Question

Homework assignment part 2 of 2 Review the case mix index (CMI) figures in tables 1 and 2, next. Compare the hospital figures to the state average and the peer facilities Table 1-Overall CMI Years 1-3 Facility Year 1 Year 2 Year 3 Hospital A 1.8694 1.9017 2.1473 Hospital EB 1.9662 2.0554 2.0267 Hospital C 1.6440 1.6873 1.7010 HospitalD 1.8454 1.7021 1.6250 State Average 1.4480 1.4778 1.4953

Questions

1. Brainstorm possible explanations for why a facility’s CMI is higher or lower than the state or its peers.

2. What MS-DRGs are included in MDC 08 that could influence changes in CMI?

Answer 1

1. In a hospital the financial department monitors the CMI ( Case Mix Index) and ideally, the hospital should have high CMI as possible. It means that the performance of the hospital is good ie, there are more number of patients admitted in the hospital and hospital receives more money from the patients.

If there is a less CMI, it is a sign of loss of revenue. Even if there is a small change in CMI, it will have a huge effect in bottomline of the hospital. Approximately , 0.10 change in CMI affects with a specific rate of $4500.

In the above given values , hospital A has an increase in CMI every year comparing to the peers and state average and hospital D has a gradual decrease in CMI. It means that hospital A has an increase in inpatient numbers every year, type of inpatient cases are more complicated and they need more care, staff, equipment and medication. Also they has a very effective resources and facilities compared to the peers.

Where as hospital D has a less CMI comparing to peers which means that the hospital is not capturing the complications and comorbidities properly and the utilisation of resources and facilities are less so that there is a less number of inpatient admission. Therefore their revenue is under loss.

2. MS-DRGs included the needed attributes of patients such as :

Severity of illness, organ system loss of function

Risk of mortality, the likelihood of dying

Resource intensity, therapeutic and bed services used in the management of a particular disease.

MSDRG completely revised the CC test and made new CC subclasses. They reduced incentives to the hospitals who are attempting to treat only the healthiest and most profitable patients. It also recognize the severity of illness and resources usage occurred.

Ms DRG also requires :

selection of the principle diagnosis

Major complication or comorbidity( MSS)

Complication or comorbidity (CC)

Procedures coded

Discharge disposition or patient status accuracy

All the significant changes or criterias included by Ms DRG is influencing the CMI to have changes. In order to be adherent to these criterias, the performance of the hospital has to be increased. And thereby increase the CMI.