Fair hours (case-mix)

Why raw hours get adjusted for how sick the residents are.

The hook

#🍼 The babysitter test

Two sitters work the same hours: one watches three calm ten-year-olds, the other three infants. Same hours, wildly different difficulty. Judging them on raw hours alone isn’t fair — you first ask "how hard were the kids?"

#The real idea

Sicker residents need more care, so CMS case-mix adjusts reported hours before scoring. Facilities report raw hours through PBJ; CMS then adjusts using PDPM nursing categories (the value is called "case-mix hours," formerly "expected hours") to reflect acuity measured from each resident’s MDS assessment. Higher acuity raises the bar, so the same raw hours convert to a lower adjusted HPRD — and it’s the adjusted number that gets looked up in the points table.

#🍁 Maple Grove example

Raw ÷ adjusted = how much harder

Suppose Maple Grove’s raw total hours imply 3.30 adjusted HPRD after case-mix. The "how much harder than average" spotting trick is raw ÷ adjusted:

if raw 3.96 ÷ adjusted 3.30 = 1.2  → residents ~20% harder than average

The bigger the acuity, the more the raw number gets discounted before scoring.

#Remember this

Facilities report raw hours; CMS scores the case-mix-adjusted hours. Acuity up → adjusted HPRD down → harder to clear a lane.

#Try it 👉

Check yourself — answers reveal on submit.

A home’s raw HPRD is 3.6 and its adjusted is 3.0. How much "harder" than average are its residents?