Validity of ICD-Based Case Mix Indices
Author Information
Author(s): Yang Che-Ming, Reinke William
Primary Institution: Taipei Medical University
Hypothesis
CMI derived from the ICD classification should correlate with the Medicare DRG CMI to a certain degree that justifies the application of ICD based CMIs.
Conclusion
An ICD-based CMI can fairly approximate the DRGCMI, especially the ICD principal diagnosis based costliness CMI.
Supporting Evidence
- The best ICD-based substitute for the DRG costliness CMI is the ICD principal diagnosis costliness CMI.
- Correlations between DRGCMI and ICDCMI-DC reached as high as 0.938 in the non-profit sector.
- The study population included 551 hospitals, with 73.3% being private hospitals.
Takeaway
This study shows that we can use ICD codes to measure how sick patients are in hospitals, just like the DRG system does.
Methodology
The study analyzed 551 acute care hospitals in Taiwan using inpatient reimbursement claims data to derive and compare CMIs from ICD and DRG.
Potential Biases
Potential for intentional upcoding by hospitals to gain reimbursement advantages.
Limitations
The study relies on the accuracy of hospital coding, which may be subject to upcoding or insufficient training.
Participant Demographics
The study included 551 acute care hospitals in Taiwan, with a majority being private hospitals.
Statistical Information
P-Value
< 0.001
Statistical Significance
p<0.001
Digital Object Identifier (DOI)
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