AvoidtheCMItrapMeasureyourCDIprogramusingseverity.pdfVIP

Avoid the CMI trap Measure your CDI program using severity-adjusted data by Robert S. Gold, MD for purchase can measure severity of illness or risk of mor- Too many organizations measure tality, as these capacities are built into them. However, these the effectiveness of their CDI program groupers are very expensive. solely by an increase in Medicare case-mix Your hospital may or may not be willing to pay for data index (CMI). This perspective is faulty in support of a CDI initiative (although, in today’s competi- for many reasons, but primarily because tive environment with oversight of a hospital’s or medical CMS frowns upon it. CMS views this practice as a strategy to staff’s performance, it is probably foolish to try to save a few increase payments for Medicare patients only—which will cer- dollars when your survival may be on the line), but if you can’t tainly grab the attention of the Office of Inspector General. secure money for a grouper, you can still track improvements Consultants who recommend measuring the change in your in severity-of-illness scores. CMI as a prime indicator of your CDI program’s success are CDI programs are designed to help with the severity mea- misleading you, and companies who promise an increase in sures for all patients and, therefore, should reflect improve- your CMI can potentially cause damage to your hospital. ments for all patients, not just Medicare. For example, changes CMI is a measure of who walks through the door, and, in severity measures for pediatric patients is just as vital to a on a daily, weekly, or monthly basis, physicians in your hospi- hospital as changes in adult medicine. Therefore, use all pay- tal treat a different mix of patients. For example, if your heart ers’ DRG assignments in these calculations. surgeon takes a vacation, your CMI will drop. If a physician The remainder of this article details