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?
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 the case-mix index?
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