Decline in CMI (Fiscal Year 2013)

evanspx@sutterhealth.orgevanspx@sutterhealth.org
in CDI Talk Archive
One of our campuses has experienced an ABRUPT decrease in the CMI for October of 2012. Has anyone else experienced the same? We are going to study the data, but I am aware the relative weights for many common MS-DRGs is lower for 2013 than for 2012 - see the R.W. for CVA, COPD, CHF, Sepsis for FY 2013.

Given October data reflects these adjusted relative weights, I wonder if this may be one of the root causes? Has anyone else seen this?

Paul Evans, RHIA, CCDS, CCS, CCS-P

Comments

  • katysuegood@gmail.comkatysuegood@gmail.com
    edited May 2016
    We don’t look at CMI monthly. But now I want to! I will ask my Director about it.

    Thanks for bringing this to our attention.

    Katy Good, RN, BSN, CCDS, CCS
    Clinical Documentation Program Coordinator
    AHIMA Approved ICD-10CM/PCS Trainer
    Flagstaff Medical Center
    Kathryn.Good@nahealth.com
    Cell: 928.814.9404
  • ssalinasssalinas
    edited May 2016
    Yes. I thought the cause was the change in wts so I created an Excel sheet and plugged in the October discharges with the CY 2012 wts. which showed the comparison side by side. The new weights were not a good thing for us!

    We knew the new weights were going to be a negative hit and this report demonstrated the changes very graphically.

    Sharon
  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited May 2016
    Our data analyst is going to perform the exact process - use the 2012 weights for the Oct cases so that we can judge the impact.
    Sharon: Can you state the degree of the impact?

    I have been advising my senior executives about the CMS strategy to remain 'revenue neutral', yet they want me to account for this decline. I don't believe they understand the impact of these decreases in relative weights.

    "Holding the line' on one's CMI may be a more realistic goal in a mature CDI program than increasing the CMI - this has been my point of view for quite some time.


    Paul Evans, RHIA, CCS, CCS-P, CCDS
     
    Manager, Regional Clinical Documentation & Coding Integrity
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell:  415.637.9002
    Fax:  415.600.1325
    Ofc:  415.600.3739
    evanspx@sutterhealth.org
  • dallend@einstein.edudallend@einstein.edu
    edited May 2016
    Our CMI is stable. Usually when we see a dramatic decrease it is related to the surgical CMI, not the medical CMI. Less surgeries, less complicated surgeries, etc.



    Deborah A Dallen,RN, CCDS
    Albert Einstein Medical Center
    Phila PA 19141
    Clinical Documentation Coordinator
    Health Information Management
    215-456-8902
  • don.cdi.rn@gmail.comdon.cdi.rn@gmail.com
    edited May 2016
    I agree about holding the line.

    Secondly, take a look at the Impact file from the IPPS final rule.
    In that file, EVERY hospital has a line that includes their FY11 ICD-9 case data pushed through the FY12 and the FY13 groupers to give a CMI. There are actually 2 CMI's for each FY -- one that reflects post acute care affected DRGs and one that doesn't. I find it helpful for an easy check on what might be anticipated. Of course, documentation pattern changes since FY11 won't be reflected.

    Thirdly, the first thing I look for with sudden & unexpected changes -- is there a variance on the individual # of DRGs 3 & 4 for the month in question?

    Fortunately (?) for us, we actually had a strong CMI for October -- though pleasant, I still don't like surprises.

    Don
  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited May 2016
    Thanks, Don

    When we have experienced such changes in the past, we have been trace the root cause to changes in the types of surgical procedures with high weights, such as tracheostomy cases, coiling of aneurysms, and so forth. I will know more about that soon.

    I will review the Impact file from IPPS - I assume I can reference my site by the Provider ID?

    Thanks,

    Paul Evans, RHIA, CCS, CCS-P, CCDS
  • don.cdi.rn@gmail.comdon.cdi.rn@gmail.com
    edited May 2016
    The file has columns for both CMS provider ID as well as name of the hospital (not certain though how quickly following a name change the file might update).

    Don
  • Unknown
    edited May 2016
    We really have not seen this? Right?

    Jamie Dugan RN
    Clinical Documentation Improvement Specialist
    Baptist Health System
    office:904-202-4345
    cellular: 904-237-7253
    Business Email-jamie.dugan@bmcjax.com
    cdis.icd10@bmcjax.com
Sign In or Register to comment.