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The US Centers for Medicare and Medicaid (CMS) is continuing its trend toward easing administrative burdens and eliminating what it believes may be duplicative quality-reporting activities—this time, by way of a proposed rule for inpatient rehabilitation facility (IRF) payment that would do away with a longstanding functional assessment and 2 outcome measures.

The assessment slated for possible elimination is the Functional Independence Measure (FIM), part of the IRF Patient Assessment Instrument. According to a CMS fact sheet on the proposed rule, data collected through the FIM are being captured in other parts of the assessment instrument. The use of the FIM dates back to 1987; its use would end October 1, 2019.

Also up for possible elimination: measures related to methicillin resistant staph aureus (MRSA) infection and the percent of patients assessed and given the seasonal flu vaccine. CMS describes both measures as ones in which costs of reporting outweigh the benefits. The reporting changes would be implemented October 1, 2018.

Other changes in the proposed rule include:

  • A 0.9% payment increase for FY 2019—about the same percentage increase as in 2018
  • Elimination of reporting requirements related to the rehabilitation physician conducting team meetings remotely
  • Allowance for the postadmission physician evaluation to count as one of the required face-to-face physician visits
  • Removal of requirements for admission order documentation—but not the requirement for admission orders themselves

Also included in the proposed rule is a general call for feedback on several topics, including ideas for achieving better electronic sharing of data between providers, the possibility of allowing the rehabilitation physician to determine whether a particular patient assessment could be conducted remotely, the training of nonphysician providers relevant to IRFs, and ways that nonphysician IRF provider roles could be expanded.

APTA will submit comments on the proposed rule by the June 26 deadline.


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