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Agent invocation · 5/9/2026, 7:51:44 AM

Which residents have HIPPS PT components below their case mix benchmark?

Latency

20s

Tools

3

Tokens

6,259

Model

claude-opus-4-7

Final response

Residents with PT Components Below Benchmark

Only one resident at CaraDay Demo currently has a PT component in the lower range (A–D):

Evelyn Strickland (ID: 21e38564…) — PT Component: B

  • Age: 88 | Payer: LTC Insurance | Admitted: 2026-01-30
  • Primary Dx: Displaced left femoral neck fracture (S72.002A), closed, initial encounter
  • Current HIPPS: BBADD (PT=B, OT=B, SLP=A, Nursing=D, NTA=D)
  • Risk Level: High

Why a "B" PT looks low for this case mix

A hip fracture admission for post-acute rehab typically benchmarks higher on the PT axis. The PT/OT components in PDPM are driven by clinical category + Section GG functional score. A "B" suggests either a high functional score (less dependency) or potential under-capture of GG self-care/mobility deficits at admission.

What the data actually shows

The HIPPS optimizer didn't flag the PT component itself — it flagged two adjacent documentation gaps that affect Nursing and NTA, both already supported by notes in her record:

  1. Depression not flagged — MD and MSW notes document "depressed mood, tearfulness, and decreased appetite" but no PHQ-9 (D0150) or staff assessment (D0500) was recorded. This impacts the Nursing component.
  2. Wound care not flagged on NTA — RN and MD notes describe a coccygeal pressure injury (1.8 × 1.5 cm) being actively monitored, but no NTA wound flag is set.

Recommended next step

Have the MDS coordinator (1) re-review Evelyn Strickland's Section GG scoring against the admission therapy eval to confirm the PT="B" is accurate for her hip fracture presentation, and (2) complete a PHQ-9 and add the NTA wound flag at the next assessment window — both are already supported by existing clinical documentation.

Would you like me to pull her full chart detail or review residents with low OT or Nursing components next?

Tool chain

  1. 01Facility summaryerror
    181ms
    input
    {
  "facility_id": "caraday-demo"
}
    result preview
    ERROR: Failed query: select "current_status", "primary_payer" from "residents" where "residents"."facility_id" = $1
params: caraday-demo
  2. 02Query residents
    215ms
    input
    {
  "limit": 25,
  "hipps_pt_letter_max": "D"
}
    result preview
    {"facilityId":"2ff057db-734f-4d27-824f-d4cbc864cac8","appliedFilters":{"payer":null,"ptLetterMax":"D","diagnosisPrefix":null,"admittedAfter":null,"riskLevel":null,"limit":25},"matchCount":1,"residents":[{"id":"21e38564-49f8-4546-81e6-a4bf3d468875","firstName":"Evelyn","lastName":"Strickland","primaryPayer":"ltc_insurance","currentStatus":"active","admissionDate":"2026-01-30","age":88,"hippsCode":"BBADD","ptComponent":"B","mdsDate":"2026-02-03","primaryIcd10":"S72.002A","primaryDiagnosis":"Fracture of left femoral neck, displaced, initial encounter for closed fracture","riskSeverity":"high","riskSummary":"Multiple compounding documentation gaps: an unwitnessed fall on 2/8 alongside documented depressed mood, tearfulness, and decreased appetite without a PHQ-9 score, plus a Stage 1 pressure …[truncated 134 chars]
  3. 03Analyze HIPPS optimization
    291ms
    input
    {
  "resident_id": "21e38564-49f8-4546-81e6-a4bf3d468875"
}
    result preview
    {"residentId":"21e38564-49f8-4546-81e6-a4bf3d468875","name":"Evelyn Strickland","currentHipps":"BBADD","components":{"pt":"B","ot":"B","slp":"A","nursing":"D","nta":"D"},"gapCount":2,"gaps":[{"type":"depression_unflagged","field":"pdpmDepression","evidence":["[MD] ... noted by staff and social work to have depressed mood, tearfulness, and decreased appetite since admission. Will continue to mon...","[MSW] ...ness during interview. Will monitor for depressive symptoms and coordinate with interdisciplinary team. Medicare Part A insurance ..."],"suggestion":"Notes describe depressive symptoms but pdpmDepression is false. Score a PHQ-9 (D0150) or staff assessment (D0500) at next MDS to capture for nursing classification."},{"type":"wound_care_unflagged","field":"ntaUlcersExceptStage4 / ntaOpen…[truncated 584 chars]

Audit ID

965306fe-733d-4048-8233-4b08420043d7

Session

demo-session