Data Coordinators Meeting Gifford Medical Center April 24, 2002

Data Coordinators Data Coordinators MeetingMeeting

Gifford Medical Center Gifford Medical Center April 24, 2002April 24, 2002

AGENDAAGENDA

• 10:00 Welcome & Introductions, Greg Farnum -VT 10:00 Welcome & Introductions, Greg Farnum -VT ExplorExplor

• 10:15 HIPAA Update, Greg Farnum- VT Explor10:15 HIPAA Update, Greg Farnum- VT Explor

• 10:30 Error Summary Analysis, Lauri Scharf –VT 10:30 Error Summary Analysis, Lauri Scharf –VT ExplorExplor– Data Status ReportData Status Report– Top Data Quality Issues Top Data Quality Issues

• Review DefinitionsReview Definitions

• Group Discussion on Problems Hospitals FaceGroup Discussion on Problems Hospitals Face

• Discuss Proposed ModificationsDiscuss Proposed Modifications

• Clarify Data Element DescriptionsClarify Data Element Descriptions

• 12:00 Lunch12:00 Lunch

• 1:00 Goals for the Vermont Hospital Inpatient and 1:00 Goals for the Vermont Hospital Inpatient and Outpatient Data Set, Dian Kahn -BISCHAOutpatient Data Set, Dian Kahn -BISCHA

• NHVSHIP backgroundNHVSHIP background

• Structure of NHVSHIP Structure of NHVSHIP

• Major accomplishments of NHVSHIPMajor accomplishments of NHVSHIP

NHVSHIP Background:NHVSHIP Background:• NHVSHIP is a volunteer organization of hospitals, NHVSHIP is a volunteer organization of hospitals,

physicians, other health care providers, health physicians, other health care providers, health plans, state health departments, and vendors. plans, state health departments, and vendors. Members are working together to improve the Members are working together to improve the understanding of and compliance with the Health understanding of and compliance with the Health Insurance Portability and Accountability Act of 1996 Insurance Portability and Accountability Act of 1996 (HIPAA). Membership is open to any organization (HIPAA). Membership is open to any organization that expresses a desire to work in a collaborative, that expresses a desire to work in a collaborative, non-commercial environment.non-commercial environment.

NHVSHIP Steering Committee:NHVSHIP Steering Committee:• BCBSVT, VAHHS & NHHA (founding members)BCBSVT, VAHHS & NHHA (founding members)• Healthcare Provider representation for home Healthcare Provider representation for home

care, long term care, physicians and physician care, long term care, physicians and physician office practicesoffice practices

• Health Plan representation (Anthem, BCBSVT, Health Plan representation (Anthem, BCBSVT, Medicare, Medicaid, MVP)Medicare, Medicaid, MVP)

• State Health DepartmentsState Health Departments• VendorsVendors• Work Group Co-ChairsWork Group Co-Chairs

NHVSHIP AccomplishmentsNHVSHIP Accomplishments::

• Each Work Group got established, assigned co-Each Work Group got established, assigned co-chairs and developed mission and goals.chairs and developed mission and goals.

• Monthly NHVSHIP meetings with NH & VT Monthly NHVSHIP meetings with NH & VT providers and health plans participatingproviders and health plans participating

• Establishment of NHVSHIP listservs (info, steering, Establishment of NHVSHIP listservs (info, steering, privacy, security, education and tci)privacy, security, education and tci)

• Establishment of the NHVSHIP web site Establishment of the NHVSHIP web site (www.nhvship.org)(www.nhvship.org)

NHVSHIP Accomplishments:NHVSHIP Accomplishments: (continued)(continued)

• HIPAA Privacy Seminar – March 2001HIPAA Privacy Seminar – March 2001

• HIPAA Security Seminar – August 2001HIPAA Security Seminar – August 2001

• NHVSHIP HIPAA Vendor Expo – Nov 2001 NHVSHIP HIPAA Vendor Expo – Nov 2001

• NHVSHIP Special Session - Last FridayNHVSHIP Special Session - Last Friday

• Establishment of a HIPAA speakers’ bureauEstablishment of a HIPAA speakers’ bureau

• WEDI SNIP Regional Affiliate status achieved – WEDI SNIP Regional Affiliate status achieved – December 2001December 2001

2001 Data Review & Future 2001 Data Review & Future PoliciesPolicies

Lauri Scharf , VT ExplorLauri Scharf , VT Explor

2001 Submissions2001 SubmissionsAs of April 22, 2002As of April 22, 2002 InpatientInpatient OutpatientOutpatient

Q1Q1 Q2Q2 Q3Q3 Q4Q4 Q1Q1 Q2Q2 Q3Q3 Q4Q4

Brattleboro Memorial HospitalBrattleboro Memorial Hospital

Central Vermont HospitalCentral Vermont Hospital

Copley HospitalCopley Hospital

Fletcher Allen Health CareFletcher Allen Health Care

Gifford Memorial HospitalGifford Memorial Hospital

Grace Cottage HospitalGrace Cottage Hospital

Mt Ascutney Hospital and Health CenterMt Ascutney Hospital and Health Center

North Country Hosp & Health CenterNorth Country Hosp & Health Center

Northeastern Vermont Regional HospitalNortheastern Vermont Regional Hospital

Northwestern Medical CenterNorthwestern Medical Center

Porter Medical CenterPorter Medical Center

Rutland Regional Medical CenterRutland Regional Medical Center

Southwestern Vermont Health CareSouthwestern Vermont Health Care

Springfield HospitalSpringfield Hospital

Veterans Affairs Medical CenterVeterans Affairs Medical Center

Top Data Quality IssuesTop Data Quality Issues

• Patient Type:Patient Type: Incorrect Incorrect categorizationscategorizations

• HCPCS:HCPCS: Missing and invalidMissing and invalid

• E Codes:E Codes: Policy clarificationPolicy clarification

• Readmit Flag:Readmit Flag: Some high numbersSome high numbers

• Admission Source:Admission Source: The newborn issueThe newborn issue

• Admission Type:Admission Type: Emergency vs. urgentEmergency vs. urgent

• Race:Race: UnknownsUnknowns

Patient TypePatient Type

• XX “Series” or “Recurring” “Series” or “Recurring” PatientsPatients

Patients Falling into Above CategoriesPatients Falling into Above Categories

• AA Ambulatory SurgeryAmbulatory Surgery Invasive ProceduresInvasive Procedures AnywhereAnywhere

• OO Observation RoomObservation Room Observation Stay OnlyObservation Stay Only

• EE Emergency RoomEmergency Room All VisitsAll Visits

Patient Type: XPatient Type: X

• Recurring VisitsRecurring Visits•Reason for Visit: Reason for Visit:

– Invasive ProcedureInvasive Procedure– ObservationObservation– Emergency RoomEmergency Room

• NotNot Therapeutic or Diagnostic! Therapeutic or Diagnostic!Since series patients are billed once a month and usually for more than one encounter, this creates a problem of overstating the data related to these patients in relationship to other single encounter patients. Because of this problem, series patients that are required to be reported should be classified as X so they can be separated from the other patient types.

Patient Type: APatient Type: A

• Invasive Procedures:Invasive Procedures:•ICD-9: ICD-9: 01.0 – 86.9901.0 – 86.99

•CPT: CPT: 10,000 – 69,99910,000 – 69,999

•Exceptions??? CPT 36,000: Vein PunctureExceptions??? CPT 36,000: Vein Puncture

• Any Surgical Location Managed by Any Surgical Location Managed by Hospital BoardHospital Board

If at any time the patient receives a procedure that is coded ICD-9 CM If at any time the patient receives a procedure that is coded ICD-9 CM 01-86.99 or CPT4 10000-69999 they should be classified as an A.01-86.99 or CPT4 10000-69999 they should be classified as an A.

Patient Type: OPatient Type: O

• All Observation Bed StaysAll Observation Bed Stays

If the patient receives observation care with no other higher ranking If the patient receives observation care with no other higher ranking patient services then they should be classified as an O.patient services then they should be classified as an O.

Patient Type: EPatient Type: E

• All ER PatientsAll ER Patients

• Admission Type: Emergency or Admission Type: Emergency or Urgent?Urgent?

If the patient receives ER care with no other higher ranking patient If the patient receives ER care with no other higher ranking patient services then they should be classified as an E.services then they should be classified as an E.

HCPCSHCPCS

• Error Rate Error Rate (4/23/02):(4/23/02): 0-0-

1.9%1.9%2-2-

5.9%5.9%6-6-

9.9%9.9% 10%+10%+

11stst Half Half

-First -First SubmitSubmit

66 00 22 66

11stst Half Half

-Resubmit-Resubmit77 44 11 22

22ndnd Half Half 88 22 33 11

HCPCSHCPCS

• Major HurdlesMajor Hurdles

• Tips for Other HospitalsTips for Other Hospitals

HCPCSHCPCS

•HCPCS Clarification from HCFA (4/12/01)– These Revenue Codes Do Not Require These Revenue Codes Do Not Require

HCPCS:HCPCS:•260260 IV TherapyIV Therapy•280, 289 280, 289 OncologyOncology•630630 Drugs IdentificationDrugs Identification•700700 Cast RoomCast Room•720, 721720, 721 Labor RoomLabor Room•762762 Observation RoomObservation Room•942942 Other Therapy – Other Therapy –

Education/TrainingEducation/Training

Readmit FlagReadmit Flag

• Patient is readmitted within 30 days, Patient is readmitted within 30 days, regardless of diagnosisregardless of diagnosis

• Several hospitals have reported rates Several hospitals have reported rates from 30% to 70%from 30% to 70%

• Two have rates below 3%Two have rates below 3%

Admission TypeAdmission Type

1. Emergency1. EmergencyEmergency care is care provided for a medical, surgical, or psychiatric Emergency care is care provided for a medical, surgical, or psychiatric

condition that requires immediate care in order condition that requires immediate care in order to save life or prevent to save life or prevent permanent impairmentpermanent impairment. Emergency care is typically sought for a serious . Emergency care is typically sought for a serious accidental injury or sudden onset of an acute medical condition, such as accidental injury or sudden onset of an acute medical condition, such as a suspected heart attack or a stroke. Admissions through an emergency a suspected heart attack or a stroke. Admissions through an emergency room or directly from a physician's office do not necessarily meet the room or directly from a physician's office do not necessarily meet the definition of emergency care.definition of emergency care.

2. Urgent2. UrgentUrgent care is the care needed to treat an unforeseen condition that Urgent care is the care needed to treat an unforeseen condition that

requires requires immediate medical treatmentimmediate medical treatment in the outpatient department of a in the outpatient department of a hospital, clinic, or doctor's office for the treatment ofhospital, clinic, or doctor's office for the treatment of acute pain, acute acute pain, acute infection, or protection of public healthinfection, or protection of public health. An urgent condition is not life-. An urgent condition is not life-threatening but may cause serious medical problems if not promptly threatening but may cause serious medical problems if not promptly treated.treated.

3. Elective3. Elective4. Newborn4. Newborn

– When does a newborn stop being a newborn?When does a newborn stop being a newborn?

Admission SourceAdmission Source

• Simplify NewbornsSimplify Newborns

– 1. Normal delivery1. Normal delivery– 2. Premature delivery2. Premature delivery– 3. Sick baby3. Sick baby– 4. Extramural birth4. Extramural birth– 9. Unknown9. Unknown


• Simplify NewbornsSimplify Newborns

– 1. Intramural delivery1. Intramural delivery ChangeChange– 2. Premature delivery2. Premature delivery– 3. Sick baby3. Sick baby– 4. Extramural birth4. Extramural birth– 9. Unknown9. Unknown


• Simplify “Referrals”Simplify “Referrals”

– 1. Physician Referral1. Physician Referral

– 2. Clinical Referral2. Clinical Referral

– 3. HMO Referral3. HMO Referral


• Simplify “Referrals”Simplify “Referrals”

– 1. Physician Referral1. Physician Referral

– 2. Clinical Referral2. Clinical Referral

– 3. HMO Referral3. HMO Referral

Race: UnknownRace: Unknown

2.0%1.8%0.5%0.4%0.2%0.1%0.0%0.0%

OVERALL 6.6%

98.2%

48.3%

11.2%

7.9%

7.7%

5.1%

2.4%

Hospital Data (Jan-Jun 2001)

E CodesE Codes

• Good Work!Good Work!

Percent of ER Percent of ER Records Coded Records Coded

(That Require a (That Require a Code)Code)

Count of Count of HospitalsHospitals

90%-100%90%-100% 99

51%-75%51%-75% 33

0%-50%0%-50% 11

E Codes: Coding Policy in E Codes: Coding Policy in 20022002VHIMA met in December and proposed VHIMA met in December and proposed

to follow regional coding guidelines to follow regional coding guidelines with these considerations:with these considerations:

• Initial treatments Initial treatments onlyonly should get an E code*. In should get an E code*. In addition, subsequent visits for follow up or other addition, subsequent visits for follow up or other care related to the initial injury should be coded care related to the initial injury should be coded with the appropriate V code and injury code to with the appropriate V code and injury code to identify the subsequent visit. identify the subsequent visit. APPLIES TO ER APPLIES TO ER PATIENTS ONLY.PATIENTS ONLY.

• Often a record will document “back strain” and Often a record will document “back strain” and not mention an injury. In instances such as this not mention an injury. In instances such as this where no injury is specified, an E code where no injury is specified, an E code shouldshould be be applied even if the diagnosis falls within the applied even if the diagnosis falls within the applicable ICD-9 diagnostic range.applicable ICD-9 diagnostic range.

E Codes: Coding PolicyE Codes: Coding Policy

*E Code “Initial Treatments” Clarification in the Ambulatory or *E Code “Initial Treatments” Clarification in the Ambulatory or ED Setting, ED Setting, by New Hampshire Hospital Associationby New Hampshire Hospital Association

• Example #1: A patient presents to the ED with a fractured radius, the Example #1: A patient presents to the ED with a fractured radius, the fracture is immobilized and the patient is told to return in the morning for fracture is immobilized and the patient is told to return in the morning for open reduction with internal fixation. An E code is placed on both the ED open reduction with internal fixation. An E code is placed on both the ED visit and the subsequent visit for reduction and fixation.visit and the subsequent visit for reduction and fixation.

• Example #2: A patient presents to the Ambulatory Surgery Unit eighteen Example #2: A patient presents to the Ambulatory Surgery Unit eighteen months post injury for removal of hardware used initially to stabilize his months post injury for removal of hardware used initially to stabilize his ankle fracture. No E code is used.ankle fracture. No E code is used.

• Example #3: A patient presents to the ED for severe burns on his Example #3: A patient presents to the ED for severe burns on his forearm. Burn is debrided and dressed. Then the patient returns daily for forearm. Burn is debrided and dressed. Then the patient returns daily for dressing changes. The initial visit to the ED carries an E code; however dressing changes. The initial visit to the ED carries an E code; however subsequent visits do not.subsequent visits do not.

• Example #4: A child cuts his finger at home, mom stops the bleeding, Example #4: A child cuts his finger at home, mom stops the bleeding, cleans the laceration and applies a Band-Aid. The patient presents to the cleans the laceration and applies a Band-Aid. The patient presents to the ED where the physician recleanses the wound and dresses it. An E code ED where the physician recleanses the wound and dresses it. An E code is applied to the visit.is applied to the visit.

• Example #5: A patient is seen in a physician’s office and treated for a Example #5: A patient is seen in a physician’s office and treated for a sprained ankle. 2 days later, the patient presents to the ED complaining sprained ankle. 2 days later, the patient presents to the ED complaining of worsening pain and more swelling. An E code is applied to the ED visit of worsening pain and more swelling. An E code is applied to the ED visit and if data is submitted from the office visit to NHHA, an E code is applied and if data is submitted from the office visit to NHHA, an E code is applied there as well.there as well.

State of VermontState of Vermont

Dian KahnDian Kahn

Banking, Insurance, Banking, Insurance, Securities, and Health Care Securities, and Health Care AdministrationAdministration


Goals for the Vermont Hospital Goals for the Vermont Hospital Inpatient and Outpatient Data SetInpatient and Outpatient Data Set

• To ensure that the State of Vermont has To ensure that the State of Vermont has an accurate, reliable and timely hospital an accurate, reliable and timely hospital inpatient and outpatient data set that is inpatient and outpatient data set that is compatible with national and state data compatible with national and state data sets from New Hampshire, sets from New Hampshire, Massachusetts and New York.Massachusetts and New York.



• To support population-based studies To support population-based studies addressing access, utilization, cost, addressing access, utilization, cost, quality and special private and public quality and special private and public health topics pertaining to Vermont health topics pertaining to Vermont residents who use hospital-based residents who use hospital-based services in and outside of Vermont.services in and outside of Vermont.



• To support national and cross-state To support national and cross-state comparisons of key measures and comparisons of key measures and indicators.indicators.



• To support longitudinal trending as well To support longitudinal trending as well as point-in-time analyses.as point-in-time analyses.


Continuous Quality Improvement Continuous Quality Improvement ProcessProcess

• Prioritize data elements based on relative Prioritize data elements based on relative importance in supporting key measures importance in supporting key measures and studies.and studies.



• Set acceptable error and missing data Set acceptable error and missing data rates for each data element based on rates for each data element based on relative importance. relative importance.



• Refine definitions and coding options to Refine definitions and coding options to promote consistent reporting among promote consistent reporting among Vermont hospitals and consistency with Vermont hospitals and consistency with national and bordering state data sets.national and bordering state data sets.



• Eliminate or collapse data elements and Eliminate or collapse data elements and coding options that do not add value to coding options that do not add value to the data set.the data set.



• Provide timely feedback to Data Provide timely feedback to Data Coordinators regarding systemic and Coordinators regarding systemic and hospital-specific problems and solutions hospital-specific problems and solutions pertaining to reporting.pertaining to reporting.



• Expect timely response from Data Expect timely response from Data Coordinators pertaining to requests for Coordinators pertaining to requests for corrections corrections



• Review proposed changes to the data set Review proposed changes to the data set and reporting issues identified by the Data and reporting issues identified by the Data Coordinators with the Hospital Data Policy Coordinators with the Hospital Data Policy Group.Group.

Documents

Data Coordinators Meeting Gifford Medical Center April 24, 2002