PDPM and Resource Consumption
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School
Black Hawk College *
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Course
156
Subject
Medicine
Date
Dec 6, 2023
Type
Pages
2
Uploaded by BailiffRain12419
1.
Practice with PDPM CMGs
Determine the CMG for the PDPM component discussed in each case presented below.
Use
tables included in chapter 6 to determine the CMG.
Case 1—PT and OT (Table 6.1)
The resident’s clinical category is “Other Orthopedic” and the patient has a function score of 7.
CMG:
Case 2—SLP (Table 6.4)
The resident’s clinical category is “Acute Neurologic.” The resident has a swallowing disorder
and cognitive impairment.
CMG:
Case 3—Nursing (Table 6.5)
The resident has a clinical condition category of “Serious Medical Conditions I.” The resident
has depression and a function score of 12.
CMG:
Case 4—NTA (Table 6.6)
The resident has a NTA socre of 15.
CMG:
2.
Examining Resource Consumption (Level 4—Analyzing)
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?
b.
Review the “Serious Medical Conditions II” rows in table 6.5. How does the function score
impact the case-mix index?
TF
SI
HBC2
NA
Depending on the function score, the severity of depression increases the CMI significantly.
A lower function score increases the CMI, decreasing reimbursement.
A high function score decreases the CMI, increasing reimbursement.
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?
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?
The combination of depression and a lower function score increases the CMI, which
then decreases reimbursement to the facility.
The use of 2 or more restorative nursing services increases the CMI which then decreases
reimbursement to the facility.
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