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Case Mix Index (CMI) is 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.

Hospital case mix index calculation

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.

The following tables list the top 25 hospitals with the largest case mix index. The average CMI of all 25 hospitals is 3.48, though CMIs range from 3.02 to 5.26
. This is a shift up from the last reporting period, which ranged from 2.75 to 4.88. CMI does not appear to correlate to the number of annual discharges, with discharges from the top 10 hospitals ranging from 5,531 to 87 annually.

Many of the hospitals with the highest CMI are located in Indiana (12 percent), Louisiana (16 percent), and Texas (32 percent). This is a shift from the previous reporting year, in which the hospitals with the highest CMI were in in Louisiana (14 percent), Oklahoma (12 percent), and Texas (28 percent).

The concentration of high CMI is likely due to barriers to care access in rural parts of these states, and high concentrations of patients with chronic illnesses that require patients to seek insurance through Medicare and Medicaid.

Top 25 Hospitals by Case Mix Index

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RankDefinitive IDHospital NameCase Mix IndexNet Patient Revenue# of DischargesExplore This Dataset
1.552489Nebraska Spine Hospital5.26$46,023,224884Explore This Profile
2.3321Oklahoma Spine Hospital4.59$72,672,2901,842Explore This Profile
3.4164Northwest Hills Surgical Hospital4.23$31,313,470515Explore This Profile
4.1561Doctors Hospital Llc3.89$22,523,663180Explore This Profile
5.3364Tulsa Spine & Specialty Hospital3.87$65,207,0081,066Explore This Profile
6.1756The Spine Hospital of Louisiana at the NeuroMedical Center3.75$47,950,8381,409Explore This Profile
7.6419Akron Childrens Hospital3.6$828,176,7269,834Explore This Profile
8.3901Baylor Scott & White the Heart Hospital Baylor - Plano3.6$315,992,7465,233Explore This Profile
9.923870Saint Camillus Medical Center3.52$18,785,696139Explore This Profile
10.3744Saint Thomas Hospital for Specialty Surgery3.42$69,535,5761,945Explore This Profile
11.2548CHI Health Nebraska Heart3.42$70,306,3442,707Explore This Profile
12.4003US Pain & Spine Hospital (Closed - No Longer Offers Inpatient Services)3.41$56,496,067218Explore This Profile
13.829049ContinueCARE Hospital at Medical Center3.27$9,346,643216Explore This Profile
14.1317St Vincent Heart Center of Indiana3.2$169,286,5224,400Explore This Profile
15.552269Cypress Pointe Hospital3.19$30,393,352516Explore This Profile
16.3918Baylor Surgical Hospital at Las Colinas3.17$68,961,665763Explore This Profile
17.553371Methodist Hospital for Surgery3.15$175,413,3832,543Explore This Profile
18.4150USMD Hospital at Fort Worth (Closed)3.13$25,626,508201Explore This Profile
19.424Miracle Mile Medical Center (Closed)3.12$20,614,180124Explore This Profile
20.277Arkansas Childrens Hospital3.11$545,886,8089,642Explore This Profile
21.1381Unity Medical and Surgical Hospital3.11$40,630,933480Explore This Profile
22.1738Specialists Hospital Shreveport3.08$60,090,8631,164Explore This Profile
23.440Keck Hospital of USC3.06$1,047,720,52611,725Explore This Profile
24.1400The Heart Hospital at Deaconess Gateway3.05$57,276,0231,516Explore This Profile
25.1818Avala Hospital3.02$37,687,424758Explore This Profile

Fig 1 Data from Definitive Healthcare's Hospitals & IDNs database. Financial data for hospital cost report period ending 12/31/2018. Data is from April 2020 Medicare Cost Report release; the next scheduled Medicare Cost Report release is July 2020.