Based on the latest data from the state of North Carolina, we can look at trends for Medicaid in skilled nursing in the state. Overall, average case-mix is up significantly, continuing a long term climbing trend. Keep in mind that in North Carolina, if the mean case-mix is increasing while your facility case-mix stays constant, your pay can go down. In other words, if the case-mix at your building is flat, your pay could be going down.
As you probably know, there are two main drivers for case-mix under the 34 grouper: therapy and ADL scores. We’ll take a look at both.
Rehab
After a couple of flat quarters, the percentage of residents in therapy has risen by one percentage point. This would certainly drive the case-mix index up.
ADL Scores
Over this same time period, average ADL scores declined slightly. In North Carolina average ADL scores tend not to move much.
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