Impact of a standardized documentation template on hospital case mix index and reimbursement for patients with traumatic brain and spine injuries.

Authors

Asha Sethuraman, Arnav Mahajan, Pooja Podugu, Megan Sharpe, Cristina Nickell, Pamela Owen, Varsha Eidnani, Jaclyn Woolnough, James Jankowski, Jennifer Davis, Deven Reddy, Alfred Bowles, Jonathan Belding, David Ben-Israel, Vanessa Ho, Michael L Kelly

Published in

Journal of neurosurgery. Pages 1-7. Jun 19, 2026. Epub Jun 19, 2026.

Abstract

The case mix index (CMI) measures the complexity and severity of hospitalized patients and is used to determine hospital reimbursement rates. Better documentation is associated with higher complexity assigned to cases as measured by CMI but remains understudied in the trauma population. The authors hypothesized that standardized templates for neurotrauma history and physical (H&P) notes are associated with increased CMI and reimbursement.
A multidisciplinary team consisting of trauma program professionals, trauma data specialists, neurosurgeons, revenue integrity specialists, and financial analysts created traumatic brain injury (TBI) and traumatic spine injury (TSI) H&P templates targeting Medicare Severity Diagnosis Related Groups (MS-DRGs). All neurotrauma cases from 2015 to 2023 were extracted from the electronic medical records with their accompanying diagnosis-related group weights and divided into pretemplate (pre-T) and posttemplate (post-T) groups. The hospital CMI and reimbursement were calculated for the TBI group, the TSI group, and a control group of patients with nonbrain or spine trauma. Comparisons were made between the pre-T and post-T groups.
The authors included 5884 neurotrauma patients. TBI and TSI patients were similar in age and sex across time periods. The Injury Severity Score was significantly higher in the post-T period (p < 0.001). CMI was significantly higher for TBI and TSI in the post-T period (2.99 vs 2.51 for TBI, p < 0.001; 4.03 vs 3.42 for TSI, p < 0.001). CMI showed no increase in the post-T period for the nonbrain or spine trauma group (2.41 vs 2.38, p = 0.57). The post-T period demonstrated a significant increase in hospital reimbursement per discharge with a 13% increase for TSI and a 22% increase for TBI.
Implementation of a neurotrauma documentation template was associated with increases in hospital CMI and reimbursement for TBI and TSI patients. Further studies are needed to explore how trauma documentation in other subpopulations is associated with hospital CMI and reimbursement.

PMID:
42320058
Bibliographic data and abstract were imported from PubMed on 20 Jun 2026.

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