Professional Documents
Culture Documents
THE FIM
Functional
Independent
Measure
Part 1
GOALS
Understand what the FIM is & how it is used
Understand FIM terminology
length of stay
Understand differences between admission &
discharge FIM
FIM
Performance-based functional assessments
which take into account the social and
physical contexts of the person
Measurement of functional abilities and
outcomes must relate to real-life situations
and settings
Emphases of rehabilitation programs include
improving the functional status of individuals
through a system of interdisciplinary
interventions
Outcomes are determined by periodic
reassessment of functional changes over
time
FIM Instrument Philosophy
The 18 item (motor & cognitive), 7 level FIM
instrument allows clinicians to measure the
effectiveness of rehabilitation interventions
and to describe the outcomes in a uniform
way, with respect to functional status and
burden of care.
The burden of care represents the amount
of assistance, in hours per day, that is
required to help the patient, once at home, to
perform basic personal care tasks.
This can be translated into financial cost.
Payment by medicare (CMS) and other
insurances is based on the justification that
the burden of care is such that the patient
must be on the rehabilitation unit.
Burden of Care
Refers to the type & amount of assistance
required for a disabled individual to perform
basic life activities effectively
Considers:
Time
Personnel
Assistive devices
Support the Burden of Care!
All disciplines, all environments, 24 hours a
day
Each FIM item MUST be scored every 24
hours
Documentation of the burden of care by
everyone is imperative.
IRF PPS Payment System
IRF PPS Payment
Payment is based on length of stay (LOS)
and case mix groups (CMG)
CMG is a patient classification system which
groups together patients with similar resource
utilization needs
These are determined from admission FIM
data
IRF PPS Payment
Therefore:
Scoring must be an accurate assessment of the
patient’s functional status
Scoring must demonstrate all we do
Admissions FIM - Implications of
Inaccurate or Higher Scoring -
TBI
FIM motor rating of 53.5 with a cognitive
rating of 24 gives LOS of 8 days and $7100
FIM motor rating of 45 with a cognitive rating
of 24 gives LOS of 10 days and $9600
FIM motor rating of 45 with a cognitive rating
of 23 gives LOS of 13 days and $11800
Admissions FIM -Implications
of Inaccurate or Higher
Scoring – LE Fracture