{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,9]],"date-time":"2026-11-09T10:25:26Z","timestamp":1794219926762,"version":"4.8.0"},"reference-count":19,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>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&amp;P) notes are associated with increased CMI and reimbursement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>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&amp;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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>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 &lt; 0.001). CMI was significantly higher for TBI and TSI in the post-T period (2.99 vs 2.51 for TBI, p &lt; 0.001; 4.03 vs 3.42 for TSI, p &lt; 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2026.1.jns252362","type":"journal-article","created":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T00:22:27Z","timestamp":1781655747000},"page":"1089-1095","source":"Crossref","is-referenced-by-count":0,"title":["Impact of a standardized documentation template on hospital case mix index and reimbursement for patients with traumatic brain and spine injuries"],"prefix":"10.3171","volume":"145","author":[{"given":"Asha","family":"Sethuraman","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arnav","family":"Mahajan","sequence":"additional","affiliation":[{"name":"Department of Surgery, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pooja","family":"Podugu","sequence":"additional","affiliation":[{"name":"Department of Surgery, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan","family":"Sharpe","sequence":"additional","affiliation":[{"name":"Case Western Reserve University School of Medicine, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Nickell","sequence":"additional","affiliation":[{"name":"Department of Surgery, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pamela","family":"Owen","sequence":"additional","affiliation":[{"name":"Department of Surgery, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Varsha","family":"Eidnani","sequence":"additional","affiliation":[{"name":"Department of Financial Planning Systems and Reporting, MetroHealth Medical Center, Cleveland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaclyn","family":"Woolnough","sequence":"additional","affiliation":[{"name":"Department of Financial Planning Systems and Reporting, MetroHealth Medical Center, Cleveland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Jankowski","sequence":"additional","affiliation":[{"name":"Department of Financial Planning Systems and Reporting, MetroHealth Medical Center, Cleveland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Davis","sequence":"additional","affiliation":[{"name":"Department of Financial Planning Systems and Reporting, MetroHealth Medical Center, Cleveland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deven","family":"Reddy","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfred","family":"Bowles","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Belding","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Ben-Israel","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vanessa","family":"Ho","sequence":"additional","affiliation":[{"name":"Department of Surgery, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael L.","family":"Kelly","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"1","key":"b1","series-title":"Economic Research-Ekonomska Istra\u017eivanja","first-page":"2341216","article-title":"Quantification of factors influencing differences in the Case Mix Index and their significance for health systems sustainability","volume":"37","author":"Gavurova B","year":"2024","unstructured":"Gavurova B, Kubak M, Vaculcikova Z. Quantification of factors influencing differences in the Case Mix Index and their significance for health systems sustainability. Economic Research-Ekonomska Istra\u017eivanja. 2024;37(1):2341216\u2013234. doi: 10.1080\/1331677X.2024.2341216"},{"issue":"1","key":"b2","series-title":"Popul Health Manag","first-page":"28","article-title":"Impact of hospital variables on Case Mix Index as a marker of disease severity","volume":"17","author":"Mendez CM","year":"2014","unstructured":"Mendez CM, Harrington DW, Christenson P, Spellberg B. Impact of hospital variables on Case Mix Index as a marker of disease severity. Popul Health Manag. 2014;17(1):28\u201334. doi: 10.1089\/pop.2013.0002"},{"issue":"5","key":"b3","series-title":"J Trauma Nurs","first-page":"238","article-title":"Improving trauma documentation in the emergency department","volume":"21","author":"O\u02bcConnor TL","year":"2014","unstructured":"O\u02bcConnor TL, Raposo EA, Heller-Wescott T. Improving trauma documentation in the emergency department. J Trauma Nurs. 2014;21(5):238\u2013243. doi: 10.1097\/JTN.0000000000000071"},{"issue":"4","key":"b4","series-title":"Surgery","first-page":"793","article-title":"Impact of standardized trauma documentation to the hospital\u2019s bottom line","volume":"148","author":"Barnes SL","year":"2010","unstructured":"Barnes SL, Waterman M, MacIntyre D, Coughenour J, Kessel J. Impact of standardized trauma documentation to the hospital\u2019s bottom line. Surgery. 2010;148(4):793\u2013798. doi: 10.1016\/j.surg.2010.07.040"},{"issue":"2","key":"b5","series-title":"J Neurotrauma","first-page":"177","article-title":"Standardizing data collection in traumatic brain injury","volume":"28","author":"Maas AIR","year":"2011","unstructured":"Maas AIR, Harrison-Felix CL, Menon D,  Standardizing data collection in traumatic brain injury. J Neurotrauma. 2011;28(2):177\u2013187. doi: 10.1089\/neu.2010.1617"},{"key":"b6","article-title":"Understanding MS-DRG and Its Effect on the Case Mix Index. SCP Health","unstructured":"Understanding MS-DRG and Its Effect on the Case Mix Index. SCP Health. Published May 19, 2022. Accessed March 11, 2026. https:\/\/www.scphealth.com\/blog\/understanding-ms-drg-and-its-effect-on-the-case-mix-index\/"},{"issue":"5","key":"b7","series-title":"J Vasc Surg","first-page":"1621","article-title":"Inpatient coding and the diagnosis-related group","volume":"66","author":"Aiello F","year":"2017","unstructured":"Aiello F, Roddy S. Inpatient coding and the diagnosis-related group. J Vasc Surg. 2017;66(5):1621\u20131623. doi: 10.1016\/j.jvs.2017.08.030"},{"issue":"4","key":"b8","series-title":"J Am Coll Surg","first-page":"652","article-title":"Concurrent chart review provides more accurate documentation and increased calculated case mix index, severity of illness, and risk of mortality","volume":"220","author":"Frazee RC","year":"2015","unstructured":"Frazee RC, Matejicka AV, Abernathy SW,  Concurrent chart review provides more accurate documentation and increased calculated case mix index, severity of illness, and risk of mortality. J Am Coll Surg. 2015;220(4):652\u2013656. doi: 10.1016\/j.jamcollsurg.2014.12.036"},{"issue":"9","key":"b9","series-title":"Injury","first-page":"1919","article-title":"Lost in translation: focused documentation improvement benefits trauma surgeons","volume":"47","author":"Fox N","year":"2016","unstructured":"Fox N, Swierczynski P, Willcutt R, Elberfeld A, Mazzarelli AJ. 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