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

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Study investigated whether clinician expertise and Functional Independence Measure (FIM) instrument rating difficulty contribute to clinician overconfidence in the assessment of patient functional status. Accurate assessment of functional status is crucial for proper case-mix group classification under Medicare's prospective payment system. Fifty medical rehabilitation professionals answered 60 true/false questions that paired a functional description with a numeric FIM code. Participants also completed a 6-category scale to assess confidence in the accuracy of their responses. Experts and novices, as well as hard and easy judgment tasks, were identified through Rasch analysis. Results indicate that clinicians were less overconfident and more accurate when they had more expertise. Also, participants were more overconfident for hard tasks than for easy tasks.

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