Paiement prospectif en soins post-aigu aux USA
Les PPS à l'activité ("fee-for-service") ont été mis progressivement en place, en 1998 pour les Skill Nurse Facilities (SNF) et 2002 pour les Inpatient Rehabilitation Facilities (IRF) l'ordre chronologique des articles retrace l'histoire de leur mise en oeuvre et des débats associés.

1994 - A case-mix classification system for medical rehabilitation, 1994, vol. 32, n° 4. - p. 366-379 Auteur(s) : Stineman, Margaret G. ; Escarce, J.J. ; Goin, J.E. ; Hamilton, B.B. ; Granger, C.V. ; Williams, S.V.
Résumé : Dissatisfaction with Medicare's current system of paying for rehabilitation care has led to proposals for a rehabilitation prospective payment system, but first a classification system for rehabilitation patients must be created. Data for 36,980 patients admitted to and discharged from 125 rehabilitation facilities between January 1, 1990, and April 19, 1991, were provided by the Uniform Data System for Medical Rehabilitation. Classification rules were formed using clinical judgment and a recursive partitioning algorithm. The Functional Independence Measure version of the Function Related Groups (FIM-FRGs) uses four predictor variables: diagnosis leading to disability, admission scores for motor and cognitive functional status subscales as measured by the Functional Independence Measure, and patient age. The system contains 53 FRGs and explains 31.3% of the variance in the natural logarithm length of stay for patients in a validation sample. The FIM-FRG classification system is conceptually simple and stable when tested on a validation sample. The classification system contains a manageable number of groups, and may represent a solution to the problem of classifying medical rehabilitation patients for payment, facility planning, and research on the outcomes, quality, and cost of rehabilitation.

Voici une réflexion de Carl Granger en 1997 avant la mise en place des PPS en soins post-aigus, bien connu pour la Mesure de l'Indépendance Fonctionnelle, moins connu pour ses écrits sur les systèmes de tarification.
Cela semble bien répondre à notre problématique française des programmes de réadaptation intensive et multidiciplinaire.

1997 - A modular case-mix classification system for medical rehabilitation illustrated - Innovations in Fee-For-Service Financing and Delivery  by Margaret G. Stineman, Carl V. Granger
http://findarticles.com/p/articles/mi_m0795/is_n1_v19/ai_20750871/?tag=mantle_skin;content

Conclusion:
"There is some overlap in the types of patients treated by inpatient rehabilitation facilities and SNFs (Kramer et al., 1997). One option in dealing with that overlap would be to determine the feasibility of modifying FRGs to include all patients receiving restorative-level rehabilitation within the full postacute continuum, regardless of setting. Such an approach to quality monitoring and payment could enhance continuity of care and discourage unnecessary shifts of patients across settings. All patients admitted to distinct-part units and rehabilitation hospitals would receive level-one rehabilitation, which, by definition, is high-intensity and restorative. In SNFs where service intensity varies and the clinical attributes and needs of populations are more heterogeneous, the overwhelming challenge would be distinguishing persons prospectively who have the potential for restorative rehabilitation from the larger group of nursing home residents who need either long-term care or a short convalescence. Like acute medical management, functional restoration requires intensive rehabilitation that is costly but time-limited and episodic. In contrast, long-term care requires an ongoing but lower daily investment of therapy and care-giving services. Among those with the capacity for functional restoration, an episodic payment approach such as an FRG-based PPS would tend to encourage timely discharge from the SNF to the community. In contrast, a per diem rate adjusted for severity of disability may provide financial incentives to maintain residents in their most dependent state. Although a unified payment system has appeal, its development presents challenges. One approach might combine elements of an episode-based system for short-term restorative-level rehabilitation patients within a larger per diem-based scheme."

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2007 - Proposals for Improved Payment Systems
http://www.nrhi.org/proposals.html

2007 - The State-of-the-Science: Challenges in Designing Postacute Care Payment Policy
http://www.sciencedirect.com/science/article/pii/S0003999307004455
2007 The impact of the inpatient rehabilitation facility prospective payment system on stroke program outcomes.Am J Phys Med Rehabil. 2007 May;86(5):356-63. Gillen R, Tennen H, McKee T.
"Patients admitted after implementation of the IRF PPS had shorter LOS but made less progress, had lower functional levels at discharge, and had higher rates of institutional discharge."

2008 - Rehabilitation facilities (Inpatient) payment system (Description du système de paiement pour les structures de réadaptation intensives - IRF - aux USA)
http://www.medpac.gov/documents/MedPAC_Payment_Basics_08_IRF.pdf

2008 - Early Effects of the Prospective Payment System on Inpatient Rehabilitation Hospital Performance. Michael J. McCue, DBA, Jon M. Thompson, PhD
http://www.archives-pmr.org/article/S0003-9993(05)01380-8/abstract

2008 Medicare's new restrictions on rehabilitation admissions: impact on the elderly. (Cet article décrit les effets de la règle des 60%)
http://journals.lww.com/ajpmr/pages/articleviewer.aspx?year=2008&issue=11000&article=00002&type=abstract
http://linkinghub.elsevier.com/retrieve/pii/S0003999397904299


2008 - A Patient-Centered Vision for Post-Acute Care ReformBy: Cherilyn G. Murer, JD, CRA
(cet article évoque les problèmes liés à la fragmentation des financements et à l'intégration des continuums de soins. Un système uniforme d'évaluation dans tout le secteur post-aigu est préconisé pour le CMS - Center for Medicare & Medicaid services, dans le PAC-PRD - Post-Acute Care Payment Reform Demonstration)