A method to risk-adjust rehabilitation outcomes using functional related groups.

In our rapidly changing and increasingly expensive health care environment, payers, patients, and other consumers are beginning to demand that rehabilitation providers demonstrate their value through outcomes data. Although self-assessment is not new to rehabilitation, the instruments and databases at our disposal generally do not fully adjust for severity of disability, health status, or other factors that may affect outcomes. This paper demonstrates a technique using functional related groups (FRGs) to adjust inpatient length of stay and treatment efficiency to reflect relative risk. This paper describes the application of an analytic method and does not involve hypothesis testing. The method uses a simple hand calculator or spreadsheet software to risk-adjust 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 population; (3) comparing the expected with the actual number of patients in each FRG; (4) adjusting length of stay and length of stay efficiency to reflect these differences. The technique described in this paper can be used by any inpatient rehabilitation providers who collect Functional Independence MeasureSM (FIMSM) data and patient diagnostic and demographic data. It is easily updated on an ongoing basis. Without adjustments for risk, outcomes may mislead providers, payers, and other users of the information, and limited resources may be expended in tracking a problem that does not exist. Even small adjustments for severity may shift perceptions regarding provider efficiency and quality.