking a federally accepted
standard comparable to those used by acute-care hospitals, rehabilitation
facilities in the past have been reimbursed for care based on an allowance
per case, regardless of the time and resources expended, Granger noted.
Approximately 80 percent of the 1,100 acute-care inpatient medical
rehabilitation facilities in the United States currently use the FIM
instrument to establish a baseline of functional limitations for each
patient and to evaluate outcomes of care. These facilities also contract
with UB's Uniform Data System for Medical Rehabilitation (UDSMR) unit
to provide periodic performance reports and benchmarking studies. As
a result, UDSMR now houses 4 million records, comprising the largest
database of medical rehabilitation treatment outcomes in the world.
The FIM instrument has been translated into five languages and is
used in Australia, Canada, Hong Kong, Japan, Finland and Sweden.