Using NOMS Data in Inpatient Rehabilitation Settings Like many other facilities providing inpatient rehabilitation services, our speech-language services department at KUMed, a teaching hospital affiliated with the University of Kansas in Kansas City, anxiously awaited the implementation of the Inpatient Rehabilitation Facility Prospective Payment System (IRFPPS). We began to prepare when we believed the Minimum Data Set ... On the Pulse
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On the Pulse  |   May 01, 2003
Using NOMS Data in Inpatient Rehabilitation Settings
Author Notes
  • Jill Georges, is manager of speech-language services at the University of Kansas Medical Center. She teaches a graduate dysphagia class at KUMed and has started a local dysphagia study group.
    Jill Georges, is manager of speech-language services at the University of Kansas Medical Center. She teaches a graduate dysphagia class at KUMed and has started a local dysphagia study group.×
Article Information
Research Issues, Methods & Evidence-Based Practice / On the Pulse
On the Pulse   |   May 01, 2003
Using NOMS Data in Inpatient Rehabilitation Settings
The ASHA Leader, May 2003, Vol. 8, 12. doi:10.1044/leader.OTP.08102003.12
The ASHA Leader, May 2003, Vol. 8, 12. doi:10.1044/leader.OTP.08102003.12
Like many other facilities providing inpatient rehabilitation services, our speech-language services department at KUMed, a teaching hospital affiliated with the University of Kansas in Kansas City, anxiously awaited the implementation of the Inpatient Rehabilitation Facility Prospective Payment System (IRFPPS). We began to prepare when we believed the Minimum Data Set would be the primary measurement tool. We prepared again when we learned that the Functional Independence Measures (FIM) would be the primary tool. And, we revised our plans once more when the Centers for Medicare and Medicaid Services issued the final rule stating that the FIM would be the only functional assessment measurement used to predict patient outcomes and determine resource allocation for Medicare beneficiaries.
Our speech department has always taken pride in providing the highest quality of care to our patients; as such, we were concerned that the FIM, which depends primarily on a patient’s self-help and mobility portions, would minimize the role of speech-language pathology and devalue our services. Specifically, we worried about not being able to provide optimal services on our rehabilitation unit. We also were concerned that fewer patients might be eligible to receive speech-language pathology services as a whole under PPS, and that decreasing lengths of stay might impact our ability to make significant changes in our patient’s communication, cognitive, and swallowing abilities.
Our department has participated in ASHA’s National Outcomes Measurement System (NOMS) for several years. Our hospital has always been receptive to our interest in obtaining outcomes information and comparing our NOMS data with national benchmarks. The clinical staff appreciates that the NOMS scales are functional and provide more information than the FIM in demonstrating a patient’s cognitive communication and/or swallowing abilities. As such, it made sense to volunteer for the NOMS data collection project. By comparing our pre-PPS NOMS data with our post-PPS NOMS data, we could assess the effects of PPS on our inpatient rehab facility and be better prepared for any changes ahead.
Now that we have been practicing under the new PPS rehabilitation guidelines for more than 12 months, we can make some observations about the ways it has and has not changed our practice. According to Sally Brandt, director of rehabilitation services at KUMed, implementation of PPS has not significantly affected the distribution of diagnoses of patients admitted to our rehabilitation unit. Although our sense is that length of stay has reduced, especially for patients whose needs are in the areas of communication and cognition, our results are consistent with the study.
Unlike the study, however, the frequency of our treatment sessions did not increase dramatically. Under PPS, we continue to see most of our patients for two 30-minute sessions per day as we have in the past. Thus, patients who do experience shorter lengths of stay may be receiving fewer treatment sessions and requiring additional speech-language pathology services in other levels of care.
The good news is that our data, like the national data, suggest that our patients continue to demonstrate significant improvement in communication, cognition, and swallowing. As our post-PPS database grows, we will be able to see if this trend holds true, or if, like the study results, our patients make less progress in multiple FCM levels.
As we continute to participate in NOMS, we will be able to use the data to ensure we maintain the highest level of care for our patients. We are currently working with the medical director of our surgical intensive care unit (ICU) to use NOMS to compare outcomes of patients who receive early rehabilitation intervention in the ICU with those of patients who do not receive early intervention. With the initiation of this project, our medical director was impressed by the fact that speech-language services is the only department that already has a system in place to look at these outcomes.
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May 2003
Volume 8, Issue 10