Inpatient Rehab Facility (IRF) – Part 4: The Functional Independence Measure (FIM)

Established in 2001 as the common instrument to assess rehabilitation patients9, the FIM tool consists of 18 functional assessments (13 motor and 5 cognitive). This non-discipline specific tool is used to objectively measure the type and amount of assistance required for a disabled person to perform basic life activities safely and effectively (i.e. their burden of care). FIM is a seven-level scale ranging from a score of 1 (complete dependence) to a score of 7 (complete independence). A score of zero can be used to indicate that the assessment or particular activity did not occur. CMS requires that the FIM tool is administered over the entire 24 hour period on each of the first three calendar days following the patient’s admission and over a single 24 hour period in one of the last three calendar days prior to discharge. The lowest, or most dependent, score for each of the 18 items is recorded on the IRF-PAI. Some facilities provide on-going FIM assessments to better meet the CMS requirement and to establish a more accurate view of patient progress across the entire length of stay. IRFs must maintain certification to use the FIM instrument. Prior to using the FIM tool, clinicians must pass a FIM mastery exam.

FIM Tool Design

CMS does provide guidelines for collecting FIM data. However, they do not provide a mandatory standardized template. Each facility has the flexibility to design a customized FIM documentation tool. The most basic and expedient FIM tool design allows the clinician to simply type in an appropriate score for each of the 18 items. This FIM model relies heavily on user training and advanced understanding of the FIM assessments. Some facilities use a decision tree structure to guide clinicians through a series of questions arriving at the appropriate score for each item. This approach, while a powerful teaching tool, significantly increases the amount of time needed to complete the assessment.

The Inpatient Rehabilitation Series continues here:

Part 1 – Inpatient Rehab Facility (IRF) – EMR Documentation Design Series Introduction

Part 2 – Pre-Admission Screen

Part 3 - Inpatient Rehabilitation Facility – Patient Assessment Instrument (IRF-PAI)

Part 5 – Interdisciplinary Documentation – Plan of Care & Team Meetings

Part 6 – Physician & Nursing Documentation

Part 7 – PT, OT, SLP, Orthotics/Prosthetics Documentation

Part 8 – Other Services Documentation

Part 9 – The 3 Hour Rule