Case Mix Measure for Medicare Skilled Nursing Facility Patients

摘要

The project studied Medicare patients in skilled nursing facilities (SNFs) and attempted to identify groups of patients, based on patient characteristics, with relatively similar resource utilization. Primary data on patient characteristics, and actual staff time spent caring for individual residents, were collected for 2500 patients in 38 nursing homes with large numbers of Medicare patients in New York, Pennsylvania, Florida, Illinois, and California. The project found that patient care was strongly driven by the care patterns of facilities and regions, and by State norms and regulations. A set of Resource Utilization Groups for title 18 (RUG-T18) was developed which was similar to the RUGs-II system the authors developed for New York State Medicaid. However, the RUG's-II system was modified by adding additional groups to differentiate rehabilitation patients common in the Medicare population. Patients are first classified as either Heavy Rehabilitation, Special Care, Clinically Complex, Severe Behavioral Problems or Reduced Physical Functioning. The Rehabilitation Group is split by the number of therapies (physical, occupational, and speech) they received intensively. These groups, further divided using an Activities of Daily Living score, result in a system which explains 55.5% of the total (nursing plus ancillary) per diem costs of care.