An Analysis of FIM Score Rating Difficulties that can Affect Rehabilitation Payments
Categories: Costs and Insurance
Does clinician expertise and the degree of difficulty for rating a Functional Independence Measure (FIM) item explain the clinician’s overconfidence in their FIM rating accuracy?
Past Studies Medicare and Medicaid use a Prospective Payment System (PPS) that is intended to transfer the financial risk to the healthcare provider, instead of the payer. This is accomplished by paying
Clinicians use an assessment called the Functional Independent Measure (FIM) to rate, record, and measure an individual’s ability to perform activities of daily living. The FIM score is based on the clinician’s observation of the individual performing the tasks. Because FIM scores are based on the clinician’s observation and interpretation, it is not a very specific process and there may be variance in the way clinicians score the same individual. It appears that there is a general tendency for health care providers to be overconfident in their ratings, with those with less expertise having a greater tendency to be so. It also appears that when the
This Study included 50 clinicians, including physical therapists, occupational therapists, rehabilitation psychologists, speech pathologists and rehabilitation nurses from three inpatient rehabilitation centers. The participants answered 60 true/false FIM questions. For each question, they completed a scale to test the confidence in the accuracy of their responses. The participants also indicated at which point they would consult a colleague, manual, or flow chart to help them make a decision. This study included expert and novice clinicians, as well as hard and easy questions. The researchers statistically analyzed the results to determine the relationship between clinician accuracy and confidence.
Overall, the clinicians were overconfident in the accuracy of their responses. The clinicians with less expertise were more likely to be overconfident. Clinicians showed less overconfidence for items that were easier to rate on the FIM than for items that were more difficult. The clinicians indicated that they would be most likely to consult a colleague, manual, or flow chart when their confidence for a response was 78.9%. When the clinicians were 78.9% confidence in their responses, their accuracy rating was approximately 65%. When the clinicians reported that they had 100% confidence in their responses, the responses were actually 78.9% correct. The researchers found that items on the FIM pertaining to thinking skills were the most difficult for the clinicians to rate
Who May Be Affected By These Findings
Clinicians, payment specialists, and individuals with traumatic brain injuries
Although the results of this study are similar to former studies, the researchers caution that the results may not be generalizable because they relied on the clinicians’ self-reports instead of observation.
Overall, the clinicians were overconfident in the accuracy of their responses. The clinicians with less expertise were more likely to be overconfident. The clinicians showed less overconfidence for items that were easier to rate on the FIM than for items that were more difficult. The researchers state that these clinicians should receive training to reduce overconfidence or that they should always double-check their ratings with the FIM
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Find This Study
Doctor, J.N., Wolfson, A.M., McKnight, P., & Burns, S.P. (2003). The effect of inaccurate FIM instrument ratings on prospective payments: A study of clinician expertise and FIM rating difficulty as contributing to inaccuracy. Archives of Physical Medicine, 84, 46-50.