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.
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.
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|Rank||Definitive ID||Hospital Name||Case Mix Index||Net Patient Revenue||# of Discharges||Explore This Dataset|
|1.||552489||Nebraska Spine Hospital||5.26||$46,023,224||884||Explore This Profile|
|2.||3321||Oklahoma Spine Hospital||4.59||$72,672,290||1,842||Explore This Profile|
|3.||4164||Northwest Hills Surgical Hospital||4.23||$31,313,470||515||Explore This Profile|
|4.||1561||Doctors Hospital Llc||3.89||$22,523,663||180||Explore This Profile|
|5.||3364||Tulsa Spine & Specialty Hospital||3.87||$65,207,008||1,066||Explore This Profile|
|6.||1756||The Spine Hospital of Louisiana at the NeuroMedical Center||3.75||$47,950,838||1,409||Explore This Profile|
|7.||6419||Akron Childrens Hospital||3.6||$828,176,726||9,834||Explore This Profile|
|8.||3901||Baylor Scott & White the Heart Hospital Baylor - Plano||3.6||$315,992,746||5,233||Explore This Profile|
|9.||923870||Saint Camillus Medical Center||3.52||$18,785,696||139||Explore This Profile|
|10.||3744||Saint Thomas Hospital for Specialty Surgery||3.42||$69,535,576||1,945||Explore This Profile|
|11.||2548||CHI Health Nebraska Heart||3.42||$70,306,344||2,707||Explore This Profile|
|12.||4003||US Pain & Spine Hospital (Closed - No Longer Offers Inpatient Services)||3.41||$56,496,067||218||Explore This Profile|
|13.||829049||ContinueCARE Hospital at Medical Center||3.27||$9,346,643||216||Explore This Profile|
|14.||1317||St Vincent Heart Center of Indiana||3.2||$169,286,522||4,400||Explore This Profile|
|15.||552269||Cypress Pointe Hospital||3.19||$30,393,352||516||Explore This Profile|
|16.||3918||Baylor Surgical Hospital at Las Colinas||3.17||$68,961,665||763||Explore This Profile|
|17.||553371||Methodist Hospital for Surgery||3.15||$175,413,383||2,543||Explore This Profile|
|18.||4150||USMD Hospital at Fort Worth (Closed)||3.13||$25,626,508||201||Explore This Profile|
|19.||424||Miracle Mile Medical Center (Closed)||3.12||$20,614,180||124||Explore This Profile|
|20.||277||Arkansas Childrens Hospital||3.11||$545,886,808||9,642||Explore This Profile|
|21.||1381||Unity Medical and Surgical Hospital||3.11||$40,630,933||480||Explore This Profile|
|22.||1738||Specialists Hospital Shreveport||3.08||$60,090,863||1,164||Explore This Profile|
|23.||440||Keck Hospital of USC||3.06||$1,047,720,526||11,725||Explore This Profile|
|24.||1400||The Heart Hospital at Deaconess Gateway||3.05||$57,276,023||1,516||Explore This Profile|
|25.||1818||Avala Hospital||3.02||$37,687,424||758||Explore 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.