Implementation of a complexity classification system for inpatient rehabilitation facilities for financing purposes - comparing scales

In Portugal, there is no formal casemix inpatient rehabilitation classification system. The budget for inpatient rehabilitation facilities within the Portuguese NHS is calculated on a per diem basis, with no relation to the diagnosis and the complexity of the patients treated. However, there is an ongoing pilot project where inpatient episodes are classified according to pathology (using ICD 9 CM), functional limitation group, and motor and cognitive functional independency (using the Functional Independence Measure). In a country where there is no systemized information on the complexity of treated rehabilitation inpatients, such a classification may give important information about the treated patients, enabling more adequate care management and resource utilization. In addition, the aim of this pilot project is to create a specific rehabilitation grouper, where each group has a different price indexed to its complexity. And, as far as rehabilitation care is concerned, it is clear that most of the instruments measuring disability do not accurately reflect the patients' overall clinical conditions. Measuring complexity, especially for financing proposes, is a controversial issue where the use of one instrument instead of another depends on the goal of the financing system. Therefore, the authors compared three different instruments concerning patient classification in rehabilitation inpatient facilities.