Decrease in CMI and How to Analyze/Explain

We had a slight decrease in CMI from FY 2018 to FY 2019 so I’m analyzing why…How would  I go about explaining the decrease in CMI when I  know it could be attributed to many factors. WE have printed a list of MDs with their CMIs  in FY 2018 vs. 2019.   If there was a large # of MCCs that changed to CCs, how would I attribute this to the change in CMI?  Or the weights of DRGs that may have changed from year to year? 

Does CMS have a mathematical factor they publish each year when the DRG weights are published to be used for budgeting purposes when there is a change in DRG weights are a decrease in MCCs to CCs and CCs to non-cc diagnoses?

Suzonne Bourque



  • 1. Yes, the relative weights for a DRG often change from one Fiscal year to another.

    .  Suggest you review your top 15 or so DRGs by volume and examine any difference in R.W.

    Keep in mind the Federal Fiscal year ‘starts’ with discharges on/after Oct 1.  

    2.  Have you reviewed the % of Surgical/Medical year to year?  Surgical DRGs have higher your volume of surgical cases changing?

  • Thanks Paul
  • I also always try to find out if we have lost any surgeons or surgical practices, or if we stopped doing any of the highly weighted surgeries that we did in the past.
    I look at the DRGs that were billed. At times our CMI is "watered down" because of an uptake in low weighted DRGs that maybe shouldnt have been inpatient.
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