Transcript Document

Direct Care Data
Direct Care Data in M2
1
TMA / WISDOM Excerpt
Direct Care Data
Objectives
• Describe the characteristics of Direct Care
Encounter-Level data files (Inpatient Admissions,
Professional Encounters, Laboratory Ancillary,
and Radiology Ancillary).
• Given a management purpose, select or avoid data
elements of the direct care encounter data files in
accordance with their applications and limitations.
• Describe appropriate use of cost and workload
measures.
2
TMA / WISDOM Excerpt
Direct Care Data
SIDR, SADR, and Ancillary
• Direct Care Data records
– Only completed records
– Most recent version of record
– Detail and Summary Files
• SIDR (Inpatient Admissions): One record per MTF
disposition.
• SADR (Professional Encounters): One record per
MTF ambulatory encounter or inpatient professional
service.
• Lab/Rad Ancillary: One record per entry into the
CHCS system (per lab test or per radiology exam).
3
TMA / WISDOM Excerpt
Direct Care Data
Direct Care Data Flow
SIDR
Monthly
MDR
CHCS
SADR
Weekly
At MTFs
M2
Lab/Rad
Monthly
4
TMA / WISDOM Excerpt
Direct Care Data
Location of Direct Care Data on M2
Ancillary
SIDR
SADR
5
TMA / WISDOM Excerpt
Direct Care Data
Records in M2*
FY
Inpatient
Professional
Dispositions Encounters
Lab
Records
Rad
Records
2001
290,159
31,369,275
2002
289,273
31,755,355
2003
288,069
32,165,280
2004
287,457
33,169,654
2005
278,727
33,311,313
29,248,066
7,362,915
2006
264,537
33,545,267
32,374,150
8,257,428
2007
42,443
11,249,882
7,704,483
2,025,876
*As of 2/9/07
6
TMA / WISDOM Excerpt
Direct Care Data
Common M2 Data Elements for SIDR,
SADR, and Ancillary Lab-Rad
7
TMA / WISDOM Excerpt
Direct Care Data
Record ID / M2 Key
• Record ID: Unique number that identifies a
record at an MTF (SIDR/SADR only).
– Inpatient Admissions Detail: CHCS Patient
Register Number (PRN)
– Professional Encounters Detail: CHCS
Appointment ID
– Use in combination with Tmt DMIS ID
• M2 Key: Field in Ancillary that uniquely
identifies a record.
8
TMA / WISDOM Excerpt
Direct Care Data
Patient Identification
• Sponsor ID – Sponsor Social Security Number
– Pseudo Sponsor ID.
• DEERS Dependent Suffix (DDS) – SIDR and SADR only
– Relationship of patient to sponsor.
– DDS is unique, but may not be consistent with FMP.
• Family Member Prefix (FMP) – SIDR, SADR, Ancillary
– Relationship of patient to sponsor.
– Coding scheme same as DDS, but values assigned differently for
non-sponsors.
– FMP uniquely assigned for data coming from CHCS, but not
necessarily unique across CHCS Hosts.
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TMA / WISDOM Excerpt
Direct Care Data
Person ID
• Person ID
– Electronic Data Interchange Person Number
(EDI_PN)
– Available in M2 in data FY02-present
– Populated 95+% in SIDR in all FYs
– Populated 99% in SADR for all FYs
– Person ID considered HIPAA compliant
10
TMA / WISDOM Excerpt
Direct Care Data
Patient Demographics
• Date of Birth (MM/DD/YYYY)
• Age: some have Age Group Code and Age Group Common
• Medicare Eligibility:
– FY03+: A, B, C, N
– FY02 and backwards: Y, N
• Gender
• Sponsor Pay Grade: Only for users with authorization to PHI
• Sponsor Rank Group
• Sponsor Service
– Sponsor Service Aggregate on Ancillary as well
11
TMA / WISDOM Excerpt
Direct Care Data
Sponsor Service
Dispositions
Encounters
Percent
Percent
(SIDR)
(SADR)
Foreign Military
118
0%
13,737
0%
Army
114,587
41%
14,252,068
43%
Coast Guard
2,471
1%
453,753
1%
Air Force
55,988
20%
7,793,916
23%
Public Health Svc
348
0%
55,195
0%
Marines
25,903
9%
2,546,201
8%
Navy
66,226
24%
7,398,855
22%
NOAA
30
0%
3,044
0%
Other/Unknown
13,056
5%
794,544
2%
Total
278,727
33,311,313
10,807,672
245,767
776
7,212,627
73,976
2,324,931
7,723,103
3,534
855,680
29,248,066
37%
1%
0%
25%
0%
8%
26%
0%
3%
3,188,956
35,228
122
1,862,107
7,715
511,862
1,608,112
470
148,343
7,362,915
43%
0%
0%
25%
0%
7%
22%
0%
2%
Foreign Military
Army
Coast Guard
Air Force
Public Health Svc
Marines
Navy
NOAA
Other/Unknown
Total
11,213,296
311,449
140
7,187,882
86,651
3,039,809
9,498,432
5,285
994,631
32,337,575
35%
1%
0%
22%
0%
9%
29%
0%
3%
3,566,184
73,842
17
2,007,467
15,219
647,533
1,672,061
895
246,836
8,230,054
43%
1%
0%
24%
0%
8%
20%
0%
3%
Sponsor Service
FY
2005
2005
2005
2005
2005
2005
2005
2005
2005
4
A
C
F
H
M
N
O
X
2006
2006
2006
2006
2006
2006
2006
2006
2006
4
A
C
F
H
M
N
O
X
74
104,434
2,039
50,248
287
22,573
57,544
20
10,906
248,125
0%
42%
1%
20%
0%
9%
23%
0%
4%
13,086
14,576,336
455,413
7,970,217
54,158
2,535,823
7,082,335
3,240
793,022
33,483,630
0%
44%
1%
24%
0%
8%
21%
0%
2%
Lab
Percent
Rad
Percent
12
TMA / WISDOM Excerpt
Direct Care Data
Beneficiary Category
• Patient Category (aka, PATCAT)

SIDR and SADR only (e.g., A11 = Army AD)
• Beneficiary Category: based on PATCAT



ACT, DA, DCO, DGR, DR, DS, GRD, IDG, IGR, NAT, OTH, RET,
UNK
E.g., PATCAT A11 mapped to ACT
Dependent of Guard/Reserve (DGR) is identifiable
• Ben Cat Common:




4=Active Duty and Guard
1=Active Duty Family Member, including Guard
2=Retirees
3=All Others (including IDG and IGR)
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TMA / WISDOM Excerpt
Direct Care Data
Ben Cat Common
FY
2005
2005
2005
2005
2006
2006
2006
2006
Ben Cat Dispositions
Encounters
Percent
Percent
Common
(SIDR)
(SADR)
1
123,941
44.5%
9,176,012
27.5%
2
36,697
13.2%
3,364,093
10.1%
3
53,705
19.3%
5,629,459
16.9%
4
64,384
23.1%
15,141,749
45.5%
Total
278,727
33,311,313
1
2
3
4
Total
113,774
31,718
46,692
55,941
248,125
45.9%
12.8%
18.8%
22.5%
9,180,347
3,356,831
5,461,617
15,484,835
33,483,630
27.4%
10.0%
16.3%
46.2%
Lab
Percent
Rad
Percent
7,444,993
4,525,229
6,484,339
10,793,505
29,248,066
25.5%
15.5%
22.2%
36.9%
1,675,129
979,092
1,880,414
2,828,280
7,362,915
22.8%
13.3%
25.5%
38.4%
8,042,848
5,248,080
7,182,925
11,863,722
32,337,575
24.9%
16.2%
22.2%
36.7%
1,863,767
1,062,064
2,132,022
3,172,201
8,230,054
22.6%
12.9%
25.9%
38.5%
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TMA / WISDOM Excerpt
Direct Care Data
Enrollment Data
• Alternate Care Value (ACV)
– TRICARE Program in which beneficiary is enrolled
Values:
• Prime: A, E (and D if using FY02 & older data)
• Overseas Prime: B, F, H, J
• Plus: G, L
• Non-enrolled Active Duty: M (~10% in FY05 SADR)
• Blank or Null: not enrolled
– USFHP should not be in data
15
TMA / WISDOM Excerpt
Direct Care Data
Enrollment Data
• Enrollment Site: DMISID of enrollment at time
care delivered, or “NONE”
 Populated Enrollment Site does not mean beneficiary
enrolled in Prime. (Could be Plus.)
• Enrollment Site Attributes
• If you offer TRICARE Plus, TRICARE Plus
enrollees will be coded with your Enrollment Site
as the DMIS ID
 Filter on ACV to limit to Prime or Plus
• PCM ID: Primary Care Manager ID
 Even though ACV shows they are enrolled, there are
instances where PCM ID is blank
16
TMA / WISDOM Excerpt
Direct Care Data
Provider Information
• Tmt DMIS ID & Attributes
• MEPRS Code of MTF department providing care
– SADR: 1 MEPRS Code (1, 2, 3, or 4 places avail.)
– SIDR: Up to 4 MEPRS Codes (2 & 3 places only)
 Admitting, Dispositioning, Up to 2 Interim
 If patient in more workcenters, info not in M2
– Lab/Rad: 1 MEPRS Code (3 and 4 places avail.)
This is the “ordering” MEPRS
17
TMA / WISDOM Excerpt
Direct Care Data
MEPRS Clinical Services (SIDR)
Clinical Service (MEPRS)
Ex
Admit
1
AAA
2
AAA
ABC
AEA
AEA
3
AAA
AAH
ABC
ABA
4
AEA
ABC
ABA
AAA
2nd
3rd
Disp
AAA
18
TMA / WISDOM Excerpt
Direct Care Data
Geography Related Fields
•
Beneficiary Zip Code: As in CHCS at time of service.
– Beneficiary Region (01-16, AK, etc.)
– Beneficiary HSSC Region (N, S, W, O) FY03+
•
–
–
–
–
HSSC = Health Services and Support Contract
Catchment Area/PRISM Area ID
Multi-Service Market Area (MSMA) fields
Market Area ID: Specific to TRO
TPR Flag: Indicates whether beneficiary resides in a
TRICARE Prime Remote designated area
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TMA / WISDOM Excerpt
Direct Care Data
Diagnosis Codes
• ICD-9 CM diagnosis codes
• 8 codes in SIDR: Diagnosis 1 – Diagnosis 8,
where Diagnosis 1 is the principle diagnosis
• 4 codes in SADR: Diagnosis 1 – Diagnosis 4
• 4 codes in Ancillary: Diagnosis 1 – Diagnosis 4,
but currently no data available (placeholders)
• No decimal points
• To find records for beneficiaries with a particular
condition, check all diagnosis code positions
20
TMA / WISDOM Excerpt
Direct Care Data
Diagnosis Filter Example
Diagnosis 1 matches
pattern ‘250%’ OR
Diagnosis 2 matches
pattern ‘250%’ OR
Etc.
21
TMA / WISDOM Excerpt
Direct Care Data
Direct Care Inpatient Admissions
22
TMA / WISDOM Excerpt
Direct Care Data
Inpatient Admissions Detail
• Each record represents the most recent version of
hospital record for a patient dispositioned from an MTF
– Only “completed” records are in M2
– MTFs collect other types of inpatient records but
they are not included in M2
– Long Stay patients included in the M2 once
discharged from the hospital (Note: inconsistent
with Purchased Care data)
23
TMA / WISDOM Excerpt
Direct Care Data
• Reporting lag inherent in inpatient data collection
– Requirement to complete SIDR w/in 30 days of
disposition… Not always met
– Lag can lead to incomplete data
 Completion Factors computed at the Tmt DMISID/FM
level based on # of SIDRs and dispositions reported in
WWR
 “Raw” = what has actually been received
 “Total” = Raw estimated to completion, what is expected
 “Total” not populated if data less than 40% complete
– Use “Total” measures to account for missing data,
as most management questions require
24
TMA / WISDOM Excerpt
Direct Care Data
SIDR: Raw vs. Total Records*
FY
Dispositions,
Raw
Dispositions,
Total
2001
290,159
290,831
2002
289,273
287,503
2003
288,069
285,935
2004
287,457
284,752
2005
278,727
276,118
2006
264,537
266,094
2007
42,443
44,543
FY
2007
2007
2007
2007
2007
2007
2007
2007
2007
2007
2007
2007
FM
1
2
3
4
5
6
7
8
9
10
11
12
Dispositions,
Raw
19,813
16,676
5,943
11
Dispositions,
Total
20,583
18,407
5,552
• FYs can look “odd” because of non-DHP MTF reporting
SIDRs for which there is no WWR
25
TMA / WISDOM Excerpt
*As of 2/9/07
Direct Care Data
• Procedure 1 – Procedure 8: ICD-9 CM
– Codes are left justified and decimals not included.
– Number of times a particular procedure was
performed is also available
• DRG: TRICARE Diagnosis Related Group
– Based on ICD-9 CM diagnosis & procedure codes.
– One DRG per record
– Can change across FYs (modified, deleted, etc.)
26
TMA / WISDOM Excerpt
Direct Care Data
• MDC: Major Diagnostic Category
– 25 codes for body system being treated
– Based on primary diagnosis
• MDC is broadest grouping, retrieves records
related to a diagnosis involving a body system.
DRGs are more specific, ICD-9 CM
diagnosis/procedure codes even more so
27
TMA / WISDOM Excerpt
Direct Care Data
 MDC 14 (Pregnancy, Childbirth, and the Puerperium)
 DRG 371 (Cesarean Section w/o CC)
ICD-9 Diagnosis 65421 (Previous Cesarean
Delivery)
What to use?
 All OB care, not just deliveries?
MDC
 Just deliveries?
DRG
 Specific kind of delivery?
Diagnosis Code
28
TMA / WISDOM Excerpt
Direct Care Data
Preventable Admissions
• Does not mean the particular admission could be
prevented
• Used as an access measure or to identify potential
case management or enrollment
• Values based on type of care (asthma, bacterial
pneumonia, cellulitis, etc…)
• Goal is low rates of these admissions for enrollees.
• These are not the Agency for Healthcare Research
and Quality (AHRQ) Prevention Quality Indicators
29
TMA / WISDOM Excerpt
Direct Care Data
Administrative Data
• Source of Admission: How patient arrived in hospital
 Transfers into an MTF (4-8)
 Admissions from ER (0)
 Live Births (L)
 Admissions from same day surgery (S)
 Routine admission (1)
30
TMA / WISDOM Excerpt
Direct Care Data
Source of Admission
FY05
Code
Description
0
ER, Direct to Military Hospital
1
Direct to Military Hosp from other than ER
4
Dispositions
FY06
Percent
Dispositions
Percent
66,492
23.86%
63,212
23.90%
151,414
54.32%
141,569
53.52%
Initial Adm in Non-Mil Hosp, tx to Mil Hosp (AD Only)
270
0.10%
228
0.09%
5
Initial Adm in Non-Mil Hosp, tx to Mil Hosp (Non-AD)
285
0.10%
300
0.11%
6
Transfer from Army Hospital
2,729
0.98%
2,561
0.97%
7
Transfer from Navy Hospital
192
0.07%
167
0.06%
8
Transfer from Air Force Hospital
701
0.25%
1,328
0.50%
L
Live Birth this Hospital
51,437
18.45%
50,078
18.93%
S
Adm resulting from APV, Direct to Military MTF
5,207
1.87%
5,094
1.93%
Total
278,727
264,537
31
TMA / WISDOM Excerpt
Direct Care Data
Discharge Status
• Disposition Status Code
– Transfer Out (02 – 05)
– Left Against Medical Advice (07)
– Death in Hospital (20)
– Routine (01)
32
TMA / WISDOM Excerpt
Direct Care Data
Disposition Status Code
FY05
Code
Description
01
Home, Self Care
02
Transfer to Short Term Facility
03
Dispositions
FY06
Percent
Dispositions
Percent
267,818
96.09%
254,462
96.19%
7,057
2.53%
6,595
2.49%
Discharged to SNF
913
0.33%
1014
0.38%
04
Discharged to ICF
658
0.24%
418
0.16%
05
Transfer to Other Facility
1
0.00%
3
0.00%
07
Left Against Medicare Advice
525
0.19%
500
0.19%
20
Death
1,755
0.63%
1,545
0.58%
Total
278,727
264,537
33
TMA / WISDOM Excerpt
Direct Care Data
Date Fields
• Admission Date: Use to stratify admissions
(Note that patients still in hospital not in M2.)
• Service Date: Date of disposition
• FY/FM and CY/CM: year and month of
disposition date
34
TMA / WISDOM Excerpt
Direct Care Data
Cost and Workload Measures
• Raw and Total:
– Most measures have both a “, Raw” and
“, Total”
– “Total” = Raw estimated to completion
• Disposition, Raw count:
– Each record is a disposition
– Set to 1 for all rows in table
35
TMA / WISDOM Excerpt
Direct Care Data
Cost and Workload Measures
• Bed Days
– Days as reported from MTF
– Some inconsistencies in reporting (e.g., some
MTFs have 0 bed days when admission date =
disposition date)
– Bed Days, Raw (and thus Total) have 0 (zero)
days changed to 1 bed day
– Bed Days of Record: the 0 bed days have not been
changed
– Many detailed bed day fields in M2 beyond total
days. See Data Dictionary
36
TMA / WISDOM Excerpt
Direct Care Data
Days by Clinical Service
Work Center (Clinical
Service)
Adm
2nd
3rd
Days
Disp
Adm
2nd
AAA
AAA
44
AAA AFA
AFA
1
35
AAC AAB ABC AAB
2
12
AAA AAH ABB ABC
2
0
3rd
Disp
Total
44
44
35
36
3
12
17
4
6
13
Summing across the clinical bed days does not equal
total bed days for the hospitalization
37
TMA / WISDOM Excerpt
Direct Care Data
Cost and Workload Measures
• RWP: Relative Weighted Products
– Intensity adjusted workload measure
– Based on DRG weight (i.e., relative costliness of that
DRG, hospital costs only), LOS, and other factors
– RWP = DRG weight for most cases although Long
Stay Outliers receive a little more for each day over
the threshold; Short Stay Outliers receive a little less
– BEST WORKLOAD MEASURE
– Case Mix = RWP / DISP, where DRG is not 469 or
470 (ungroupable DRGs)
38
TMA / WISDOM Excerpt
Direct Care Data
RWP Calculation
RWP
3.9431 +
(0.33)*(0.6918)*
(days-LST)
Inliers
5.0
Short Stay
Outliers
4.0
3.9431
3.0
2.0
Long Stay
Outliers
(2)*(0.6918)*(Days)
1.0
0.0
2
SST
5.7
GMLOS
6.2
ALOS
19
LST
Length of Stay (Days)
DRG
Wgt
109 Coronary Bypass 3.9431
w/o Cardic Cath
ALOS
GMLOS
SST
LST
Per Diem
6.2
5.7
2
19
0.6918
39
TMA / WISDOM Excerpt
Direct Care Data
Workload Measures
FY
Tmt
DMIS ID
2005
0029
NMC SAN DIEGO
2005
0037
2005
Tmt DMIS ID Name
Dispositions Bed Days
RWP
ALOS
CMI
19,685
70,831 18,452.48
3.6
0.9374
WALTER REED AMC-WASHINGTON DC
9,878
65,031 15,178.63
6.6
1.5366
0066
89TH MED GRP-ANDREWS
2,992
2,119.63
2.6
0.7084
2005
0067
NNMC BETHESDA
9,599
46,099 11,055.69
4.8
1.1518
2005
0109
BROOKE AMC-FT. SAM HOUSTON
10,539
51,283 17,727.27
4.9
1.6821
2005
0117
59TH MED WING-LACKLAND
15,423
58,866 17,137.69
3.8
1.1112
2006
0029
NMC SAN DIEGO
18,737
65,487 16,729.49
3.5
0.8929
2006
0037
WALTER REED AMC-WASHINGTON DC
9,572
61,172 14,793.80
6.4
1.5455
2006
0066
89TH MED GRP-ANDREWS
2,534
5,917
1,783.69
2.3
0.7039
2006
0067
NNMC BETHESDA
9,452
40,473
9,623.98
4.3
1.0182
2006
0109
BROOKE AMC-FT. SAM HOUSTON
11,083
48,717 17,274.48
4.4
1.5586
2006
0117
59TH MED WING-LACKLAND
15,500
58,627 16,746.30
3.8
1.0804
7,753
Even though San Diego had double the number of dispositions than
Walter Reed, Walter Reed actually expended more resources (CMI)
40
TMA / WISDOM Excerpt
Direct Care Data
Top 10 DRGs (Dispositions) - FY06*
DRG
Description
Dispositions
RWP
CMI
391
NORMAL NEWBORN
35,580
3,932.31 0.1105
373
VAGINAL DELIVERY W/O COMPLICATING DIAGNOSES
30,787 12,511.70 0.4064
630
NEONATE, BIRTHWT >2499G, W/O SIGNIF OR PROC, W OTHER PROB
11,121
2,630.18 0.2365
371
CESAREAN SECTION W/O CC
9,599
6,970.42 0.7262
143
CHEST PAIN
6,810
3,980.50 0.5845
372
VAGINAL DELIVERY W COMPLICATING DIAGNOSES
6,387
3,306.46 0.5177
359
UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W/O CC
3,975
3,875.05 0.9749
430
PSYCHOSES
3,168
1,981.90 0.6256
183
ESOPHAGITIS, GASTROENT & MISC DIGEST DS AGE >17 W/O CC
2,963
1,864.43 0.6292
370
CESAREAN SECTION W CC
2,829
2,579.60 0.9118
*FY05 produces the same results
41
TMA / WISDOM Excerpt
Direct Care Data
Top 10 DRGs (RWPs) – FY06*
DRG
Description
Dispositions
RWP
CMI
373
VAGINAL DELIVERY W/O COMPLICATING DIAGNOSES
31,808 12,940.48
541
TRACH W MV 96+ HR OR PDX EXC FACE, MOUTH & NECK DX W MAJ O.R.
371
CESAREAN SECTION W/O CC
9,546
7,012.03
0.7346
143
CHEST PAIN
7,805
4,613.87
0.5911
209
MAJOR JOINT & LIMB REATTACHMENT PROC, LOWER EXTREMITY
1,760
4,210.64
2.3924
359
UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W/O CC
4,306
4,079.32
0.9474
391
NORMAL NEWBORN
37,119
3,921.05
0.1056
148
MAJOR SMALL & LARGE BOWEL PROCEDURES W CC
1,018
3,531.66
3.4692
372
VAGINAL DELIVERY W COMPLICATING DIAGNOSES
6,456
3,285.39
0.5089
217
WND DEBRID/SKN GRFT EXC HAND, FOR MUSCSKELET/CONN TISS DS
879
2,934.63
3.3386
346
7,306.57 21.1172
*FY05 produces the same results
42
TMA / WISDOM Excerpt
0.4068
Direct Care Data
Cost Data
• Based on historical MEPRS data combined with direct
care encounter records. Inflation applied (Patient Level
Cost Allocation – or PLCA methodology)
• Incorporates hospital cost, as well as ancillaries,
professional services and pharmacy
• Cost allocated to cases based on DRG weight, whether
the patient had surgery, costliness of provider, and other
key factors
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Direct Care Data
Full Cost vs. Variable Cost
• Full Cost: All portions of the hospital’s cost.
• All MEPRS “A” expenses which include Rx, salaries,
supplies, etc
• Variable Cost: “Cost to do one more”
• All MEPRS “A” expenses identified as variable costs based
on the Standard Expense Element Code (SEEC)
Lights vs. Laundry
• FY05 and backwards: based on MEPRS expense data
from respective FY
• FY06 and forward: based on FY05 MEPRS expense
data, inflated to appropriate FY
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Direct Care Data
Full Cost vs. Variable Cost
• Full and Variable Cost broken out by:
 Direct (less salary): based on bed days
 Support: based on bed days
 Laboratory: based on laboratory weighted workload by DRG
 Radiology: based on radiology weighted workload by DRG
 Other Ancillary: based on RWP
 Clinician Salary: based on professional weighted product
 Other Salary: based on bed days
 ICU: based on ICU days
 Surgical: based on surgical DRG weight
• Sum of components equal Full Cost / Variable Cost
• Covered more thoroughly in other sections
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Direct Care Data
Normative Data - Norms, Raw and Total
Civilian
MTF
MTF Peer
Bed Days
X
X
X
Deaths
X
X
X
Variable Cost
NA
X
X
Full Cost
NA
X
X
For example, your MTF’s expected number of bed
days vs. other MTFs or Civilian data
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Direct Care Data
Questions ?
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