CMS has proposed changes to the Case-Mix Weights for 2015.  This would mean we would be operating with Case-Mix Weights that were different for the last three years!  We as an industry cannot feel comfortable with the changes in the points scoring mechanism without further information provided and explained in simple, every-day language as opposed to the dry, technical verbiage of a contractor’s analytical report.

Going from 164 scoring variables as it currently is to 121 scoring variables as per the Proposed Rule could be rife with issues that you’re not going to see or have to deal with when all your using to analyze this information is paper, pencils, calculators and computers, but NOT the real-live clients that we have to care for.  We do not want to be overpaid for what we do; but we don’t want to be underpaid either: we just want to be fairly paid, and these changes are rife with issues that could make things worse (we have seen this happen with proposed changes as implemented before). The changes in the scoring variables as noted in the Proposed Rule are as follows:

  • 43 scoring variables are eliminated
  • 56 do increase, whereas
  • 28 do decrease


Is the balance reasonable? Or is it going to make it harder to get to each incremental acuity level, meaning the likelihood of being underpaid for many, if not a majority of episodes becomes the norm? After all, this will be the third year in a row that we have had different Case-Mix Weights!