Case Mix Index (CMI)

I have been watching discussion on CDI-Talk about Case Mix Index (CMI) as well as an article in CDI Strategies, April 16, 2015.
It reminded me that organizations’ finance departments need to look at more than just CMI when predicting the future revenue. I am reminded that CMI is a mathematical formula of the billed DRG averages. Since DRGs are reached with single CC or MCC capturing, it does not provide a holistic view of the patient population being treated. Severity of Illness (SOI) and Risk of Mortality (ROM) are becoming more valued with the growth of population health models and risk modeling. Severity of Illness (SOI) and Risk of Mortality (ROM), which capture all of the secondary conditions associated with the patient’s current hospital stay, will result in a clearer picture of the outcomes being achieved at the organization. In today’s healthcare environment it is key to remember that it’s important to look at the whole picture, and reviewing CMI, CC/MCC capture rate, SOI and ROM, along with the query rate, query response rate and query agree rate are all important markers for a successful CDI program. The bottom line is that a successful CDI program which is holistic and monitors all parameters will provide a positive impact to the bottom line of the organization as well as improved outcomes.

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