This document discusses trends in case mix index (CMI) and nursing acuity at a hospital from January to December. The CMI and average nursing acuity have risen significantly over this period, especially for a large institution. If January and February are excluded, nursing acuity correlates closely with CMI. While the budget was exceeded in December based on the fixed budget, the actual performance was favorable when adjusted for increased workload and acuity levels. A continued rise in nursing workload is expected to show the department of nursing was also favorable to budget in January despite the initial unfavorable appearance.

1. Trailing 12 Months Case Mix Index and Nursing Acuity
2.48
2.50
2.52
2.54
2.56
2.58
2.60
2.62
2.64
January
February
March
April
May
June
July
August
September
October
November
December
2.01
2.02
2.03
2.04
2.05
2.06
2.07
2.08
2.09
2.10
2.11
CMI Average Acuity Linear (CMI ) Linear (Average Acuity)
• What we are seeing is a repeat of December. We were over budget based on the fixed
budget but when TSI reports were run it showed we were actually favorable to
budget.
• The graph above (based on Partners’ data) shows how much our Case Mix Index has
risen recently. This is very significant especially for an institution the size of MGH.
• If we throw out January and February (monitoring increase), Nursing Acuity
correlates pretty closely with CMI.
• We know TSI staff flex variable expenses, including labor, based on Nursing
Workload. I’m expecting TSI to show DON will be favorable to budget again. While
I don’t have access to January data yet (until after the close) to make a definitive
statement on January, there is continued uptrend in nursing workload (cases * acuity)
justifying the unfavorable budget situation based on the January’s fixed budget.
• Another statistic, average daily caseload (cases * case mix / days), appears to have
risen as well.