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ADL Scores

Providing Measurable Value In CaseMix

How many therapy companies tell you they’ll help you improve your case-mix? How many tell you they’ll help you with ADL training? (Section G isn’t going away if you live in a case-mix state.) How many claim their clients have better reimbursement because of more complete documentation?

The answer is nearly all of us make those claims.

How many rehab companies follow through? How many are will to talk about proof that they follow through?

Let’s look at the data

The following information came from the state of North Carolina.

Broad River Rehab Customers have higher average ADL scores.

Statewide our customers average higher ADL scores. Why? Better documentation: We train our customer CNAs to recognize the work they do and document it appropriately. Our acuity isn’t higher but our percentage of correct documentation is.

We use on-site as well as mobile training to continue to reinforce Section G. Training isn’t an event, it’s a way of life in skilled nursing.


Broad River Rehab Customers have higher than average case-mix.

Proper documentation results in more accuracy. More accuracy in case-mix usually brings higher case-mix. It isn’t complicated but it requires sustained effort and focus.


Broad River Rehab Customers have higher than average Medicaid PPD.

This one should be obvious, but here it is. Our customers average about $10 per patient per day more.


But, correlation does not equal causation!

Right you are. Let’s look at a facility we started serving in Kentucky recently. (I am picking this one for convenience. The North Carolina buildings look the same.)

Case-mix went up.


Pay followed.


In this building, Broad River Rehab was the only change. We’ve seen this happen again and again.

If you think your provider is under-performing or isn’t responsive to your needs, we can talk about strategies to help improve. We can create an action plan to help with case-mix, star ratings, or quality measures. We can also help get you ready for PDPM.

Contact us today!

The ADL Difference

The ADL Difference

Take a look at this: (click to enlarge)

This is data from 2016. At that time, Broad River Rehab was just getting started. We were serving only 8 facilities. But even at this early stage you can see that our customers had significantly higher ADL scores than national averages. We’d effectively moved more than 13% of residents from the A & B end split to the C category. (This is Part A data.)

How did we do that? Obviously we don’t have any impact on the ADLs themselves. The patients didn’t change.

What did change was the understanding of the people who DO the scoring. We visited every facility quarterly and explained to every shift not just HOW to score ADLs but WHAT to look for and perhaps most importantly, WHY it’s important. People need to know not just what to do, but the best way to do it and that their work is important.

We are passionate about what we do and love sharing the knowledge we’ve gained along the way. It’s one of the ways Broad River Rehab is different.

As we continue to grow, we’re looking at ways to bring that knowledge to more people. (You’ll see an important one in early 2019, stay tuned!) One of the ways we’re doing that is through our training software, BRRit. BRRit brings training materials straight to the phones of the people you want to train. It supports images and even videos.

We use BRRit internally to help bring our team up to speed on whatever topic we want. We just finished a series of training modules on PDPM. We not only put the material in front of people more often, but we can easily see what things people understand and where we have opportunities to improve. Perhaps next we’ll focus on the nuances of case-mix by state.

We just completed another roll out of BRRit to a client to help with ADL scoring. It’s part of our commitment to bring some clarity to the complex healthcare environment.

A side benefit of BRRit is that it is fully configurable. You can create any training module you like and have it automatically scheduled, delivered and scored at a frequency that is right for you. We’ll highlight areas where people are struggling and then retest periodically. You choose the frequency and can start and stop or add and remove people at any time you wish. Additionally, you can manage everything from your phone or desktop.

BRRit is great in our ever-changing regulatory environment. Imaging putting your Section GG or PDPM training straight into the hands of just the people that need to know. (Or HIPAA, or blood-borne pathogens, or … you get the idea.)

If you’d like to experience the Broad River Rehab difference and get the benefits of our passion and knowledge, contact us today! (You can also get BRRit.)

Also, if you’d like to test your knowledge of ADL scoring with a free training to your phone, contact us for that too!

Trends in North Carolina Medicaid

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.


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. 


If you'd like to get a custom analysis of your Medicaid or a market analysis, contact us today!

Latest ADL Scoring By State

Latest ADL Scoring By State

The Pepper reports give us a glimpse into trends in Medicaid Part A in skilled nursing facilities. Sometimes you have to do a little summarizing yourself to figure out what you want to know. What I wanted to know was "Which states report the highest ADL scores?" Pepper had the data but it needed a little TLC.

As you can see in the map below (ht Tableau), there is a lot of variation nationwide on ADL scoring. The states with the highest percentage of Medicare Part A patients with high ADL scores follow a path up the Mississippi river and into the northeastern US. The pattern is similar to the "Stroke Belt" data published by the Heart Attack and Stroke Prevention Center.

I added pie chart for each state so you could see the proportion of high (ADL score 11-16), medium (6-10) and low (0-5). The pie charts are sized based on the number of Part A days.