• Richard C Frazee, Anthony V Matejicka, Stephen W Abernathy, Matthew Davis, Travis S Isbell, Justin L Regner, Randall W Smith, Daniel C Jupiter, and Harry T Papaconstantinou.
• Department of Surgery, Baylor Scott & White, Temple, TX. Electronic address: RFRAZEE@sw.org.
• J. Am. Coll. Surg.. 2015 Apr 1;220(4):652-6.

BackgroundCase mix index (CMI) is calculated to determine the relative value assigned to a Diagnosis-Related Group. Accurate documentation of patient complications and comorbidities and major complications and comorbidities changes CMI and can affect hospital reimbursement and future pay for performance metrics.Study DesignStarting in 2010, a physician panel concurrently reviewed the documentation of the trauma/acute care surgeons. Clarifications of the Centers for Medicare and Medicaid Services term-specific documentation were made by the panel, and the surgeon could incorporate or decline the clinical queries. A retrospective review of trauma/acute care inpatients was performed. The mean severity of illness, risk of mortality, and CMI from 2009 were compared with the 3 subsequent years. Mean length of stay and mean Injury Severity Score by year were listed as measures of patient acuity. Statistical analysis was performed using ANOVA and t-test, with p < 0.05 for significance.ResultsEach year demonstrated an increase in severity of illness, risk of mortality, and CMI compared with baseline values (p < 0.05). Length of stay was not significantly different, reflecting similar patient populations throughout the study. Injury Severity Score decreased in 2011 and 2012 compared with 2009, reflecting a lower level of injury in the trauma population.ConclusionsA concurrent documentation review significantly increases severity of illness, risk of mortality, and CMI scores in a trauma/acute care service compared with pre-program levels. These changes reflect more accurate key word documentation rather than a change in patient acuity. The increased scores might impact hospital reimbursement and more accurately stratify outcomes measures for care providers.Copyright © 2015 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

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