Opportunities for Engaging Long-Term and Post-Acute Care Providers in Health Information Exchange Activities: Exchanging Interoperable Patient Assessment Information. Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI)

12/01/2011

The IRF-PAI is a data collection instrument used to document the effectiveness and efficiency of rehabilitation care. It is used in IRFs and in distinct rehabilitation units of acute care facilities. IRF-PAI was developed for the CMS and is based in large part on the Functional Independence Measure (FIM), a tool comprised of eighteen assessment items related to motor activities and cognitive skills, each item being accompanied by a rating scale of one to seven, designating level of dependence.110 The sum of item scores describes severity of disability and reflects how much assistance is required to complete activities of daily living (ADLs). As severity of disability changes during rehabilitation, FIM® data can be used to track changes and analyze outcomes of treatment. The FIM® tool, by design, includes a minimum number of items. It was originally created to support research and to improve the quality of care in rehabilitation facilities. However, as described in more detail below, in 1995, HCFA entered into a licensing agreement that gave HCFA permission to use the FIM in the IRF-PAI, and for classifying patients into case-mix groups for reimbursing IRFs for Medicare Part A-covered services. Since the scale rates patients according to their need for assistance to perform a particular activity, the need for assistance translates to the time and energy another individual must spend to serve the needs of the functionally-impaired individual.

Admission FIM® scores must be collected during the first three calendar days after admission to an IRF. Scores are based on activities performed during the entire three-day period. The discharge assessment includes activities performed on the day of discharge and two days preceding.

Both admission and discharge IRF-PAI items must be completed before data records are transmitted to the CMS.111 Completion of all items in the IRF-PAI, except the sections for Medical Needs and Quality Indicators, is mandatory. For reimbursement, federal regulations require that patient data be collected within the facility and submitted electronically using the free software (IRVENr) available from the CMS web site. The data collected by CMS are used also to develop an analytical database for monitoring and assessing the implementation of the payment system.

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