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Cross-Setting Discharge Function Score for Inpatient Rehabilitation Facilities

CBE ID
4630
Endorsement Status
1.0 New or Maintenance
Is Under Review
Yes
Next Maintenance Cycle
Fall 2024
1.6 Measure Description

This outcome measure estimates the percentage of Inpatient Rehabilitation Facility (IRF) Medicare patient stays that meet or exceed an expected discharge function score. The expected discharge function score is a risk-adjusted estimate that accounts for patient characteristics. The measure includes patients who are 18 years of age or older and the timeframe for the measure is 12 months.

Measure Specs
General Information
1.7 Measure Type
1.7 Composite Measure
No
1.3 Electronic Clinical Quality Measure (eCQM)
1.8 Level of Analysis
1.10 Measure Rationale

Measuring functional status of inpatient rehabilitation facility (IRF) patients can provide valuable information about a IRF’s quality of care. A patient’s functional status may be associated with adverse health outcomes such as falls, fractures, exacerbation of chronic conditions, and a higher risk of readmissions following IRF care. Predictors of poorer recovery in function include greater age, complications after hospital discharge, and residence in a nursing home. Understanding factors associated with poorer functional recovery facilitates the ability to estimate expected functional outcome recovery for patients, based on their personal characteristics.

IRFs can positively impact their patients’ functional outcomes. During a IRF stay, the goals of treatment include fostering the patient’s ability to manage their daily activities so that the patient can complete functional (i.e., self-care and mobility) activities as independently as possible and, if feasible, return to a safe, active and productive life in a community-based setting. 

The Cross-Setting Discharge Function Score (Discharge Function) measure determines how successful each IRF is at achieving or exceeding an expected level of functional ability for its patients at discharge. An expectation for discharge function score is built for each IRF stay by accounting for patient characteristics that impact their functional status. The Cross-Setting Discharge Function for a given IRF is the proportion of that IRF’s stays where a patient’s observed discharge function score meets or exceeds their expected discharge function score. IRFs with low percentage indicate that they are not achieving the functional gains at discharge that are expected based upon patient characteristics and patient status at admission for a larger share of their patients. The measure provides information to IRFs that has the potential to hold providers accountable for functional outcomes and encourages them to improve the quality of care they deliver. This measure also promotes patient wellness, encourages adequate nursing and therapy services to help prevent adverse outcomes (e.g., potentially preventable hospitalization) and increases the transparency of quality of care in the IRF setting. Discharge Function adds value to the IRF QRP function measure portfolio by using specifications that allow for better comparisons across Post-Acute Care  settings, considering both self-care and mobility activities in the function score, and refining the approach to addressing missing activity scores including those coded with activity not attempted codes.

1.20 Types of Data Sources
1.25 Data Source Details

The Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI) data are collected on all Medicare patients who receive services from IRFs More information about the IRF-PAI is available at: https://www.cms.gov/medicare/payment/prospective-payment-systems/inpatient-rehabilitation/pai