A METHOD TO RISK-ADJUST REHABILITATION OUTCOMES USING FUNCTIONAL RELATED GROUPS

In our rapidly changing and increasingly expensive health cave environ ment, payers, patients, and other consumers are beginning to demand th at rehabilitation providers demonstrate their value through outcomes d ata. Although self-assessment is not new to rehabilitation, the instru ments and databases at our disposal generally do not fully adjust for severity of disability, health status, or other factors that may affec t outcomes. This paper demonstrates a technique using functional relat ed groups (FRGs) to adjust inpatient length of stay and treatment effi ciency to reflect relative risk. This paper describes the application of an analytic method and does not involve hypothesis testing. The met hod uses a simple hand calculator or spreadsheet software to risk-adju st outcomes using FRGs. Steps in the analysis consist of the following : (1) determining FRG categorization for each patient; (2) estimating the expected number of patients in each FRG, given total provider popu lation; (3) comparing the expected with the actual number of patients in each FRG; (4) adjusting length of stay and length of stay efficienc y to reflect these differences. The technique described in this paper can be used by any inpatient rehabilitation providers who collect Func tional Independence Measure(SM) (FIMSM) data and patient diagnostic an d demographic data. It is easily updated on an ongoing basis. Without adjustments for risk, outcomes may mislead providers, payers, and othe r users of the information, and limited resources may be expended in t racking a problem that does not exist. Even small adjustments for seve rity may shift perceptions regarding provider efficiency and quality.