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.
a. Review the “Serious Medical Conditions I” rows in table 6.5. How does depression impact the
case-mix index?
The depression increases the case-mix index.
b. Review the “Serious Medical Conditions II” rows in table 6.5. How does the function score
impact the case-mix index?
The lower the CMI, the greater the function score.
c. 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?
Depression with a high function score has a lower CMI. However, since the patient is
dependent on assistance, a low function score leads to a higher CMI.
d. 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?
A higher restorative nursing service makes the CMI higher.
