Podcast recap: Educate C-suite and staff on nuances, benefits of the case mix index

by A.J. Plunkett

Understanding the nuances and uses of the case mix index (CMI) can seem like a challenge, but once mastered, it can be a helpful tool to both the CDI professional and the C-suite.

Delving into CMI can be intimidating, but it’s really just basic math, said Laurie L. Prescott, RN, MSN, CCDS, CCDS-O, CDIP, CRC, interim ACDIS director and CDI education director for HCPro, during the August 31 episode of the ACDIS Podcast episode.

Each Medicare Severity-Diagnosis Related Group (MS-DRG) has a relative weight, a numeric measure of how complex or how much resource consumption that the DRG is expected to use. CMI is simply an average of the relative weight tied to a specific population or specific patient encounters. This can be what Prescott called “a nice touchstone for your CFO to understand and predict what your payments are going to be.”

It is a versatile metric that has many uses but is misunderstood, added Kim Conner, BSN, CCDS, CCDS-O, CDI education specialist for ACDIS/HCPro, during podcast.

“When I first started in CDI and I learned about case mix index, I was told that the finance of every organization rises and falls on case mix index,” but that is changing, Conner said. “I think as we continue to move forward in more of a value and quality space, case mix is going to become less and less of a driver for finance. […] But it is very versatile, and I think there is a lot of information that can be pulled from it.”

However, since CMI is such a common metric organizations look at, it is even more important for CDI professionals to explain what it is and what it can and can’t be used for, both Prescott and Conner agreed.

Which is why the ACDIS Advisory Board has produced a new white paper to help educate CDI staff and the C-suite, Demystifying and Communicating Case Mix Index. The white paper offers a simple explanation of the CMI formula and samples of uses, and explains how CDI professionals are involved.

Don’t make an assumption that people above you understand CMI, Prescott said, because often they really don’t. And make sure CDI staff understand it as well, added Conner.

“Everybody should be educated about it,” said Prescott. “It’s one metric in a forest of metrics. Look at it within that mosaic of other metrics.”

Editor’s note: This article is a recap of the August 31, 2022, episode of the ACDIS Podcast. Plunkett is an editor with ACDIS’ sister brand, DecisionHealth. To receive updates about new podcast episodes, subscribe to CDI Strategies today!