What is needed to determine a facility's CMI
What does CMI mean?
CMI MEANS CASEMIX INDEX..
TO GET IT:
DURING THE MONTH OF MARCH, A HEALTHCARE FACILITY SEES 140 TOTAL CASES AND PROVIDES SERVICE WITH A TOTAL VALUE OF 179. WHAT IS THE CASEMIX INDEX FOR THE PERIOD? 179/140=1.27=1.3
To determine a facility's Case Mix Index (CMI), several pieces of information are required. The CMI is a measure used in healthcare to assess the severity and complexity of patients treated in a healthcare facility, such as a hospital or skilled nursing facility. It helps determine the level of reimbursement the facility will receive for their services.
Here are the key elements needed to determine a facility's CMI:
1. Patient Information: The facility must have detailed information about the patients it treats, including their medical diagnoses, procedures performed, length of stay, and other relevant data. This information can be obtained through comprehensive medical records, coding documentation, and other sources.
2. Diagnostic Codes: Accurate and specific diagnostic codes, often referred to as International Classification of Diseases (ICD) codes, are used to classify patients' medical conditions. These codes are standardized and act as the basis for assessing the severity of illnesses and conditions.
3. Procedure Codes: Similarly, procedure codes, such as Current Procedural Terminology (CPT) codes, capture the interventions, treatments, and surgeries performed on patients. These codes enable an understanding of the resources and complexity involved in caring for patients.
4. Case Weight or Relative Weight: Each diagnostic and procedure code is assigned a specific weight known as the case weight or relative weight. This weight represents the average cost or complexity associated with treating a patient with that specific condition or undergoing a particular procedure. Case weights can be obtained from industry-standard software systems like Medicare Severity-Diagnosis Related Groups (MS-DRGs) or other relevant tools.
5. Calculation: Once the case weights for individual patients are determined, the CMI is calculated by dividing the sum of the case weights for all patients treated in the facility by the total number of patients. The resulting CMI provides insight into the facility's patient population's acuity level and complexity.
It is important to note that the specific process of determining CMI may vary slightly depending on the healthcare facility and the payment system being used, such as the Medicare or Medicaid system. However, the general principles outlined above remain consistent across different contexts.