Tip: Look for more than CMI improvement from your program metrics

Too many organizations measure the effectiveness of their CDI program solely by an increase in Medicare case-mix index (CMI). This perspective is faulty for many reasons, but primarily because CMS frowns upon it. CMS views this practice as a strategy to increase payments for Medicare patients only—which will certainly grab the attention of the Office of Inspector General.

 

CMI is a measure of who walks through the door, and, on a daily, weekly, or monthly basis, physicians in your hospital treat a different mix of patients. For example, if your heart surgeon takes a vacation, your CMI will drop. If a physician performs three tracheostomies one month and not the next, your overall CMI will fall.

 

The best way to evaluate your CDI program’s statistical success is through a true severity-adjusted system—one in which analysis of the ICD-9-CM codes and patient risk demographics factor into the determination of severity of illness or risk of mortality.

 

Editor’s Note: This article was excerpted from “Avoid the CMI trap: Measure your CDI program using severity-adjusted data” published in the December 2009 issue of the CDI Journal. Dr. Gold is founder of DCBA, Inc., in Atlanta, a consulting firm that provides physician-to-physician programs in CDI. Contact him at 770/216-9691 or by e-mail at DCBAInc@cs.com.