Case-mix adjustments require tighter documentation

Six states currently incorporate case-mix adjustments into their payment formulas for long-term care, and Medicare is likely to follow suit in the near future. Case-mix systems require facilities to keep detailed records on patients' functional abilities, medical conditions, daily progress, and treatment plans. Much of the information required is similar to the data that the Patient Care and Services (PaCS) survey program will collect and evaluate for the new Medicare and Medicaid certification process. Long-term care facilities must establish policies and procedures to accommodate the new requirements. Recommended steps include: Redesign medical record forms so that each patient's functional limitations and medical conditions can be documented. Design care plans so that they identify the patients' disabilities and medical problems, set realistic short- and long-term treatment goals, establish appropriate interventions, and designate the care giver responsible for each intervention. Focus progress notes on problem resolution. Replace medical care evaluation processes with a quality assurance program that determines whether care plans are followed and goals reached.