Abstract
Abstract
Introduction
Hospitals face increasing financial pressures. Hospital reimbursement is tied to the Case Mix Index (CMI). The CMI is a measure of complexity of care provided by the hospital and the total reimbursement is the CMI multiplied by a base pay factor, multiplied by the total number of discharges from the hospital. The few studies in the literature have involved logistically complex attempts to improve documentation. We sought to determine whether limited, structured chart review by surgeons can improve CMI in a multihospital system.
Methods
We performed a prospective, observational study in a four-hospital academic medical system on all surgical patients from 10/2022 to 7/2026. Two clinically busy trauma surgeons performed limited structured chart reviews for select surgical patients. In the limited intervention period (1/2024-9/2024) this focused only on the trauma division. In the full intervention period (10/2024-7/2026) expanded to all surgical patients across the system. The main outcome was surgical case mix index (CMI).
Results
A total of 35,695 patients were included (13,811 pre-intervention, 9,337 limited intervention, 12,547 full intervention). CMI increased significantly among surgical patients across the whole system (2.68 (95%CI 2.65-2.71) to 2.87 (95%CI 2.82-2.92) to 2.97 (95%CI 2.93-3.01), ANOVA p
Conclusion
Having trauma surgeons review targeted surgical patients for high value documentation capture significantly enhanced the CMI and estimated revenue of surgical services across a multi-hospital integrated health system. Such documentation reviews may represent a practical method to improve hospital documentation and revenue.
Level of Evidence
Level IV
Study Type
Prospective cohort study with historical controls
Key Messages
What is already known on this topic: Documentation is critically important for hospital billing. Previous studies in trauma and acute care surgery have shown that large, intensive, and dedicated interventions can improve documentation and improve revenue generation. What this study adds: By creating a list of Major Comorbidity/Complication (MCC) and Comorbidity/Complication (CC) codes for targeted review, two clinically busy trauma surgeons were able to perform limited, targeted chart review with significant improvement in DRG capture and Case Mix Index.
How this study might affect research, practice or policy: Improvements in documentation are facilitated by the targeted list of MCC and CC codes that other centers can use to improve their DRG capture, further demonstrating the financial benefit of a trauma and acute care surgery service.