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Case Mix Index (CMI) is a top area of concern for clinical documentation improvement (CDI) specialists and programs. And when ICD-10 goes live, CMI may be your fastest barometer for measuring effective, or ineffective, clinical documentation. To measure the impact of ICD-10 on CMI, you must know where you are today. That means you should get as granular as possible, benchmark your current CMI and compare to your peers. Here is some additional advice.
 Tips for Effectively Measuring CMI
When CMI changes, your immediate reaction may be to assume coding errors have occurred. You question if there is a new coder. You ask the HIM director what is going on in her department.
While coding issues may be a possibility, it could actually be a true case mix shift, new physician or recently added service line. Most importantly for CDI specialists, it could be insufficient documentation.
Doing a historical analysis of CMI gives you the baseline of normal seasonality and expected variances. Knowing that CMI fluctuations are beyond your expected standard deviation allows you to start the process of digging deeper to find out why it has changed.
Under ICD-10, it will be even more important to know if CMI fluctuations are due to poor coding, weak documentation or one of the other factors mentioned above. Here are some questions to ask:
- Have any new service lines been added?
- Are there any strategic moves -- both increases and/or decreases in service lines?
- Has your organization brought on any new physicians or medical groups?
- Have there been any changes in the medical/surgical mix?
- Has the percentage of complications and co-morbidities changed? If so, why?
- If CMI changes are due to weak documentation, there are a number of "first responder" steps to take. And they begin with education.
Train the Team
CDI underlies not only the path to a successful transition to ICD-10, but is the underpinning of your CMI accuracy. Your CDI team needs to be assessed, educated and benchmarked as much as your coders do. Many providers are contracting with outside experts to assess and train their coders.
It is my recommendation that you do the same for CDI specialists. The combination of coding and CDI assessment and training gives you a coordinated approach and economies of scale.
Finally, getting your physicians on board with CDI and ICD-10 is key to your success. In fact, educating and changing physician behavior is probably the biggest challenge to a successful transition. Waiting until 2013 to educate physicians is a potential road to failure. Physicians learn and buy-in if you have a physician champion and deliver the knowledge in short, bite size pieces over a longer period of time. So get started now, if you have not already begun.
Alice O. Zentner is director of ICD-10 Auditing & Education, TrustHCS. To read more on CDI, see her blog titled .
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