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No Functional Abilities Crosswalk

Written by: Dennis Stevenson Jr., MBA on Monday, March 7, 2016 Posted in: Acute Care Rehab, Inpatient Rehab

A simple bridge between FIM™ and IRF-PAI Section GG does not exist

As part of the massive expansion of the IRF-PAI for 2017, CMS introduced Section GG, a duplicative Functional Abilities and Goals section, to the tool. This section seemingly replicates the assessment and scoring of many of the FIM™ items. Since the release of the IRF-PAI 1.4 manual, providers have been asking, “Can I crosswalk from my FIM™ scores to the Section GG items?”

Sadly, the answer is NO.

Some might point out that there seems to be a natural mapping between the 7-point FIM™ scale to the 6-point functional abilities scale. This is true in a technical or mathematical sense, but focusing on the math fails to account for the more foundational fact that the two assessments are measuring completely different things.

The FIM™ is used for individual facility reimbursement calculations to measure the burden of care required by the patient and to compensate the provider for that burden. As such, the FIM™ scoring instructions specify that the practitioner should capture the full burden of care by recording the lowest score actually observed during the assessment period.

The FIM rating should reflect the lowest functional score from treating disciplines during the assessment time frame. (IRF-PAI Training Manual, Section 3, page 2)

By contrast, the new Functional Abilities and Goals in Section GG have a different purpose. They will be used for the purposes of comparing facilities – specifically comparing different settings for their rehabilitation cost effectiveness. It has no participation in the reimbursement process. To this end, practitioners are instructed to record a typical score that represents the patient’s functional ability over the assessment period.

Record the patient’s usual ability to perform self care, indoor mobility (ambulation), stair and functional cognition prior to the current illness, exacerbation, or injury.
(IRF-PAI Training Manual, Section GG, page GG-2)

It may be tempting to crosswalk patient’s FIM™ scores into their Functional Abilities and Goals. However, taking this approach is a deviation from CMS’ direct instruction and a misuse of the IRF-PAI instrument.

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