Certified Nurse Manager and Leader (CNML) Practice Test

What does the Case Mix Index help determine?

1. The average age of patients treated

2. The reimbursement rate for hospitals

3. The staffing needs of a healthcare facility

4. The types of insurance accepted by a facility

The correct answer is: The reimbursement rate for hospitals

The Case Mix Index (CMI) is a critical metric used in healthcare to evaluate the diversity and resource intensity of the patient population served by a healthcare facility. It specifically informs the reimbursement rate that hospitals receive for the care they provide. A higher CMI indicates a more complex patient population, which typically correlates with higher costs for care and thus may justify a higher reimbursement rate from insurers, particularly in systems that utilize diagnostic-related groups (DRGs). The CMI is calculated based on the diagnoses and procedures of patients treated and reflects the complexity of cases handled by the facility. This financial aspect is essential for various healthcare organizations as it influences budgeting, financial planning, and resource allocation. Understanding and using the CMI effectively aids in maximizing revenue based on the severity of cases treated, ensuring that the facility receives appropriate compensation for the services rendered. While the other options relate to different aspects of hospital operation or patient management, they do not directly tie into the core function of the Case Mix Index, which revolves around financial reimbursement associated with patient care complexities.