What is case mix analysis?
Case-mix measurement is a system that measures hospital performance, aiming to reward initiatives that increase efficiency in hospitals. Case-mix also serves as an information tool that allows policy makers to understand the nature and complexity of health care delivery.
How is CMI calculated?
Case mix index is calculated by adding up the relative Medicare Severity Diagnosis Related Group (MS-DRG) weight for each discharge, and dividing that by the total number of Medicare and Medicaid discharges in a given month and year.
What is a case mix system?
Casemix is a term referring to a system that combines information about patients (for example age and race), and the associated medical procedures carried out during their hospitalization, into groups, based on the type and mix of patients (4-6).
How is CMI calculated example?
Total all of the relative weights and divide that number by the total number of individual DRGs. The result is your hospital’s CMI for the calculation period. For example, if your hospital billed 35 DRGs for a one-month period and relative weights totaled 40, the CMI for one month is 0.875, or 35 divided by 40.
Why is case mix important?
CMI is an important performance indicator for your hospital not because it tells a big story in and of itself, but because of how it impacts your hospital’s finances. CMI is a measure of the average severity level of a hospital’s procedures. While the logic may be debatable, the revenue impact on hospitals is not.
Is it better to have a high or low CMI?
The financial department monitors case-mix index (CMI), and in an ideal world, the hospital’s CMI would be as high as possible. A high CMI means the hospital performs big-ticket services and therefore receives more money per patient.
What is considered a good case mix index?
The average CMI of all 25 hospitals is 3.48, though CMIs range from 3.02 to 5.26. This is a shift up from the last reporting period, which ranged from 2.75 to 4.88. CMI does not appear to correlate to the number of annual discharges, with discharges from the top 10 hospitals ranging from 5,531 to 87 annually.
What is a case mix adjustment?
Case-mix adjustment uses statistical models to predict what each hospital’s ratings would have been for a standard patient or population, thereby removing from comparisons the predictable effects of differences in patient characteristics that are consistent across hospitals.
Why is Case Mix important?
What is case mix data?
The Case Mix Index (CMI) is the average relative DRG weight of a hospital’s inpatient discharges, calculated by summing the Medicare Severity-Diagnosis Related Group (MS-DRG) weight for each discharge and dividing the total by the number of discharges.
What is a good case mix score?
How does CMI affect reimbursement?
A higher CMI means more reimbursement dollars for providing care because it indicates that a hospital is treating a sicker patient population. Increasing the CMI hinges on having clinical documentation that accurately reflects the severity level of patients’ conditions.
Is the case mix index tied to hospital charges?
However, CMI is not tied to hospital charges nor the expense associated with caring for each individual patient. It is an average of all Medicare patients within the MS-DRG.
What is the purpose of case mix measurement?
Case-mix measurement is a system that measures hospital performance, aiming to reward initiatives that increase efficiency in hospitals. Case-mix also serves as an information tool that allows policy makers to understand the nature and complexity of health care delivery.
What is the purpose of case mix funding?
Case-mix also serves as an information tool that allows policy makers to understand the nature and complexity of health care delivery. Diagnosis-related groups (DRGs) is the best-known classification system that is used in the case-mix funding model.
How are diagnosis related groups used in case mix?
Diagnosis-related groups (DRGs) is the best-known classification system that is used in the case-mix funding model. It classifies acute inpatient episodes into a number of manageable categories based on clinical condition and resource consumption — the DRG is a group of similar clinical conditions that consume similar amount and type of resources.