Transcript Document

Using Administrative Data to Assist in
Completing The Leapfrog Hospital
Survey
Survey Townhall Calls
April 29, 2009
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Town Hall Call Overview
• Introduction
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Why are we doing this town hall call?
What is administrative data? (See Disclosure’s Summary)
Where to find the data?
Should I use administrative data?
What does administrative data include?
• Survey Submission Logistics/Timeline/Web Resources
• Survey Sections Where Administrative Data Can
Reduce Burden
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Common Acute Conditions (CACs)
Evidence-based Hospital Referral (EBHR)
Resource Utilization
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Q&A
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Slides for this presentation can be found at: www.leapfroggroup.org –see
the right hand column and look for announcement of town hall calls. Click
through and select link for slides
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Why are we doing this call?
• Increasing use of standardized measures—considerable
number of NQF-endorsed measures make use of
administrative data
• Burden reduction—use administrative data for measures of
volume, observed death; for first cut of cases (reducing
chart review time) in normal deliveries; for risk factor counts
for risk adjustment in the LOS
• Some problems in submission last year for resource
utilization risk factors and readmission
• Ongoing monitoring of cases for internal quality
improvement activities found in Safe Practices
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What is Administrative Data?
• Claims data is considered administrative data
• Hospital Discharge Abstract*--an abstract from the
claims data
Each of these contain standardized information on
hospitalizations and/or test results—stored under an
individual patient’s ID (usually medical record
number, sometimes SSN)
*It is based on a summary for each discharge—many
states/hospital associations/vendors collect this
information on a quarterly basis from hospitals. It is
frequently used by states and others for comparative
performance reporting.
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Where do I find the data?
• If not in the quality department—it can be found in
billing or claims processing
• If not available there—48 states collect this
information—acquire from state health data agency
or hospital association
• Use information from submitted claims (if using paid
claims be sure it includes those claims where no
payment has been received)
• May need to request assistance in data access and
analysis (don’t wait until the last minute)
• Can have specific subsets of data dumped into excel
spreadsheets for analysis (request separate files for
specific measures using ICD codes)
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Should I Use Administrative Data?
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Does your hospital store hospital discharge
abstracts? For how long?
Do you have access to this information? Could you
have access?
Do you routinely analyze this type of data? If not,
is there someone in your facility that does? Does
your hospital have a vendor analyze this data?
What format is the data available in? Database?
Excel?
Do you have the coding requirements for the
survey questions? (If no code for a component of
the measure—will need to augment with clinical
chart data)
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What Does Administrative Data Include?
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Demographics (age, gender, address)
Patient Identifier (Med Rec #, SSN, name)
Dates of admission and discharge
Diagnosis Codes (ICD-9-CM Diagnosis Codes)
– Present on Admission (POA)
• Procedure Codes (ICD-9-CM Procedure Codes)
includes day of procedure
• Admission status (from home, ED, nursing home)
• Discharge Status (Deceased, Home, Nursing Home,
etc.)
• Health plan, hospital and physician identifiers
• Revenue codes—can be used to identify ICU stay
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What Can It Be Used For?
• Can use to measure outcomes of care (death,
complications, hospital readmission)
• Can use to measure processes of care (e.g., CABG
done using IMA)
• Can use to measure volume of a procedure
• Can use to measure resource utilization (LOS, ICU
care)
• Can use to examine disparities in care based on
gender, or payer status
• Can use to examine market share for certain
diagnoses, procedures
• Cannot be used when clinical details are needed—for
example parity (first born)
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Survey Submission Logistics, Timeline,
Website Resources
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2009 Timeline
• April 2, 2009 -- Leapfrog launched 2009
Survey
• June 30, 2009 -- RRO-targeted hospitals
report or be listed on Leapfrog’s website as
Did Not Respond
• July 21, 2009 -- Leapfrog website lists new
results
• Top Hospitals List/Highest Value Hospitals –
Must have submitted survey prior to
August 31, 2009
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Website Resources for EBHR
• Medical Coding for High-Risk Procedures and Conditions
Procedure code, diagnosis codes and other specifications for
counting high-risk surgery volumes
• Process Measures -- Specifications
Detailed specifications for Leapfrog’s procedure-specific
process measures of quality -- for CABG, PCI, AAA Repair, and
high-risk deliveries.
• Resource Utilization Measures – Specifications
Detailed specifications for Leapfrog’s CABG and PCI including:
– Coding for counting eligible cases
– Coding and other criteria for identifying cases with risk
factors
– Reporting geometric mean length of stay
– Criteria for identifying cases followed by readmission
• Excel Tool for Computing Geometric Mean Length of Stay
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Website Resources for Common Acute
Conditions (CAC)
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Volume Standard Coding: Medical Coding for Common Acute Conditions
Procedure/diagnosis codes and other specifications for counting AMI and Pneumonia
volume
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Process Measures - Specifications
Specifications for Leapfrog’s nationally-endorsed condition-specific process measures of
quality -- for AMI, Pneumonia, and Normal Deliveries.
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Resource Utilization Measures – Specifications
Detailed specifications for Leapfrog’s Common Acute Conditions (AMI and Pneumonia) –
including:
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Coding for counting eligible cases
Coding and other criteria for identifying cases with risk factors
Specifications for reporting geometric mean length of stay
Criteria for identifying cases followed by readmission
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Excel Tool for Computing Geometric Mean Length of Stay
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Outcome Measures for Normal Deliveries
– Coding for counting eligible cases (denominator)
– Criteria for determining numerator
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2009: Time to Use Existing Resources
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Common Acute Conditions
• Acute Myocardial Infarction (AMI)
– Can submit responses based on submission to CMS (use all cases)
instead of chart pull
OR
– Find number of patients in administrative data discharged with
principal diagnosis code within range defined in survey
documentation and not indicated as an exclusion (answer Q1) (If
total <30 cases over 24 months no further data reported)
– Pull charts for identified cases, use process measure specifications
to submit cases measured and cases adhering to process (answers
for (b) and (c)
• Pneumonia (PNE)
– Can submit responses based on submission to CMS (use all cases)
instead of chart pull
OR
– Find number of patients discharged with a diagnosis code of
pneumonia or septicemia or respiratory failure using administrative
data (denominator) and not indicated as an exclusion (If total < 30
cases (24 months) no further data reported)
– Pull charts for identified cases, use process measure specifications
to submit number of cases where
process took place (numerator)
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Resource Utilization for AMI and PNE
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Use administrative data to report total number of inpatient cases
meeting AMI criteria (specific inclusions/exclusions for resource
utilization measures)
Use administrative data to find re-admissions from those reported
inpatient cases to your hospital for any cause. Look for
“readmission”—use patient ID or Medical Record Number to search for
additional admissions within 14 days of discharge.
Determine in each administrative record the LOS for the specific
hospitalization. Record on Geometric Mean worksheet.
Risk factors were designed to be supportable by claims data Dx/PX.
When identifying risk factors, make sure to count the case only once for
each risk factor. Then, tabulate the number of cases with the risk factor
present. Refer to specifications document for ICD-9-CM codes.
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Common Acute Conditions: Normal
Deliveries
• New condition added to the 2008 survey
• Four new measures (two outcome; two
process)
– Elective Deliveries between 37 completed
weeks and 39 completed weeks
– Elective, low-risk C-Sections
– DVT prophylaxis for Cesarean Sections
– Bilirubin Screening
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Normal Deliveries-1: Elective Delivery Prior to
39 Completed Weeks Gestation
• To find cases—use either birth registry or
administrative data. For administrative data-– Find all cases where gestational age at delivery = at or after
37 completed weeks (ICD-9-CM code 765.29) and births that
were a singleton birth (exclude cases with multiple gestation
ICD-9 code 651) Report in Q2
– Exclude cases from total above using ICD-9 codes listed in
Normal Deliveries: Leapfrog Specifications. Report new total
in Q3
– Determine number of elective deliveries at or before 39
completed weeks gestation using:
• ICD-9 Procedure code 73.4--for medical induction
• ICD-9 Procedure code 654.2--for previous cesarean delivery
complicating pregnancy, childbirth, or the puerperium. Report
in Q4
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Normal Deliveries-2: Cesarean Rate
Denominator:
• Use administrative data to identify total number of Live Births using
listed ICD-9-CM codes (see specification document for codes)
• Be sure to drop case exclusions listed in Leapfrog specifications—this
will considerably pare down number of cases
• Then pull charts/birth record and keep and record those cases that
meet all of the following requirements:
– Parity = 0
– Presentation = Vertex or cephalic
– Gestational age at delivery = at or after 37 completed weeks gestation code
(765.29)
– Plurality = 1 (i.e., singleton)
Numerator:
• Using DRG codes count number of cases (meeting criteria above)
where c-section occurred (765 or 766)
• Report counts on survey by age group (number in age group and
number with c-section)
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Normal Deliveries-3: Newborn Bilirubin
Screening Prior to Discharge
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Count number of newborns born at or beyond 35 completed weeks
gestation using ICD-9 codes 765.28 and 765.29. Exclude cases
where discharge status was death prior to discharge, admitted to NICU,
or parental refusal (will need to go to charts for two of the exclusions).
Report number of Measured Cases.
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Count number of eligible cases who have a serum or transcutaneous
bilirubin screen prior to discharge to identify risk of hyperbilirubuinemia.
Report in Cases Adhered.
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Normal Deliveries-4: Appropriate DVT
Prophylaxis in Women Undergoing Cesarean
Delivery
• Include cases with following MS-DRG:
– 765 Cesarean section w CC
– 766 Cesarean section w/o CC
• No exclusions –Put this number in Measured
Cases
• Determine from chart whether mother
received fractionated or unfractionated
heparin or pneumatic compression devices
prior to surgery. Record in Cases Adhere.
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Evidence-based Hospital Referral
• All procedures require a volume count and a
count of observed deaths—both available
within discharge data
• Some procedures also require process
measures, some can also be determined
from electronic data (eg. CABG using IMA);
others will require chart review if not
submitted to an external reporting entity, such
as STS, ACC, VON, CMS. (Note:
specifications may differ from volume count)
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EBHR Survival Predictor
• Use administrative data to count number of
procedures performed (meeting specific ICD9- CM procedure codes or CPT codes in
EBHR specifications document)
• Count number of deaths that occurred during
or following procedure (inpatient death only).
Use discharge status to ascertain death.
Report number of deaths
• White paper available on LF website
http://www.leapfroggroup.org/media/file/SurvivalPredictorWhitepaper.pdf
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EBHR Resource Utilization Measures
• CABG and PCI both require completion
of the resource utilization section—see
specific codes for resource utilization—
when the hospital performs elective
procedures.
• Complete in same manner as AMI and
PNE
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Dates of Town Hall Calls
• 2009 Leapfrog Hospital Survey Overview
Call #3
– Date/Time: Friday, May 1st at 2 pm ET/1
pm CT/12 noon MT/11 am PT
Call-in number: (866) 802-4364
• CPOE Evaluation Tool
– Date/Time: Wednesday, May 6th at 2 pm ET/1 pm
CT/12 noon MT/11 am PT
Call-in number: (866) 802-4321
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Questions?
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