The effect of inaccurate FIM instrument ratings on prospective payment: a study of clinician expertise and FIM rating difficulty as contributing to inaccuracy.

Abstract

To test whether clinician expertise and FIM instrument rating difficulty explain clinician overconfidence in FIM rating accuracy. Participants answered 60 true/false FIM questions and, for each question, completed a 6-category scale to assess confidence in the accuracy of their responses. Experts and novices, as well as hard and easy items, were identified through a Rasch analysis. The relation between confidence and accuracy was examined for these different groups. Three urban medical centers. Fifty medical rehabilitation professionals, including physical therapists, occupational therapists, rehabilitation psychologists, speech pathologists, and rehabilitation nurses. Not applicable. Observed proportion of correct responses to 60 true/false questions and responses from the 6-category confidence scale. The amount of overconfidence was mediated by the difficulty of the FIM task and the level of expertise of the clinical judge. Decreasing the level of overconfidence in FIM scoring is a promising avenue for improving the accuracy of functional assessment. Accurate assessment of functional status for case-mix group classification will be of even greater importance under the recently initiated Medicare prospective payment system.