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Written by: Bob Habasevich, PT on Tuesday, December 20, 2011 Posted in: Inpatient Rehab

Ever since CMS mandated the use of FIMu2122 as a methodology requirement to classify patients for payment in IRFs it has become a universal yardstick to describe a patientu2019s functional status in rehabilitation hospitals.  As a metric of rehabilitation effectiveness the FIMu2122 provides valuable information about the patientu2019s status and how it is changing in response to our therapeutic interventions.  FIMu2122 change over the course of hospitalization is routinely used to describe both effectiveness and efficiency of the rehabilitation care process.

While the FIMu2122 instrument was designed to communicate a patientu2019s overall care burden with respect to functional independence in performing 18 standard tasks, its language and item descriptions have been applied to describing a patientu2019s participation in many ADL tasks.  For example, u201cmodified independentu201d is used to describe the patientu2019s ability to feed herself and u201cmaximal assistanceu201d is required to get on or off the toilet and communicate both patient status care expectation to any care giver.

Use of the FIMu2122 item descriptions are common to daily communication of patient participation in ADLs and care requirements, but should not be considered functional assessments simply because these words appear somewhere in a patient chart.  And yet it has become common practice for individuals seeking information to complete the IRF-PAI to search out these words describing patient participation or response to therapy and enter their interpretation as primary assessment data to classify the patient upon admission or discharge.

When asked, how frequently do you FIMu2122 it is common to hear nurses respond, u201cEvery shiftu2014 our aides are trained to capture the true burden of care overnight when the patient is tired.u201d These practices should not be avoided and may add value in describing a patientu2019s attendant needs variation; however, caution should be exercised when interpreting these comments as functional independence assessments.

Analysis of IRF-PAI data gives evidence of trend, suggesting that industry practices of documenting functional status at admission and discharge in an IRF is undergoing some change.  For example, data presented at the AMRPA meeting in September identified that over the past ten years of the IRF PPS program, patient acuity has generally increased as evidence by the average case weight (CMI) over the period, during the same time the average length of stay has decreased slightly.  Literal interpretation would suggest that the Medicare patient population was getting sicker or more impaired but with shorter stays in the hospital.  Now with that being the case, one would expect the sicker patient with shorter time in rehab would demonstrate less improvement, however, average FIMu2122 gain for these patients has increased by almost 20 percent.

Go figure.

Read Part 2 of this topic