SHM Converge Scientific Abstract ePoster Gallery-The Case-Mix Index and Readmission Rates Across U.S. Hospitals

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This study examined whether hospital case-mix index (CMI), used as a proxy for better documentation of patient diagnoses, was associated with lower readmission rates across U.S. hospitals. Because diagnoses influence billing, DRG assignment, and hospital performance metrics, improved documentation could potentially affect measured readmissions.<br /><br />Using CMS data from 3,372 eligible U.S. hospitals, the authors analyzed readmission rates for pneumonia, heart failure (HF), and acute myocardial infarction (AMI) across five non-overlapping periods from 2005 to 2019. They used mixed linear models adjusting for hospital characteristics and community factors such as ownership, teaching status, bed count, rural/urban location, and hospital service area demographics.<br /><br />Results showed that readmission rates declined over time for all three conditions. In the most recent period, average readmission rates were 16.8% for pneumonia, 21.9% for HF, and 15.8% for AMI, all significantly lower than baseline. Hospitals with higher mean CMI had significantly lower readmissions for pneumonia, HF, and AMI. In addition, increases in CMI over time were also associated with lower readmission rates.<br /><br />The authors conclude that higher CMI and rising CMI are linked to reduced readmissions, suggesting that improved documentation of patient diagnoses may explain at least part of the national decline in hospital readmissions.

Asset Subtitle

Cynthia J. Avila

Meta Tag

Author List Cynthia J. Avila, Rehan Qayyum

Category Research

Concept Diagnosis Documentation

Concept Case Mix Index

Concept Readmission Rate

Concept Diagnosis-Related Group

Concept DRG Weight

Distinguished Non-Finalist

Presenter Organization Virginia College of Osteopathic Medicine

Presenting Author Cynthia J. Avila

Track Outcomes Research

Keywords

hospital case-mix index

CMI

readmission rates

patient documentation

diagnosis coding

CMS data

pneumonia

heart failure

acute myocardial infarction

hospital performance metrics

Diagnosis Documentation

Case Mix Index

Readmission Rate

Diagnosis-Related Group

DRG Weight