The story of function-related groups--please, first do no harm

Area of Science:

• Health Services Research
• Rehabilitation Medicine
• Health Economics

Background:

• The Health Care Financing Administration (HCFA) proposed a new prospective payment system for inpatient rehabilitation.
• This system aims to classify patients into case-mix groups (CMGs) for payment scaling.
• The proposed CMGs are modeled after existing systems but will be derived from the Minimum Data Set for Post-Acute Care (MDS-PAC).

Purpose of the Study:

• To evaluate the proposed shift to the Minimum Data Set for Post-Acute Care (MDS-PAC) for classifying patients in rehabilitation.
• To assess the potential impacts of this shift on patient need assessment, service access, and payment equity.

Main Methods:

• Analysis of the proposed prospective payment system by the Health Care Financing Administration (HCFA).
• Review of the proposed derivation of case-mix groups (CMGs) from the Minimum Data Set for Post-Acute Care (MDS-PAC).
• Assessment of the scientific evidence supporting the use of MDS-PAC for this classification.

Main Results:

• The proposed system relies on the Minimum Data Set for Post-Acute Care (MDS-PAC) for case-mix classification.
• There is limited scientific evidence supporting the use of MDS-PAC for this specific application.
• The proposed system may negatively affect patient need expression and service access.

Conclusions:

• The proposed prospective payment system's reliance on MDS-PAC lacks sufficient scientific validation.
• This shift may compromise the accuracy of patient need assessment in rehabilitation settings.
• Potential negative impacts on service accessibility and payment equity warrant further investigation.