FUNCTION-BASED PAYMENT MODEL FOR INPATIENT MEDICAL REHABILITATION - AN EVALUATION

Objective: To describe the components of a function-based prospective payment model for inpatient medical rehabilitation that parallels diag nosis-related groups (DRGs), to evaluate this model in relation to sta keholder objectives, and to detail the components of a quality of care incentive program that, when combined with this payment model, create s an incentive for providers to maximize functional outcomes. Data Sou rces: This article describes a conceptual model, involving no data col lection or data synthesis. Data Synthesis: The basic payment model des cribed parallels DRGs. Information on the potential impact of this mod el on medical rehabilitation is gleaned from the literature evaluating the impact of DRGs. The conceptual model described is evaluated again st the results of a Delphi Survey of rehabilitation providers, consume rs, policymakers, and researchers previously conducted by members of t he research team. Conclusions: The major shortcoming of a function-bas ed prospective payment model for inpatient medical rehabilitation is t hat it contains no inherent incentive to maximize functional outcomes. Linkage of reimbursement to outcomes, however, by withholding a fixed proportion of the standard FRG payment amount, placing that amount in a ''quality of care'' pool, and distributing that pool annually among providers whose predesignated, facility-level, case-mix-adjusted outc omes are attained, may be one strategy for maximizing outcome goals. ( C) 1996 by the American Congress of Rehabilitation Medicine and the Am erican Academy of Physical Medicine and Rehabilitation