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What does case-mix index mean to you?

Case Management Monthly, June 1, 2010

This is an excerpt from a member only article. To read the article in its entirety, please login or subscribe to Case Management Monthly.

To calculate CMI, choose a time period (e.g., one month) to examine. Within that time, take all the DRGs your hospital billed and add up the relative weights (RW). Now, divide that number by the total number of DRGs. What you are left with is your hospital’s CMI for that month.

Finance departments consider CMI when determining the hospital’s budget. If the hospital’s actual CMI is less than what the finance department predicted, the hospital may experience a loss in revenue.

Even seemingly small changes in CMI have a large effect on the hospital’s bottom line. The table on p. 5 shows how a 0.10 change in CMI affects a hospital with a hospital specific rate of $4,500. CMS determines hospital-specific rates based on geographic location and overhead costs, graduate medical education costs, and indigent patients served.

Case management departments can use CMI like a barometer of change within an organization, Lynne Spryszak, RN, CCDS, CPC-A, clinical documentation improvement (CDI) education director at HCPro, Inc., in Marblehead, MA.

If your CMI drops, it could be a sign of change in surgical or medical volumes, for example. Similarly, if your hospital’s CMI is lower than hospitals in your area, it could be a sign that the hospital is not capturing the complications and comorbidities (CC) and major CCs (MCC) that group those accounts into a higher-weighted DRG. 

This is an excerpt from a member only article. To read the article in its entirety, please login or subscribe to Case Management Monthly.

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