Headline numbers
- Hospitals ranked
- 3,075
- 6,736,757 Medicare discharges in the claims year
- Median CMI v44
- 1.6817
- v43: 1.6861
- Discharge-weighted CMI v44
- 1.9505
- average weight of all discharges
- Hospitals at 2.0 or above
- 665
- 58 below 1.0
- CMI fell from v43 to v44
- 2,354
- 708 rose, 13 unchanged
- Middle 80% of hospitals
- 1.2833 to 2.3031
- range 0.6601 to 5.3626
The discharge-weighted index (1.9505) sits well above the median hospital (1.6817) because large hospitals, which treat most Medicare inpatients, carry heavier case mixes: the median is 1.4584 for hospitals under 100 beds and 2.1649 for hospitals with 500 beds or more. Teaching hospitals (a positive IME factor) have a median of 1.8637 against 1.5564 for the others, and rural hospitals 1.4452 against 1.7755 in large urban areas.
Find a hospital's case mix index
Search by name or CMS Certification Number. The result shows the hospital's CMI under both groupers, its national rank out of 3,075 and its rank in its state, and opens the DRG payment calculator at that hospital.
Highest case mix index: hospitals with 1,000 or more Medicare discharges
Rank is the national rank among all IPPS hospitals. Heart, orthopedic and large academic hospitals dominate once very small hospitals are set aside; the DSH and IME columns are the operating adjustment factors CMS modelled for FY2027, applied as a percentage of each stay's operating payment.
| Rank | Hospital (CCN) | State | CMI v44 | Change | Wage index | Beds | DSH | IME |
|---|---|---|---|---|---|---|---|---|
| 22 | Ascension St Vincent Heart Center 150153 | IN | 3.8079 | +0.0064 | 1.0380 | 80 | none | none |
| 24 | Baylor Scott & White The Heart Hospital Plano 670025 | TX | 3.7477 | +0.0238 | 0.9909 | 108 | none | 9.92% |
| 32 | Swedish Medical Center / Cherry Hill 500025 | WA | 3.5852 | +0.0120 | 1.2599 | 181 | 2.15% | 17.81% |
| 33 | Chi Health Nebraska Heart 280128 | NE | 3.5806 | +0.0197 | 1.0195 | 59 | none | none |
| 44 | Cleveland Clinic 360180 | OH | 3.4137 | +0.0312 | 0.8888 | 1,293 | 2.43% | 30.25% |
| 49 | Keck Hospital Of Usc 050696 | CA | 3.3495 | +0.0372 | 1.3985 | 326 | 4.53% | 25.88% |
| 53 | Baylor Scott & White Heart And Vascular Hospital 450851 | TX | 3.3291 | +0.0201 | 0.9909 | 55 | none | 4.01% |
| 58 | Hca Healthone Presbyterian St Luke's 060014 | CO | 3.2849 | +0.0663 | 1.0635 | 321 | 6.25% | 2.92% |
| 62 | Ohsu Hospital And Clinics 380009 | OR | 3.2330 | +0.0195 | 1.1907 | 561 | 7.04% | 31.14% |
| 63 | New England Baptist Hospital 220088 | MA | 3.2216 | +0.1002 | 1.3072 | 75 | none | 5.92% |
| 66 | Avera Heart Hospital Of South Dakota 430095 | SD | 3.2135 | +0.0216 | 1.0000 | 53 | none | none |
| 68 | University Of Maryland Medical Center 210002 | MD | 3.2003 | +0.0217 | 0.8959 | 750 | 6.55% | 19.45% |
| 76 | Oklahoma Heart Hospital, Llc 370215 | OK | 3.1261 | +0.0247 | 0.8904 | 97 | none | none |
| 77 | Hospital Of Univ Of Pennsylvania 390111 | PA | 3.1210 | +0.0189 | 1.0471 | 1,003 | 4.35% | 38.00% |
| 78 | Ucsf Medical Center 050454 | CA | 3.1150 | +0.0810 | 1.7243 | 887 | 6.98% | 33.60% |
| 85 | Fairview Hospital University 240080 | MN | 3.0882 | +0.0334 | 1.0328 | 647 | 5.05% | 29.07% |
| 87 | Uh Cleveland Medical Center 360137 | OH | 3.0461 | +0.0236 | 0.8888 | 656 | 4.34% | 38.65% |
| 89 | Oklahoma Heart Hospital South, Llc 370234 | OK | 3.0029 | +0.0587 | 0.8904 | 43 | none | none |
| 90 | Deborah Heart And Lung Center 310031 | NJ | 2.9998 | +0.0287 | 1.1804 | 84 | none | 17.21% |
| 95 | Medstar Washington Hospital Center 090011 | DC | 2.9631 | +0.0080 | 1.2572 | 737 | 5.65% | 24.27% |
| 96 | Emory University Hospital 110010 | GA | 2.9490 | +0.0177 | 0.9968 | 666 | 1.10% | 22.00% |
| 98 | Sentara Norfolk General Hospital 490007 | VA | 2.9373 | +0.0097 | 0.9726 | 481 | 4.87% | 13.91% |
| 100 | University Of Alabama Hospital 010033 | AL | 2.9348 | +0.0269 | 0.7883 | 1,166 | 4.06% | 14.33% |
| 101 | Chi St Luke's Health Baylor College Of Medicine Me 450193 | TX | 2.9199 | +0.0112 | 0.9909 | 643 | 1.87% | 8.45% |
| 103 | Ronald Reagan Ucla Medical Center 050262 | CA | 2.9064 | +0.0075 | 1.3985 | 446 | 6.39% | 64.97% |
| 104 | Adventist Health St Helena 050013 | CA | 2.9057 | +0.0357 | 1.4675 | 141 | 6.08% | none |
| 105 | The University Of Chicago Medical Center 140088 | IL | 2.8942 | +0.0124 | 1.1720 | 765 | 7.73% | 41.63% |
| 107 | Hospital For Special Surgery 330270 | NY | 2.8625 | +0.0505 | 1.4269 | 158 | none | 25.27% |
| 108 | Penn Presbyterian Medical Center 390223 | PA | 2.8583 | +0.0125 | 1.0471 | 342 | 5.72% | 28.07% |
| 110 | Barnes Jewish Hospital 260032 | MO | 2.8437 | +0.0411 | 0.9506 | 1,279 | 3.78% | 29.41% |
| 112 | Ssm Health Saint Louis University Hospital 260105 | MO | 2.8367 | +0.0082 | 0.9506 | 382 | 5.39% | 36.41% |
| 114 | University Of Iowa Health Care Medical Center 160058 | IA | 2.8274 | +0.0195 | 0.8565 | 743 | 5.60% | 31.03% |
| 115 | Intermountain Health Saint Joseph Hospital 060028 | CO | 2.8214 | -0.0007 | 1.0635 | 352 | 4.67% | 13.66% |
| 116 | Piedmont Hospital, Inc 110083 | GA | 2.7966 | +0.0162 | 0.9980 | 593 | none | 0.51% |
| 117 | Brigham And Women's Hospital 220110 | MA | 2.7890 | +0.0106 | 1.3072 | 827 | 2.58% | 33.80% |
| 118 | Northwestern Memorial Hospital 140281 | IL | 2.7806 | +0.0208 | 1.1720 | 929 | 2.13% | 22.76% |
| 119 | Massachusetts General Hospital 220071 | MA | 2.7713 | +0.0165 | 1.3072 | 997 | 3.26% | 31.37% |
| 120 | University Of Colorado Hospital Authority 060024 | CO | 2.7567 | +0.0402 | 1.0635 | 763 | 5.33% | 26.34% |
| 122 | Mayo Clinic Hospital Rochester 240010 | MN | 2.7552 | +0.0105 | 1.1183 | 1,155 | 1.39% | 18.59% |
| 124 | Banner Heart Hospital 030105 | AZ | 2.7512 | +0.0203 | 1.0780 | 111 | none | 0.44% |
| 126 | Banner - University Medical Center Phoenix 030002 | AZ | 2.7493 | +0.0162 | 1.0780 | 654 | 7.70% | 15.22% |
| 128 | Memorial Hermann Texas Medical Center 450068 | TX | 2.7396 | +0.0110 | 0.9909 | 1,131 | 6.50% | 21.68% |
| 129 | Medstar Georgetown University Hospital 090004 | DC | 2.7321 | +0.0208 | 1.2572 | 474 | 3.22% | 27.75% |
| 131 | Mount Sinai Hospital 330024 | NY | 2.7199 | +0.0111 | 1.4269 | 1,049 | 6.27% | 42.16% |
| 132 | Tristar Centennial Medical Center 440161 | TN | 2.7188 | +0.0085 | 0.9016 | 635 | 3.63% | 4.09% |
| 134 | Medical Center Of The Rockies 060119 | CO | 2.7035 | +0.0116 | 1.0635 | 180 | 0.87% | none |
| 135 | Uams Medical Center 040016 | AR | 2.7018 | +0.0121 | 0.8295 | 558 | 7.46% | 27.25% |
| 136 | Carolinas Medical Center/Behav Health 340113 | NC | 2.7007 | +0.0320 | 0.9765 | 1,243 | 6.71% | 8.27% |
| 137 | Adventhealth Porter 060064 | CO | 2.6971 | +0.0479 | 1.0635 | 169 | 2.60% | none |
| 138 | St. Joseph's Hospital And Medical Center 030024 | AZ | 2.6966 | +0.0318 | 1.0780 | 518 | 5.16% | 17.63% |
Highest case mix index: all IPPS hospitals
Without a volume floor the top of the ranking belongs to small surgical specialty hospitals: 21 of these 25 had fewer than 500 Medicare discharges in the claims year, so a handful of high-weight surgical stays can set the index. Read the index together with the discharge count.
| Rank | Hospital (CCN) | State | CMI v44 | Medicare discharges | Beds | Type |
|---|---|---|---|---|---|---|
| 1 | Nebraska Spine Hospital, Llc 280133 | NE | 5.3626 | 322 | 34 | IPPS hospital |
| 2 | The Woodlands Specialty Hospital 670267 | TX | 5.2828 | 52 | 6 | IPPS hospital |
| 3 | Orthocolorado Hosp At St Anthony Med Campus 060124 | CO | 4.9639 | 206 | 48 | IPPS hospital |
| 4 | Altus Houston Hospital, Lp 670135 | TX | 4.9524 | 14 | 10 | IPPS hospital |
| 5 | Surgery Specialty Hospitals Of America Se Houston 450831 | TX | 4.7051 | 4 | 37 | IPPS hospital |
| 6 | Oklahoma Spine Hospital 370206 | OK | 4.6846 | 606 | 23 | IPPS hospital |
| 7 | Northwest Specialty Hospital 130066 | ID | 4.6706 | 336 | 31 | IPPS hospital |
| 8 | Methodist Hospital For Surgery 670073 | TX | 4.5606 | 257 | 32 | IPPS hospital |
| 9 | Cypress Pointe Surgical Hospital 190303 | LA | 4.4283 | 78 | 30 | IPPS hospital |
| 10 | Mercy Specialty Hospital Southeast Kansas 170203 | KS | 4.4100 | 148 | 26 | IPPS hospital |
| 11 | Saint Thomas Hospital For Specialty Surgery 440218 | TN | 4.2966 | 358 | 23 | IPPS hospital |
| 12 | Insight Surgical Hospital 230264 | MI | 4.2301 | 18 | 13 | IPPS hospital |
| 13 | Fresno Surgical Hospital 050708 | CA | 4.1999 | 379 | 27 | IPPS hospital |
| 14 | Tulsa Spine & Specialty Hospital 370216 | OK | 4.1744 | 267 | 38 | IPPS hospital |
| 15 | Rush Specialty Hospital, Llc 140310 | IL | 4.0741 | 11 | 44 | IPPS hospital |
| 16 | Northwest Surgical Hospital 370192 | OK | 4.0199 | 17 | 9 | IPPS hospital |
| 17 | Orthopaedic Hospital At Parkview North Llc 150167 | IN | 3.9882 | 139 | 37 | IPPS hospital |
| 18 | Asem 400127 | PR | 3.9626 | 28 | 69 | IPPS hospital |
| 19 | Treasure Valley Hospital 130063 | ID | 3.9295 | 215 | 7 | IPPS hospital |
| 20 | Specialists Hospital Shreveport 190278 | LA | 3.9080 | 455 | 30 | IPPS hospital |
| 21 | The Spine Hospital Of Louisiana 190266 | LA | 3.8566 | 239 | 23 | IPPS hospital |
| 22 | Ascension St Vincent Heart Center 150153 | IN | 3.8079 | 1,392 | 80 | IPPS hospital |
| 23 | Sugar Land Surgical Hospital Llp 450860 | TX | 3.7847 | 20 | 6 | IPPS hospital |
| 24 | Baylor Scott & White The Heart Hospital Plano 670025 | TX | 3.7477 | 3,384 | 108 | IPPS hospital |
| 25 | Texas Orthopedic Hospital 450804 | TX | 3.7084 | 597 | 42 | IPPS hospital |
Largest changes from grouper v43 to v44
Both indexes come from the same FY2025 claims, so a change here is the effect of the FY2027 MS-DRG reclassification and recalibration on the hospital's existing case mix. The tables cover the 2,235 hospitals with at least 500 Medicare discharges; the FY2027 MS-DRG weight changes report shows which groups moved, and a hospital that discharges many cases in those groups moves with them.
| Hospital (CCN) | State | CMI v43 | CMI v44 | Change | Discharges |
|---|---|---|---|---|---|
| Oklahoma Spine Hospital 370206 | OK | 4.3725 | 4.6846 | +0.3121 (+7.14%) | 606 |
| Arizona Specialty Hospital 030112 | AZ | 3.2367 | 3.3468 | +0.1101 (+3.40%) | 548 |
| Kansas City Orthopaedic Institute 170188 | KS | 2.1315 | 2.2029 | +0.0714 (+3.35%) | 564 |
| New England Baptist Hospital 220088 | MA | 3.1214 | 3.2216 | +0.1002 (+3.21%) | 1,269 |
| Scripps Green Hospital 050424 | CA | 2.3653 | 2.4398 | +0.0745 (+3.15%) | 2,977 |
| Black Hills Surgical Hospital Llc 430091 | SD | 2.9664 | 3.0547 | +0.0883 (+2.98%) | 601 |
| Ucsf Medical Center 050454 | CA | 3.0340 | 3.1150 | +0.0810 (+2.67%) | 9,668 |
| Jack Hughston Memorial Hospital 010168 | AL | 2.6545 | 2.7130 | +0.0585 (+2.20%) | 585 |
| Chi Saint Joseph London 180011 | KY | 1.8577 | 1.8984 | +0.0407 (+2.19%) | 1,029 |
| Pennsylvania Hospital 390226 | PA | 2.1500 | 2.1956 | +0.0456 (+2.12%) | 3,068 |
| Hca Healthone Presbyterian St Luke's 060014 | CO | 3.2186 | 3.2849 | +0.0663 (+2.06%) | 1,190 |
| Oklahoma Heart Hospital South, Llc 370234 | OK | 2.9442 | 3.0029 | +0.0587 (+1.99%) | 1,513 |
| Crystal Clinic Orthopaedic Center 360351 | OH | 2.4347 | 2.4821 | +0.0474 (+1.95%) | 647 |
| Adventhealth Porter 060064 | CO | 2.6492 | 2.6971 | +0.0479 (+1.81%) | 1,615 |
| Hoag Orthopedic Institute 050769 | CA | 3.1820 | 3.2392 | +0.0572 (+1.80%) | 973 |
| Hospital For Special Surgery 330270 | NY | 2.8120 | 2.8625 | +0.0505 (+1.80%) | 2,857 |
| Adventhealth Carrollwood 100069 | FL | 2.0799 | 2.1162 | +0.0363 (+1.75%) | 1,128 |
| Kansas Heart Hospital 170186 | KS | 2.6780 | 2.7228 | +0.0448 (+1.67%) | 759 |
| Alaska Regional Hospital 020017 | AK | 2.3394 | 2.3756 | +0.0362 (+1.55%) | 2,693 |
| Ascension Saint Thomas Hospital 440082 | TN | 2.5178 | 2.5556 | +0.0378 (+1.50%) | 8,971 |
| Hospital (CCN) | State | CMI v43 | CMI v44 | Change | Discharges |
|---|---|---|---|---|---|
| Umd Rehabilitation & Orthopaedic Institute 210058 | MD | 1.4776 | 1.4473 | -0.0303 (-2.05%) | 841 |
| Essentia Health Duluth 240019 | MN | 1.4669 | 1.4489 | -0.0180 (-1.23%) | 833 |
| Chi St Luke's Health Brazosport 450072 | TX | 1.4633 | 1.4455 | -0.0178 (-1.22%) | 830 |
| Texas Orthopedic Hospital 450804 | TX | 3.7538 | 3.7084 | -0.0454 (-1.21%) | 597 |
| Palestine Regional Medical Center 450747 | TX | 1.3714 | 1.3550 | -0.0164 (-1.20%) | 536 |
| Prattville Baptist Hospital 010108 | AL | 1.2238 | 1.2100 | -0.0138 (-1.13%) | 673 |
| Mount Nittany Medical Center 390268 | PA | 1.6540 | 1.6353 | -0.0187 (-1.13%) | 2,331 |
| Sutter Santa Rosa Regional Hospital 050291 | CA | 1.8610 | 1.8405 | -0.0205 (-1.10%) | 2,998 |
| Medstar Good Samaritan Hospital 210056 | MD | 1.5739 | 1.5567 | -0.0172 (-1.09%) | 3,598 |
| Orlando Health Melbourne Hospital 100291 | FL | 1.9176 | 1.8970 | -0.0206 (-1.07%) | 1,191 |
| Essentia Health Virginia 240084 | MN | 1.4724 | 1.4571 | -0.0153 (-1.04%) | 598 |
| Lutheran Hospital 360087 | OH | 2.3678 | 2.3431 | -0.0247 (-1.04%) | 577 |
| Community Hospital Of Huntington Park 050091 | CA | 1.5616 | 1.5455 | -0.0161 (-1.03%) | 608 |
| Baystate Noble Hospital 220065 | MA | 1.2135 | 1.2011 | -0.0124 (-1.02%) | 1,134 |
| Owatonna Hospital 240069 | MN | 1.2768 | 1.2638 | -0.0130 (-1.02%) | 543 |
| Logan Regional Medical Center 510048 | WV | 1.4496 | 1.4348 | -0.0148 (-1.02%) | 792 |
| Carle Health Pekin Hospital 140120 | IL | 1.2825 | 1.2695 | -0.0130 (-1.01%) | 603 |
| Penn Highlands Mon Valley 390147 | PA | 1.7946 | 1.7765 | -0.0181 (-1.01%) | 606 |
| Mcleod Health Clarendon 420109 | SC | 1.3192 | 1.3061 | -0.0131 (-0.99%) | 522 |
| Ssm Health St Clare Hospital - Baraboo 520057 | WI | 1.2976 | 1.2849 | -0.0127 (-0.98%) | 615 |
Case mix index by state
The median hospital in each state and the highest index among the state's hospitals with at least 1,000 Medicare discharges. Maryland hospitals are listed because CMS includes them in the impact file, although Maryland's all-payer rate system, not IPPS, sets their payment.
| State | Hospitals | Median CMI v44 | Median change | Highest (1,000+ discharges) |
|---|---|---|---|---|
| Alaska | 8 | 1.6972 | -0.0030 | Alaska Regional Hospital (2.3756) |
| Alabama | 70 | 1.4495 | -0.0066 | University Of Alabama Hospital (2.9348) |
| Arkansas | 39 | 1.7263 | -0.0050 | Uams Medical Center (2.7018) |
| Arizona | 64 | 1.7262 | -0.0026 | Banner Heart Hospital (2.7512) |
| California | 276 | 1.7973 | -0.0065 | Keck Hospital Of Usc (3.3495) |
| Colorado | 51 | 2.0040 | -0.0004 | Hca Healthone Presbyterian St Luke's (3.2849) |
| Connecticut | 26 | 1.7207 | -0.0060 | Hartford Hospital (2.2747) |
| District of Columbia | 7 | 1.7570 | -0.0022 | Medstar Washington Hospital Center (2.9631) |
| Delaware | 6 | 1.6973 | -0.0049 | Christianacare (2.0235) |
| Florida | 167 | 1.7315 | -0.0044 | Mayo Clinic (2.5693) |
| Georgia | 96 | 1.6482 | -0.0068 | Emory University Hospital (2.9490) |
| Hawaii | 11 | 1.8835 | -0.0030 | Straub Clinic And Hospital (2.5146) |
| Iowa | 30 | 1.6275 | -0.0043 | University Of Iowa Health Care Medical Center (2.8274) |
| Idaho | 16 | 2.0707 | +0.0063 | Eastern Idaho Regional Medical Center (2.4344) |
| Illinois | 114 | 1.6898 | -0.0062 | The University Of Chicago Medical Center (2.8942) |
| Indiana | 82 | 1.6741 | -0.0040 | Ascension St Vincent Heart Center (3.8079) |
| Kansas | 44 | 1.8068 | -0.0012 | University Of Kansas Hospital (2.6323) |
| Kentucky | 59 | 1.5785 | -0.0069 | University Of Kentucky Hospital (2.4932) |
| Louisiana | 82 | 1.6246 | -0.0040 | Ochsner Lsu Health Shreveport (2.3953) |
| Massachusetts | 52 | 1.5033 | -0.0069 | New England Baptist Hospital (3.2216) |
| Maryland | 43 | 1.6218 | -0.0079 | University Of Maryland Medical Center (3.2003) |
| Maine | 14 | 1.5018 | -0.0042 | Northern Light Eastern Maine Medical Center (2.1691) |
| Michigan | 90 | 1.6993 | -0.0061 | Henry Ford Health Hospital (2.6056) |
| Minnesota | 45 | 1.5847 | -0.0072 | Fairview Hospital University (3.0882) |
| Missouri | 62 | 1.6762 | -0.0043 | Barnes Jewish Hospital (2.8437) |
| Mississippi | 55 | 1.4640 | -0.0091 | University Of Mississippi Med Center (2.4943) |
| Montana | 11 | 1.8470 | -0.0013 | St Patrick Hospital (2.4193) |
| North Carolina | 80 | 1.5602 | -0.0065 | Carolinas Medical Center/Behav Health (2.7007) |
| North Dakota | 7 | 1.9731 | -0.0056 | Sanford (2.1691) |
| Nebraska | 25 | 1.9850 | +0.0015 | Chi Health Nebraska Heart (3.5806) |
| New Hampshire | 13 | 1.6276 | -0.0061 | Mary Hitchcock Memorial Hospital (2.4678) |
| New Jersey | 61 | 1.6588 | -0.0070 | Deborah Heart And Lung Center (2.9998) |
| New Mexico | 25 | 1.5397 | -0.0053 | Lovelace Medical Center (2.5070) |
| Nevada | 21 | 1.9430 | -0.0069 | Sunrise Hospital And Medical Center (2.1666) |
| New York | 126 | 1.6842 | -0.0072 | Hospital For Special Surgery (2.8625) |
| Ohio | 117 | 1.6060 | -0.0049 | Cleveland Clinic (3.4137) |
| Oklahoma | 75 | 1.5086 | -0.0064 | Oklahoma Heart Hospital, Llc (3.1261) |
| Oregon | 32 | 1.7083 | -0.0071 | Ohsu Hospital And Clinics (3.2330) |
| Pennsylvania | 131 | 1.6260 | -0.0058 | Hospital Of Univ Of Pennsylvania (3.1210) |
| Puerto Rico | 52 | 1.4880 | -0.0058 | Auxilio Mutuo Hospital (1.7902) |
| Rhode Island | 10 | 1.5400 | -0.0059 | Rhode Island Hospital (2.2407) |
| South Carolina | 52 | 1.6229 | -0.0049 | Prisma Health Richland Hospital (2.5458) |
| South Dakota | 18 | 1.6948 | -0.0014 | Avera Heart Hospital Of South Dakota (3.2135) |
| Tennessee | 76 | 1.5606 | -0.0069 | Tristar Centennial Medical Center (2.7188) |
| Texas | 280 | 1.7921 | -0.0046 | Baylor Scott & White The Heart Hospital Plano (3.7477) |
| Utah | 32 | 1.7988 | -0.0029 | University Of Utah Hospital And Clinics (2.5812) |
| Virginia | 72 | 1.6469 | -0.0063 | Sentara Norfolk General Hospital (2.9373) |
| Vermont | 6 | 1.4250 | -0.0089 | University Of Vermont Medical Center (2.2593) |
| Washington | 46 | 1.7310 | -0.0052 | Swedish Medical Center / Cherry Hill (3.5852) |
| Wisconsin | 65 | 1.6298 | -0.0057 | Froedtert Memorial Lutheran Hospital (2.4695) |
| West Virginia | 24 | 1.5830 | -0.0062 | West Virginia University Hospitals, Inc (2.3524) |
| Wyoming | 9 | 1.5161 | -0.0025 | Wyoming Medical Center (1.8637) |
Case mix index by hospital size, type and location
| Group | Hospitals | Median CMI v44 | Median change | Median wage index |
|---|---|---|---|---|
| Under 100 beds | 1,154 | 1.4584 | -0.0084 | 0.9715 |
| 100 to 249 beds | 1,072 | 1.6742 | -0.0062 | 1.0000 |
| 250 to 499 beds | 595 | 1.9180 | -0.0026 | 1.0423 |
| 500 beds or more | 254 | 2.1649 | +0.0014 | 0.9980 |
| Group | Hospitals | Median CMI v44 | Median change | Median wage index |
|---|---|---|---|---|
| Teaching (operating IME adjustment above 0) | 1,327 | 1.8637 | -0.0036 | 1.0328 |
| Not teaching | 1,748 | 1.5564 | -0.0071 | 0.9909 |
| Receives operating DSH | 2,571 | 1.6820 | -0.0057 | 0.9909 |
| No operating DSH | 504 | 1.6790 | -0.0049 | 0.9909 |
| Group | Hospitals | Median CMI v44 | Median change | Median wage index |
|---|---|---|---|---|
| Large urban | 1,152 | 1.7755 | -0.0050 | 1.0380 |
| Other urban | 1,252 | 1.7621 | -0.0041 | 0.9968 |
| Rural | 671 | 1.4452 | -0.0088 | 0.9493 |
| Rural referral centers (incl. SCH/RRC) | 1,031 | 1.8715 | -0.0028 | 0.9909 |
| Sole community hospitals (incl. SCH/RRC) | 419 | 1.5279 | -0.0075 | 0.9726 |
| Other IPPS hospitals (type 0) | 1,771 | 1.6247 | -0.0067 | 0.9909 |
| Medicare-dependent hospitals (MDH flag) | 166 | 1.4119 | -0.0091 | 0.9018 |
Method and reuse
Every figure comes from the FY2027 IPPS impact file as corrected by CMS-1849-CN3, which lists 3,075 hospitals (one more than the final-rule file, after CMS restored a hospital it had wrongly treated as converted to a rural emergency hospital). The ranking uses the column CMIV44 (the case mix index under grouper v44); the CSV also carries TACMIV44, the transfer-adjusted index, which counts a transfer case as a fraction of a discharge. Change is CMIV44 minus CMIV43. Wage index, beds, the DSH patient percentage, the operating DSH factor (after the 75 percent reduction under section 1886(r) of the Social Security Act) and the operating IME factor are the values CMS used to model FY2027 payments; CMS notes that the contractors pay from the Provider Specific File, which can differ. The steps are on the reference methodology page. The data is public; figures may be reused with attribution to QuickIntell and a link to this page.
To turn an index into dollars for one stay, use the MS-DRG payment calculator, which applies the same impact-file wage index, IME and DSH factors to any MS-DRG weight; the MS-DRG reference lists every weight behind the index.
Download the full table
The CSV holds every IPPS hospital ranked by FY2027 case mix index, with the v43 index, the change, transfer-adjusted CMI, discharges, beds, wage index, CBSA, location, provider type and the DSH and IME factors: 3,075 rows, one header row and the columns rank, ccn, hospital, state, state rank, cmi v44, cmi v43, cmi change, cmi change pct, transfer adjusted cmi v44, medicare discharges fy2025, beds, wage index fy2027, geographic cbsa, location, provider type, dsh patient percentage, operating dsh adjustment, operating ime adjustment, resident to bed ratio. Its first line is a comment that names each CMS source file with its SHA-256, the data date and the attribution line to keep when you reuse the table.
Table SHA-256 (the rows after the comment line): 1d42120e16e5cbb4adee6ca74ae07ead9057164b9d4c717c5a908861bd926b2b. Data as of 2026-10-01.
Where QuickIntell fits with case mix
A hospital's case mix index rises and falls with how completely the record supports the MS-DRG of each stay. QuickIntell's inpatient billing workflow brings DRG review and pre-bill documentation queries to qualified coders before the claim drops, with human review, and QuickCode supports coder review and documentation clarification.
Frequently asked questions
What is a hospital case mix index?
A case mix index (CMI) is the average MS-DRG relative weight of a hospital's Medicare discharges. Because each stay is paid its weight times the hospital's wage-adjusted standardized amount, a CMI of 2.0 means the hospital's Medicare stays are paid, on average, about twice that amount before add-ons; a higher index means a more resource-intensive mix of cases. Across the 3,075 IPPS hospitals in the FY2027 impact file the median CMI under grouper v44 is 1.6817, and 665 hospitals are at 2.0 or above.
Why compare CMI v44 with CMI v43?
CMS computes both indexes from the same FY2025 Medicare claims (MedPAR, March 2026 update): CMIV43 groups them with the FY2026 MS-DRG grouper and CMIV44 with the FY2027 grouper. The difference therefore shows how the FY2027 reclassification and recalibration revalue a hospital's existing cases, not a change in its patients. 2,354 hospitals fall and 708 rise; the median change is -0.0056.
Which hospitals have the highest case mix index?
The highest CMI v44 in the file is 5.3626 at Nebraska Spine Hospital, Llc (NE), a hospital with 322 Medicare discharges in the claims year. Small surgical specialty hospitals lead the full list; with few Medicare discharges, a handful of high-weight surgical stays can set the index. Among hospitals with at least 1,000 Medicare discharges, Ascension St Vincent Heart Center (IN) leads at 3.8079.
How does the case mix index relate to Medicare payment?
The operating payment for a stay is its MS-DRG weight times the hospital's wage-adjusted standardized amount, so a hospital's average operating payment per discharge moves roughly in proportion to its CMI. At the FY2027 full-update standardized amount of $6,848.00 and a wage index of 1.0, a CMI of 2.0 corresponds to about $13,696.00 per discharge before capital, teaching, DSH, outlier and transfer adjustments. The DRG payment calculator applies each hospital's own factors.
How is each hospital's state determined?
From the first two digits of its CMS Certification Number (CCN), the CMS state code. The projection checks every CCN against the state of the county the impact file gives for the hospital, and the two agree for every hospital in the FY2027 file.
Sources
Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.
- IPPS FY2027 impact file as corrected by CMS-1849-CN3 (hospital wage index, case mix and payment factors)Version FY2027 (correction notice, September 2026) · effective 2026-10-01 · file FY 2027 IPPS Impact File - Correction Notice.txtSHA-256 c2d099bffcd25d4d…
- IPPS FY2027 Table 5 as corrected by correction notice CMS-1849-CN3Version v44 FY2027 (final rule + CN3) · effective 2026-10-01 · file CMS-1849-CN Table 5.txtSHA-256 2cc4e0b083e62e40…
Disclaimer
Case mix indexes and payment factors are reproduced from the CMS impact file as an operational reference. They are CMS modelling values for FY2027, not payment determinations; the Medicare contractor pays from the Provider Specific File. Not legal, clinical or billing advice.
Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.