Feds Choose Assessment Survey Developed at UB as Basis for New Payment System for Medical Rehabilitation

BUFFALO, N.Y. -- The federal agency responsible for setting medical reimbursement policy for Medicaid and Medicare programs has designated an assessment survey developed at the University at Buffalo 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 FIMTM 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, M.D., professor and chair of UB's Department of Rehabilitation Medicine and one of the developers of the FIMTM 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 FIMTM instrument. Everyone wants to talk to us. It's an affirmation of the work that has been accomplished at UB."

Michael E. Bernardino, M.D., UB 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 FIMTM instrument for their accomplishments and the national attention they have brought to the university.

"The selection of the FIMTM 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 FIMTM 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 FIMTM instrument was developed at UB 15 years ago through a three-year grant to UB 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 U.S. currently use the FIMTM 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 four million records, comprising the largest database of medical rehabilitation treatment outcomes in the world.

The FIMTM instrument has been translated into five languages and currently is used in Australia, Canada, Hong Kong, Japan, Finland and Sweden.