Stineman Margaret G
Department of Rehabilitation Medicine, the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA 19104, USA.
Arch Phys Med Rehabil. 2002 Dec;83(12):1802-5. doi: 10.1053/apmr.2002.36067.
The Centers for Medicare and Medicaid Services has implemented an inpatient rehabilitation facility prospective payment system (IRF-PPS) based on case-mix groups (CMGs). The CMGs, now almost identical in structure to the Functional Independence Measure-Function-Related Groups (FIM-FRGs), will measure patients' functional severity by the FIM trade mark instrument, rather than by the Minimum Data Set for Post-Acute Care, as was initially planned. Although this late change in plans is a major triumph for physical medicine and rehabilitation and for the patients we serve, economic incentives inherent in the IRF-PPS may still transform inpatient rehabilitation as it is currently practiced in the United States. This commentary compares the CMGs with the FIM-FRGs; addresses the implications of the CMGs' implementation for patients, researchers, and clinicians; and highlights ways of adapting previous FIM-FRG applications and research to help meet the challenges presented by the new IRF-PPS.
医疗保险和医疗补助服务中心已经实施了基于病例组合分组（CMG）的住院康复机构前瞻性支付系统（IRF-PPS）。CMG目前在结构上几乎与功能独立性测量-功能相关分组（FIM-FRG）相同，将通过FIM商标工具来衡量患者的功能严重程度，而不是像最初计划的那样通过急性后期护理的最小数据集来衡量。尽管这一计划的后期变更对物理医学与康复以及我们所服务的患者来说是一个重大胜利，但IRF-PPS所固有的经济激励措施仍可能改变美国目前实行的住院康复模式。本评论将CMG与FIM-FRG进行了比较；探讨了CMG实施对患者、研究人员和临床医生的影响；并强调了调整先前FIM-FRG应用和研究的方法，以帮助应对新的IRF-PPS带来的挑战。
