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Mastering Case Mix Index
Paperback
Business GeneralMedical Reference
ISBN13: 9789948520078
Publisher: Alaa Independent Author-Publisher.
Published: Sep 25 2026
Pages: 288
Weight: 1.18
Height: 0.75 Width: 6.00 Depth: 9.00
Language: English
Mastering Case Mix Index: A Practical Guide for Healthcare Professionals explains how the clinical reality of patient care becomes documentation, classification, data, and ultimately organizational performance.
Case Mix Index (CMI) is often viewed as a financial or administrative metric. In practice, it reflects something much more fundamental: the severity, complexity, and resource needs of the patients an organization treats. Yet many physicians, clinical leaders, CDI professionals, and healthcare teams are expected to work with CMI without ever being shown how the entire system fits together.
This practical guide closes that gap.
Beginning with the foundations of Diagnosis-Related Groups (DRGs), Severity of Illness (SOI), Risk of Mortality (ROM), relative weights, and IR-DRGs, the book explains how patient complexity is translated into measurable information. It then moves into the realities of clinical documentation, coding, CDI, operative-note integrity, leadership, performance measurement, and organization-wide improvement.
At the center of the book is the DEFENSIBLE Framework, a physician-centered approach designed to help clinicians translate clinical reasoning into documentation that is clear, specific, clinically supported, consistent, and complete from admission through discharge.
Readers will learn how to:
- Understand the relationship between DRGs, SOI, ROM, relative weights, and CMI
- Recognize how documentation affects the representation of patient complexity
- Strengthen collaboration between physicians, CDI specialists, coders, and healthcare leaders
- Improve the quality and defensibility of operative and clinical documentation
- Apply the DEFENSIBLE Framework in daily clinical practice
- Use CMI and CDI KPIs and dashboards to identify performance gaps
- Build leadership, governance, and multidisciplinary structures for sustainable improvement
- Apply structured improvement methods, including the IHI Model for Improvement and PDSA cycles
Written for physicians, CDI specialists, coders, quality and performance professionals, healthcare executives, and clinical leaders, Mastering Case Mix Index connects bedside clinical practice with the systems organizations use to classify, measure, manage, and improve healthcare.
This is not a book about simply increasing a number. It is about ensuring that the medical record accurately reflects the clinical reality of the patient-so organizations can measure more accurately, allocate resources more intelligently, and make better decisions for patient care.
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