Average National Case Mix Weight Decreases

The national average case mix weight (CMW) in 2016 decreased to 1.0384, according to data compiled by Northampton, Massachusetts-based home health and hospice consulting firm Fazzi Associates.

This data was compiled by Fazzi’s analysis of Medicare home health claims for non low utilization payment adjustment (non-LUPA) episodes. The overall decrease in the national average CMW marked a -0.7% reduction from 2014, where the national average CMW sat at 1.0458.

CMW is a measure of the acuity or health condition of the patient, and is an overall scoring system derived from a home health agency’s Outcome and Assessment Information Set (OASIS), according to Lynn Harlow, partner and director of development at Fazzi.


“It’s a scoring that they get from the OASIS assessment and if that comes to 1 then they get the episode payment rate,” said Harlow. “If it comes to 1.2, they get the episode payment rate 1.2 times.”

If the CMW is decreasing, not only does it indicate the acuity of the patient, but it also affects how a home health agency is going to be reimbursed by the Centers for Medicare & Medicaid Services (CMS), added Eileen Freitag, MBA, partner and director of strategic consulting division at Fazzi.

“If the base rate stays the same and your multiplier goes down, then [the care provider is] going to get less money,” said Freitag.


In total, 23 states saw a decrease in CMW from 2014 to 2016, while 29 saw an increase; two states saw no changes in average CMW.

Chart by Fazzi

In their analysis of 2016 numbers, Fazzi reported that Minnesota saw the largest increase in average CMW, up 5.0%, followed by North Dakota (4.5%) and Washington (3.9%).

Guam saw the largest decrease (-4.9), followed by Florida (-4.3%), Utah (-3.4%) and New Mexico (-3.3%), according to Fazzi.

Mississippi and Missouri saw no changes in their average CMW.

The five states that had the lowest average CMW in 2016 were California (0.957); Louisiana (0.946); Texas (0.952);  Oklahoma (0.931); and Guam (0.904).

On the flip side, the five states with the highest average CMW in 2016 included Florida (1.159); Idaho (1.189); Utah (1.105); West Virginia (1.141); Colorado (1.150); and Washington (1.150).

Written by Carlo Calma