The Effect of Medicare???s Prospective Payment System on Patient Satisfaction

Parag K. Shah, Allen W. Heinemann, Larry M. Manheim
2007 American Journal of Physical Medicine & Rehabilitation  
Shah PK, Heinemann AW, Manheim LM: The effect of Medicare's prospective payment system on patient satisfaction: an illustration with four rehabilitation hospitals. Am J Phys Med Rehabil 2007;86:169 -175. Objective: To examine the impact of Medicare's Prospective Payment System (PPS) on patient satisfaction at four inpatient rehabilitation hospitals. Design: Prospective study using a satisfaction survey to examine the effects of Medicare's PPS for rehabilitation hospitals. Surveys were conducted
more » ... at four affiliated rehabilitation hospitals in the Midwest. Results : Patient characteristics varied only slightly pre-to post-PPS, and several characteristics were related to overall satisfaction, including motor functional gain, discharge to home, and respondent (patient or proxy). A 12-point increase on a 12-item motor function scale resulted in 1.13 greater odds (95% CI: 1.04, 1.24) of reporting excellent satisfaction. Patient respondents were 1.27 times more likely (95% CI: 1.07, 1.50) than proxies to report excellent satisfaction, and patients discharged home were 1.65 times more likely (95% CI: 1.31, 2.07) to report excellent satisfaction than patients discharged elsewhere. We found an increase in observed satisfaction from 60.3 to 63.4% (P Ͻ 0.05) after PPS implementation, despite a decrease in motor FIM gain. Conclusions: Patient characteristics such as motor FIM gain, discharge status, and respondent type were significantly associated, although only slightly, with patient satisfaction in inpatient rehabilitation. Percentage of excellent satisfaction improved at these four facilities after PPS implementation, despite declines in motor FIM gain. The improvement may be the result of numerous ongoing quality-improvement initiatives directed at improving patient satisfaction at these facilities. ABSTRACT Aybay C, Erkin G, Elhan AH, Sirzai H, Ozel S: ADL assessment of nondisabled Turkish children with the WeeFIM instrument. Am J Phys Med Rehabil 2007; 86:176 -182. Objective: To evaluate the WeeFIM instrument's reliability and internal construct validity for the Turkish child population. Design: License was taken from UDSmr to use the WeeFIM instrument. For the reliability and validity studies of the Turkish translation of the WeeFIM instrument, 573 Turkish nondisabled children were included in the study. The reliability of the instrument was assessed by Cronbach's alpha coefficient, intraclass correlation coefficient (ICC), and test-retest reliability. Internal construct validity was assessed by both using Rasch unidimensional measurement model and testing for differential item functioning for age and gender. Results: Cronbach ␣ value was 0.99 for motor WeeFIM rating and 0.99 for cognitive WeeFIM rating. ICC was 0.81 for motor WeeFIM rating and 0.92 for cognitive WeeFIM rating. The internal construct validity of the Turkish translation of the WeeFIM instrument was confirmed by excellent fit to the Rasch measurement model. Two subscales were found from the principal component analysis of standardized residual correlation for items. Among the items, bowel management, bladder management, eating, and comprehension showed considerable levels of misfit. Conclusions: The Turkish translation of the WeeFIM instrument is valid, reliable, and practical for the Turkish child population. Further studies are required to determine the cross-cultural validity of the instrument.
doi:10.1097/phm.0b013e31802efff7 pmid:17314702 fatcat:os7zwfl24vchndws6xzdbnx6he