Patient Mix, decoded

Where the data comes from

The view is built on the CMS Minimum Data Set (MDS) Facility Frequency Report, a publicly published, quarterly dataset aggregating every resident assessment CMS receives — about 498 MDS items per facility per quarter, broken out by Overall % / Short-Stay % / Long-Stay %. Crucially, this is all-payer: it covers Medicare Advantage, traditional Medicare, Medicaid, and private pay alike. That's a sharper lens for behavioral and memory-care identification than Medicare-only sources, where many of those residents are excluded by definition.

Source dataset: CMS MDS Facility Frequency. SNF Shark ingests the latest published quarter, filters down to ~27 curated items (see below), pivots into one row per facility per quarter, and pre-computes a national benchmark for every column. The card you see on Operating Metrics is reading that one pivoted row.

What we surface (the curated 27)

MDS publishes far more than a financial-diligence persona needs. We curated 27 items across four buckets — chosen because each one either (a) helps classify the facility, or (b) materially changes the underwriting question the user is asking. Items pulled directly via their MDS code prefix:

Age distribution (Section A)

MDS publishes 6 buckets (0–30, 31–64, 65–74, 75–84, 85–95, 96–999); we collapse to four. The under-65 column carries most of the diagnostic weight — paired with elevated schizophrenia coding it's the strongest signal we have that this is a real behavioral / IMD-style facility rather than an over-coded general SNF.

• A0900 Age of resident — 4 buckets: Under 65, 65–74, 75–84, 85+

Cognitive & behavioral diagnoses (Section I, "Yes")

• I4200 Alzheimer's
• I4800 Non-Alzheimer's dementia
• I6000 Schizophrenia (coding caveat — see below)
• I5800 Depression (other than bipolar)
• I5900 Bipolar disorder
• I5700 Anxiety disorder
• I5950 Psychotic disorder (other than schizophrenia)
• I6100 PTSD

Physical comorbidities (Section I, "Yes")

• I0600 Heart Failure (CHF) · I6200 COPD · I2900 Diabetes
• I4500 Stroke / CVA · I5300 Parkinson's · I1500 Renal failure / ESRD

Behavioral indicators (Section E, "presence")

We invert the "Behavior not exhibited" rate to get presence. So "Physical aggression: 12%" means 12% of residents exhibited physical aggression at any frequency during the assessment.

• E0200A Physical aggression · E0200B Verbal aggression
• E0800 Rejection of care · E0900 Wandering
• E0100A Hallucinations · E0100B Delusions

Acuity profile (Section O, "While a Resident")

• O0110K1B Hospice · O0110F1B Mechanical ventilator (invasive)
• O0110J1B Dialysis · O0110H1B IV medications
• O0110E1B Tracheostomy · O0110C1B Oxygen therapy · O0110M1B Isolation / quarantine

The four classifications + thresholds

We compute a single facility-level classification at backfill time and cache it on the row. The pill on the Snapshot tab uses this directly. Thresholds are intentionally conservative — we'd rather under-classify a typical SNF than mislabel one that's slightly above national average.

Precedence when multiple triggers fire: memory-care > behavioral-heavy > high-acuity.

Known caveats & what we excluded

How the "vs X% [STATE]" benchmark is computed

Bars compare the facility's value to its state average rather than national, since patient mix varies more by state than by region (Medicaid policy, IMD rules, and local demographics all matter). National is used as a fallback for very small states where the state row has fewer than 5 reporting facilities.

The average treats CMS-suppressed cells (small cell counts, shown as _ in the source data) as 0, not as missing. Without this adjustment, the "average" for low-incidence items like schizophrenia or mechanical ventilator would silently mean "average among facilities that report a value", which is selection-biased upward — those facilities are exactly the ones with elevated rates. With the adjustment, the benchmark approximates the true population mean: typical facilities (with 0 or suppressed counts) pull the average toward zero, and outliers stand out clearly.

Schizophrenia coding (CMS QSO-23-05-NH)

CMS has flagged schizophrenia as a known noisy MDS item — historically over-coded by some facilities, sometimes to justify antipsychotic use. The 2023 QSO memo (QSO-23-05-NH) introduced stronger audits. We surface the % as-published and flag the bar with a tooltip, but treat very high outliers (e.g. 25%+) as worth investigating rather than taking at face value.

Cell suppression

CMS replaces values with _ when a cell would identify too few residents (small-cell suppression). We treat these as NULL— the bar and the % both render as "—". Facilities where every curated item is suppressed get no MdsFacilityProfile row at all, and the card simply auto-hides. Most of these are very small facilities or new admissions.

Race / ethnicity

MDS publishes a 15-category resident race / ethnicity breakdown. We deliberately don't surface it — the financial-diligence persona isn't asking that question, and adding the columns would invite editorial decisions we'd rather not litigate. If you have a legitimate need for those fields, get in touch and we'll add them with the right framing.

Medications (Section N)

MDS Section N covers antipsychotic / antianxiety / antidepressant / opioid use, and CMS already surfaces antipsychotic % as a star-rating input — see QM 419 on the Clinical Dashboard. To avoid duplication, the Patient Mix card intentionally doesn't double-up on medication frequencies.

Cadence & freshness

CMS publishes MDS Facility Frequency quarterly, with roughly a one-quarter lag. SNF Shark ingests each new release as it drops — see the live freshness tracker on Data sources for the exact "our last refresh" date.