Use of functional status measures for payment of medical rehabilitation services

In the search for an appropriate payment system for medical rehabilitation hospitals and units, the use of a functional status measure (FSM) has emerged as a recurring theme. Conceptually, functional status measurement is important because the primary goal of medical rehabilitation is to enhance patient function and independence. Studies indicate that functional status and functional gain are among the best predictors of resource utilization at rehabilitation facilities. This article examines conceptually the use of FSMs in payment for medical rehabilitation in two different types of payment systems--as a means of classifying patients for purposes of determining the applicable payment amount (ie, a "classification system"), and as a means of justifying that payment, or continued payment, for services is appropriate (ie, a "justification system"). Several payment models using an FSM are described and analyzed. An agenda for future research is proposed.