Nursing documentation for Part A patients in skilled nursing is important but, roughly 9 times out of 10, it doesn't effect your reimbursement since most residents are in therapy RUGs. Given that, it's at least conceivable that some might choose not to be as rigorous with the nursing part of the documentation.
It's hard to know how often this goes on however because even if you have access to the data files like RESDAC or MedPAR you don't get the entire MDS. With the release of the PDPM proposal, CMS released a provider-specific PDPM estimate. This file takes all 2017 assessments, calculates PDPM and summarizes the results.
As you are probably aware, the PDPM nursing RUG is very similar to the RUG IV 66 Grouper with the therapy RUGs removed. Given that, we can look at the underlying nursing RUGs for the first time.
To look for differences, I grouped the facilities by ownership type. (For Profit, Non Profit, etc.) Next I picked a RUG category that I suspect would reflect differences. I selected Clinically Complex. (Reduced Physical Function is interesting too, but Clinically Complex more clearly illustrates the difference.)
Next I did ANOVA to check for differences. As you can see in the results below, there are more Part A residents in the Clinically Complex nursing category in non profit skilled nursing facilities than for profit facilities. The results are statistically significant.
Click to enlarge
Let me be clear: I am not trying to say why this difference exists. I am merely pointing out the difference. I would love to hear your opinion. Let me know in the comments.