CMI help

angelisa.romanelloangelisa.romanello
edited April 2016 in CDI Talk Archive
Hello,
Recently our CMI has taken a dive. I have been asked to speak to our physicians related to CMI and I would enjoy any thoughts, ideas or suggestions anyone can offer.
Thank you
Lisa



Lisa Romanello, RN,BSN,FNS,CCDS
Manager, Clinical Documentation Improvement
Quality and Compliance
CJW Medical Center
Office phone: 804-228-6527
Cell phone: 804-629-0396
AHIMA Approved ICD-10 CM/PCS Trainer
Angelisa.Romanello@HCAHealthcare.com




Comments

  • katysuegood@gmail.comkatysuegood@gmail.com
    edited April 2016
    Have you investigated other causes of change in CMI? Decrease in surgical volume or changes in how obs/IP status is being determined?

    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


  • byrd06byrd06
    edited April 2016
    I would be interested in this as well ours has taken a dive. I would like to hear some thoughts.

    Corrine Byrd, RHIT
    Clinical Documentation Improvement Manager
    Health Information Management
    ccbyrd@mdanderson.org
    T 713-792-2262



  • angelisa.romanelloangelisa.romanello
    edited April 2016
    Katy,
    I have taken a deep dive into the reason. My reasoning is a reduction in our cardiac surgeries as we have lost two cardiac surgeons as well as the flu.
    We had many people here with the flu with very low weighted DRGs.
    Thanks
    Lisa

  • m.leblancm.leblanc
    edited April 2016
    I would agree with Katy that the increase in Observation patients would cause a decrease in CMI. Have you looked at your trends over the last year?

    The decreased cardiac surgery patients and medical patients with the flu would be an impact as you point out.

    I am wondering if you have data by service line that you utilized for this deep dive reasoning? You also might find it helpful to look for service lines that have increased CMI to give positive feedback as well.

    It is nice to have positive to go with any negative message that we have to deliver.

    Great post and one that I wonder will not be an issue with ICD-10 implementation?

    Mark

    MARK LEBLANC, RN, MBA, CCDS
    DIRECTOR CDI SERVICES

    952-353-3505
    m.leblanc@thewilshiregroup.net



  • angelisa.romanelloangelisa.romanello
    edited April 2016
    Thank you Mark. I will research the observation patients as you and Katy have mentioned.

    I have evaluated the decrease by service lines. In addition to the decrease in cardiac surgery, a new orthopedic surgical center has opened across the street and many of our surgeries are now taking place over there.

    Thank you
    Lisa

  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited April 2016
    Lisa

    Excellent points by Mark and Katy

    Very briefly, as this type of analysis can be complicated, I'd:

    1. Review data to derive the percentage of Medical versus Surgical MS-DRGs given surgical DRGs carry higher weight. We had an abrupt change at one point, and the change was 2/2 fact that we lost a physician that performed neurovascular procedures with very high RW...the loss of his procedures impacted greatly the Surgical contribution to the overall CMI.

    2. Review separately the CC/MCC Capture Rate for Medical DRGs and Surgical DRGs.....plot the changes with a process control chart for any statistical significance.

    3. Are you able to compare these performances to Med Par Data?




    Paul Evans, RHIA, CCS, CCS-P, CCDS
     
    Manager, Regional Clinical Documentation & Coding Integrity
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell:  415.412.9421

    evanspx@sutterhealth.org



  • martin.conroymartin.conroy
    edited April 2016
    Just to jump on the previous points.
    You need to address any drop in CMI & volume.
    I agree you must separate Medical & Surgical cases.
    I suggest breaking them down by MDC.
    Calculate CMI by MDC and add volume. Simple math will allow you to measure actual CMI contribution & subsequent drop in contribution due to lower volume.
    Calculate change in CMI contribution per MDC (Sur. & Med. Separately). This way even if CMI stays high for a MDC you can see impact of lower volume on overall CMI.
    I usually exclude observation from any CMI calculation.
    Consider also calculating with & without OB, Babies, Rehab, Psych., .........

    Remember as ICD-10 approaches and insurance companies update their groupers you may be seeing grouper impact. Some insurance palns are going to APR rather than MS-DRGs which carry lower weights and may not be impacting $$$$.


    Marty
    Temple Health

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