List of Top 50 Hospitals by Case Mix Index

Case Mix Index (CMI) is a measure used by the Centers for Medicare and Medicaid Services (CMS) to determine funding allocation for Medicare and Medicaid beneficiaries in hospitals and other care facilities. Patients are classified into diagnosis-related groups (DRGs) depending on condition, case complexity, and medical needs. CMS is able to evaluate the resources required to treat patients in each DRG compared to other DRGs and to patients outside a DRG.

Case mix is used to find and adjust the average care cost per patient at a hospital or other care facility based on the patient population demographics. This can have an impact on quality ratings and reimbursement rates, as the weight of each DRG is determined by CMS. As an example, if a hospital’s average cost per patient is $1,000 and its annual CMI is 0.80, the adjusted cost per patient would be $1,250. CMI is a vital indicator of hospital performance because of the way it impacts finances.

However, CMI is dependent on clinical documentation—theoretically, two hospitals with the same caseload could have different CMIs, which is why financial staff at care facilities focus so heavily on proper documentation. This includes medical devices used during a procedure as well as the severity of a patient’s condition.

The following tables list the top 50 hospitals with the largest case mix index. The average CMI of all 50 hospitals is 3.03, though CMIs range from 2.59 to 6.55. CMI does not appear to correlate to the number of annual discharges, with discharges from the top 10 hospitals ranging from 2,357 to 246 annually.

 Top 5 Hospitals By Case Mix Index

HOSPITAL NAME

CASE MIX INDEX

NET PATIENT REVENUE 

# OF DISCHARGES 

Children's Medical Center at Legacy in Plano

6.55

$341,763,847

2,357

Nebraska Spine Hospital

4.01

$56,062,366

1,292

Oklahoma Spine Hospital

 3.63

$63,496,947

2,002

The Heart Hospital Baylor - Plano

3.56

$297,717,483

4,798 

Unity Medical And Surgical Hospital

3.44

$40,614,079

326


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