In the Medicare Skilled Nursing Facility Services Payment System, the case-mix index value represents the level of resource consumption, similar to the relative weight of MS-DRGs in the Medicare Hospital Acute Inpatient Services Payment System. Examine table 6.5 in the textbook. Using the questions below as a guide, analyze the connection between PDPM nursing elements and resource consumption. Note: A higher function score indicates that the resident is more independent (i.e., can perform tasks alone or with some help). A lower function score indicates the resident is dependent on assistance.
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· Review the “Serious Medical Conditions I” rows in table 6.5. How does depression impact the case-mix index?
· Review the “Serious Medical Conditions II” rows in table 6.5. How does the function score impact the case-mix index?
· Review the “Conditions requiring Complex Medical Care” rows in table 6.5. How does the combination of depression and function score impact the case-mix index?
· Examine “Behavioral or Cognitive Symptoms” and “Assistance with Daily Living and General Supervision” rows in table 6.5. How does the use of restorative nursing impact case-mix index?