Clinicians focused on solving patient problems must pay close attention to the resource costs involved. Improving mobility is a prime example of how the best solution may not be possible when a payor states unequivocally that a powered, stair climbing, auto reclining, elevating, self leveling, all-terrain wheelchair that provides a patient with the independent mobility needed to visit Machu Picchu, simply isn’t covered. However, less obvious are the considerations of costs involved with caring for an elderly patient who has lost the ability to get in or out of bed because of mobility impairments. Clearly, assistance is necessary to perform this task, along with all the other tasks required to get through the day. This functional assistance requirement has a cost, regardless of the setting where the patient is currently sleeping and varies with any changes in functional impairment status.
CMS is fully aware of these costs and builds into its prospective payment system a resource requirement payment which varies with a patient’s functional ability. Simply put, the higher a patient’s function the lower the payment available to care for that patient. For the past nine years, Medicare has been collecting function status scores for every patient admitted and discharged to/from an inpatient rehabilitation hospital. It is simple to calculate the change in functional ratings by subtracting where a patient began at admission from where a patient ended at discharge. We often refer to this as FIM™ change. And while this has evolved as a common descriptor for change in patient status, it fails to consider the economic value of that change and ignores the cost effectiveness of producing it. As providers, and a society, we must concentrate on reducing the residual disability costs of patients. For inpatient rehabilitation hospitals, the ability to estimate and track each patient’s care cost burden and manage required resources accordingly, is the management paradigm for tomorrow’s success.
Soon the rehabilitation industry will begin reporting quality indicators to compare providers. It is reasonable to assume that someone will consider the quality of inpatient rehabilitation care directly related to the reduction in care cost burden resulting from that patients rehab length of stay. These initiatives are born in the CMS recently released Value-Based Purchasing Incentive Plan. Rehabilitation Hospitals do not currently report quality measures to CMS and therefore are outside the hospital’s value-based purchasing plan. However, rehabilitation providers should not be complacent with this calm before the storm. Post Acute Care Rehabilitation Providers will soon recognize that their skill and discipline in measuring and quantifying patient status along with the requirement to report care delivery performance metrics will determine payment. Quality outcomes will be defined not only in terms of effectiveness but also efficiency as well.