Function-based payment model for inpatient medical rehabilitation: an evaluation

Area of Science:

• Health Services Research
• Rehabilitation Medicine
• Health Economics

Background:

• Prospective payment models are crucial for healthcare resource allocation.
• Diagnosis-related groups (DRGs) have shaped hospital reimbursement, but their application to rehabilitation requires adaptation.
• Current models may not adequately incentivize functional outcome maximization in medical rehabilitation.

Purpose of the Study:

• To outline a function-based prospective payment model for inpatient medical rehabilitation.
• To assess this model against stakeholder needs and objectives.
• To design a quality incentive program to enhance functional outcomes.

Main Methods:

• This study presents a conceptual model, not involving new data collection.
• The model's framework is informed by existing literature on DRGs.
• Evaluation incorporates findings from a prior Delphi survey of rehabilitation stakeholders.

Main Results:

• The proposed model parallels the structure of diagnosis-related groups (DRGs).
• Insights from DRG literature inform the potential impact on medical rehabilitation.
• The conceptual model's alignment with stakeholder perspectives was assessed.

Conclusions:

• A primary limitation of function-based payment models is the lack of inherent incentive for maximizing functional outcomes.
• Integrating a quality of care incentive program is proposed.
• This program involves pooling a proportion of payments for distribution based on achieved, case-mix-adjusted outcomes.