Cited by 130Healthcare Policy and ManagementMedical Coding and Health InformationHealthcare Quality and Management

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Impact of Hospital Variables on Case Mix Index as a Marker of Disease Severity

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Mendez, Carmen M., Harrington, Darrell W., Christenson, Peter, Spellberg, Brad·2014·Population Health Management

DOI 10.1089/pop.2013.0002PMC PMC3931432

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Abstract

Case mix index (CMI) has become a standard indicator of hospital disease severity in the United States and internationally. However, CMI was designed to calculate hospital payments, not to track disease severity, and is highly dependent on documentation and coding accuracy. The authors evaluated whether CMI varied by characteristics affecting hospitals' disease severity (eg, trauma center or not). The authors also evaluated whether CMI was lower at public hospitals than private hospitals, given the diminished financial resources to support documentation enhancement at public hospitals. CMI data for a 14-year period from a large public database were analyzed longitudinally and cross-sectionally to define the impact of hospital variables on average CMI within and across hospital groups. Between 1996 and 2007, average CMI declined by 0.4% for public hospitals, while rising significantly for private for-profit (14%) and nonprofit (6%) hospitals. After the introduction of the Medicare Severity Diagnosis Related Group (MS-DRG) system in 2007, average CMI increased for all 3 hospital types but remained lowest in public vs. private for-profit or nonprofit hospitals (1.05 vs. 1.25 vs. 1.20; P <0.0001). By multivariate analysis, teaching hospitals, level 1 trauma centers, and larger hospitals had higher average CMI, consistent with a marker of disease severity, but only for private hospitals. Public hospitals had lower CMI across all subgroups. Although CMI had some characteristics of a disease severity marker, it was lower across all strata for public hospitals. Hence, caution is warranted when using CMI to adjust for disease severity across public vs. private hospitals. ( Population Health Management 2014;17:28–34)

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Authors: Mendez, C. M., Harrington, D. W., Christenson, P., & Spellberg, B.
Affiliations: University of California, Los Angeles (US)
Corresponding author: Spellberg, Brad
ORCID: Spellberg, Brad
Venue: Population Health Management
Publisher: SAGE Publications
Published: 2014-02
Volume: 17
Issue: 1
Pages: 28-34
ISSN: 1942-7891 (ISSN-L)
1942-7905
DOI: 10.1089/pop.2013.0002
PMC: PMC3931432
OpenAlex: W2335477057
Cited by: 130
References: 22
Citations by year: 2026: 13 · 2025: 12 · 2024: 8 · 2023: 9 · 2022: 18 · 2021: 16 · 2020: 9 · 2019: 12 · 2018: 13 · 2017: 5 · 2016: 6 · 2015: 4 · 2014: 5
FWCI: 11.74
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations: Population Health Management (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Funders: National Institutes of Health (UL1TR000124)
National Center for Advancing Translational Sciences
Topics: Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
Health Sciences › Health Professions › Health Information Management › Medical Coding and Health Information
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Healthcare Quality and Management
Keywords: case mix index, disease severity, public hospitals, private hospitals, teaching hospitals, trauma centers, hospital size, hospital reimbursement, hospital type comparison
MeSH terms: Cross-Sectional Studies, Diagnosis-Related Groups, Hospitals, Public, Humans, Prospective Payment System, Severity of Illness Index, United States, Centers for Medicare and Medicaid Services, U.S., Databases, Factual, Hospitals, Private, Clinical Coding

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Impact of Hospital Variables on Case Mix Index as a Marker of Disease Severity

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