Know Your Numbers Part 2 – Case Mix Weights

Yesterday, we listed five questions that agency leadership should know in order to make informed decisions. Today, we want to discuss the first question in greater detail. What is your average Case Mix Weight?

Most software systems have the capability of running reports with this information on it. The problem is that once you get the number, what does it mean?

A case mix weight of 1.0 means that your agency gets exactly the base payment for the patient which is in the neighborhood of $2350.00 these days. Case mix weights below 1.0 means that you are receiving less per patient than the base pay and case mix weights higher than 1.0 pay a lot more. This much is simple.

The real question is whether or not your case mix weight is where it should be. An excessively high average may mean that your agency stands a better chance of scrutiny from our regulatory bodies. A low case mix weight may mean that your agency is under-billing for your patients.

In order to determine if your case mix weight is where it should be, an audit should be done on a significant number of your clinical records. This can be done electronically using a program such as Episode Master by Lewis Computer Services or PPS Plus. If electronic means are not available you can have clinicians pull clinical records and review data for accuracy. If you are using an electronic data, information should be obtained on all records. For agencies dependent on clinical record reviews, ten to twenty percent of patients should be sufficient. This can be part of your QA process.

I possible it is helpful to know the case mix weight of your competitors. If theirs is considerably higher and they are reputable agencies, ask how it is that an agency in your same community with the same patient population and referral sources and health care access can be scoring higher than you. Do your research.

Once you know your number and determine where it should be, it is time to take action. Be aware that with nurses, it may take up to 90 days to establish new patterns. In clinical record reviews look for trends and focus efforts where problems are identified. If coding is an issue, consider hiring a coding company for a brief period of time and compare their professional results with your agency’s results.

Finally, one of the greatest factors influencing case mix weight is episode timing. Agencies with a majority of patients in later episodes will score less than agencies with a fresh supply of patients. The answer is never to discharge patients that need care covered by Medicare but rather to intensify your marketing efforts to increase the percentage of ‘early’ patients in your case mix.

We will continue to explore these numbers in the coming weeks. Your comments are always welcome below and we appreciate your emails at haydelconsulting@bellsouth.net.