CONSUMER GUIDE TO HEALTH CARE IMPLEMENTATION: Focus on Illinois Reporting Requirements and Release o

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CONSUMER GUIDE TO HEALTH CARE IMPLEMENTATIONFoc
us on Illinois Reporting Requirements and Release
of Data

• Illinois Hospital Association
• July 12, 2007

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OBJECTIVES

• Understand Background of Consumer Guide
• Historical Reporting of Data and Release of Data
  Under Illinois Health Care Cost Containment
  Council (IHCCCC)
• Discuss Collaborative Approach Among Project
  Partners Illinois Department of Public Health
  (IDPH), Illinois Hospital Association (IHA), and
  Providers
• Understand Reporting Requirements and Time Frames
• Highlight Critical Importance of Timely,
  Accurate, and Complete Data
• Getting Started for Expanded Reporting
• Hospital Support Services
• Manuals
• Conference Calls, Webinars, and Training Programs
• Helpline Support
• Consumer Guide
• Data Availability and Patient Confidentiality
  Protections

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CONSUMER GUIDE

• Legislation Approved and Signed into Law in 2005
  Introduced by Representative Hamos
• Requirements Include
• Expanded Reporting of Hospital Data
• ASTC Reporting
• Consumer Guide Publicly Available
• Release of Non-Identifiable Patient Level Data

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HISTORICAL PERSPECTIVEIHCCCC

• IHCCCC Collected Inpatient Data From 1987 Until
  Early 2000s When IDPH Became Designated Agency
• Over 3 Dozen States Collect and Release Info
• Historically Released Consumer Info
• Service and Procedure Reports
• Deliveries, Transplants, Select Procedures, etc.
• Limited Data Sets for Commercial Usage
• Expanded Data Sets for Research Purposes

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COLLABORATIVE APPROACH

• Hospitals and Several ASTCs Currently Report to
  IHA and IHA Forwards to IDPH
• Reduces Redundant Reporting and Burden
• IHA and IDPH Collaborate on Training
• IDPH Established Rules for Data to Be Reported
  Under State Law
• IDPH Will Oversee Process
• IDPH Has Ability At Any Time to Audit Providers
  and IHA

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REPORTING REQUIREMENTSHospital Inpatient

• July 1, 2007 December 31, 2007 Discharges
• Production Data Reporting Remains The Same No
  Changes
• Test Data Utilizes Expanded Data Set or HIPAA 837
  4010 A1 Formats

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REPORTING REQUIREMENTSHospital Inpatient

• January 1, 2008 Discharges and Beyond
• Production Data Reporting Utilizes Expanded Data
  Set or HIPAA 837 4010 A1 Formats
• Includes Expanded Data Reporting Elements, Such
  As
• Present on Admission Code For Every Diagnosis
  Code
• Birthweight in Grams
• Race and Ethnicity Using OMB Standards
• 25 Diagnoses and 25 Procedure Codes
• DNR

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PRESENT ON ADMISSION

• Decade Old Discussion at National Level
• California Started in 1996 New York a few years
  ago
• MEDPAC Identified As Key in March 2005 Report to
  Congress
• Discussed For Past 4 Years by NUBC
• Approved Coding Schema in 2005 In Response to
  States, Health Plan and AHRQ Requests

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Present on Admission Coding

• Reporting Options
• Y - Yes
• N - No
• U - Unknown
• W Clinically undetermined
• Unreported/Not used (Exempt from POA reporting)
  
• Reporting Definitions
• Y present at the time of inpatient admission
• N not present at the time of inpatient
  admission
• U documentation is insufficient to determine if
  condition
• is present on admission
• W provider is unable to clinically determine
  whether condition was present on admission or not
  
• Official Guidelines at http//www.cdc.gov/nchs/dat
  a/icd9/POAguideSep06.pdf
• (http//www.cdc.gov/nchs/datawh/ftpserv/ftpicd9/ic
  dguide06.pdf also includes POA and other ICD
  Coding Guidelines)

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ENVIRONMENTIMPLEMENTATION PLANS

• Medicare Transmittal
• Reporting October 1, 2007 with Grace Period
  Through December 2007
• Monitoring Starting January 1, 2008
• Payment Changes October 1, 2008
• Other Health Plans
• Situational (Optional) Item on 837 4010A1
• Public Reporting
• AHRQ Measurements Available Spring 2007

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HOSPITAL IMPLEMENTATION

• Assess Hospital Readiness and Areas To Be
  Addressed
• Health IT Services Internal and External
• Medical Records Staff Training
• Clinician and Physician Education and Training
• CEO, CFO, CMO, Quality, Board Discussions
• Clinical Quality Areas

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Health Information Technology

• Internal Changes
• Admission Areas
• Medical Records EHRs
• Billing Systems
• Internal Management Systems
• External Changes
• Health IT Vendors
• Clearinghouses
• Health Plan Handling If Used for Payment or
  Performance Reporting
• Challenge with coordinating Diagnoses and POA
  Codes in 837 4010A1

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Medical Records Staff

• Education on New Coding Conventions
• Understanding Nuances and FAQs
• Internal Discussions Over Diagnostic and Lab
  Results
• Developing Collaborative Approach To Securing
  Present on Admission Codes on Hospital Records
• Increase Sensitivity On Validation Processes and
  Medicare Linkage of Claims and Quality Records

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Clinician and Physician Education

• Background on New Requirement
• Timelines for Medicare Billing Remain
• Payment and Public Reporting Implications
• Medicare Compliance Initiatives
• Internal Value of POA
• Utilization With Existing Quality and Patient
  Safety Measurements

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CEO, CFO, CMO, Quality, Board

• Understand Complexity of Requirement
• Provide Necessary Resources to Accomplish and
  Conduct Internal Audits
• Begin Impact Analysis
• Identify Opportunities for Improvement
• Monitor Targeted Areas

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REPORTING REQUIREMENTSHospital and ASTC
Outpatient Surgical Data

• July 1, 2007 December 31, 2007 Patient Cases
• Production Data Reporting Remains The Same No
  Changes
• Test Data Utilizes Expanded Data Set or HIPAA 837
  4010 A1 Formats
• January 1, 2008 and Beyond Patient Cases
• Production Data Utilizing Expanded Data Set or
  HIPAA 837 4010 A1 Formats

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REPORTING REQUIREMENTSHospital Observation Care
and Emergency Department Data

• April 1, 2008 to December 31, 2008 Patient Cases
• Test Data Utilizes Expanded Data Set or HIPAA 837
  Formats
• Every Hospital Required to Successfully Past
  Testing by December 31, 2008
• January 1, 2009 and Beyond Patient Cases
• Production Data Utilizing Expanded Data Set or
  HIPAA 837 Formats

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Quarterly Reporting - Time Lines for Reporting

• Submission Deadlines are Non-Negotiable by IDPH
• Patient Level Data
• Initial Within Approximately 60 Days Following
  Close of Quarter
• Final Within Approximately 65 Days Following
  Close of Quarter
• Monthly Counts
• Initial Within 30 Days
• Final Within 60 Days
• Requests to Modify Beyond 60 Days Must Each Time
  Be in Writing to IDPH from Provider Administrator

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MINIMUM LEVEL OF DATA COMPLIANCE

• Hospitals 98 Reporting For EACH Calendar Month
  Starting with July 2007
• ASTCs
• 90 Reporting for EACH Calendar Month Starting
  with July 2007 and ending March 31, 2008
• 95 Reporting for EACH Calendar Month Starting
  with April 1, 2008 and ending March 31, 2009
• 98 Reporting for EACH Calendar Month Starting
  with April 1, 2009 and Beyond

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TRAINING OPPORTUNITIES

• Two Types of Trainings
• Webinar
• Onsite Training
• Essential to Attend Both Not Redundant
• All Training Information Available at
  www.compdatainfo.com
• Register for Webinar at http//compdatainfo.com/tr
  aining/ildatawebinarrep.html
• Register for Onsite Training at
  http//compdatainfo.com/training/ildataonsite.html
  
• All Manuals Available on EFT and Feedback Report
  Websites

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TRAINING TOPICS Webinar

• Upcoming Reporting Requirements
• New Data Elements
• Implementation Time Frames
• Expanded Flat File Format
• 837 4010A1 Format
• Present on Admission (POA)
• Expanded Data Applications

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TRAINING TOPICS Onsite

• Reminder of Implementation Timeframes and New
  Data Submission Formats
• Managing Compliance Under the New Requirements
• Submission of NPI and Taxonomy Codes
• Updated Production and Test System Screens for
  New Format and Data
• New Test File Deletion Process
• Changes to Feedback Reports
• Outpatient Counting Method and Special Case
  Handling

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HOSPITAL TRAINING UPDATE

• Approximately 214 Licensed Hospitals in Illinois
• To Date
• 68 Have Attended Webinar Training
• 79 Have Attended Onsite Training
• Additional Monthly Sessions Available for Those
  That Have Not Yet Attended
• Must Be Prepared for 01/01/08 Implementation
• Testing Questionnaire to Go Out Shortly

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Quality of Data

• Coordinate Monitoring and Internal Auditing of
  Data by Several Areas Within Hospital
• Present Results Routinely to Hospital Staff,
  Management, and Board
• Deadlines by IDPH Not Negotiable
• Information Will Be Reflective Of Your Hospital
• Ensure Internal Hospital Systems Are Aligned
  Data Will Be Matched By Others

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Dissemination of Data and Information

• Consumer Guide Under Development
• Hospitals Will Have 15 Working Days To Review and
  Comment (No Change in Data)
• Data Access Public Use and Special Data Files
• Special Data Files Usage Agreements Protecting
  Patient Confidentiality
• Will Be Utilized by Many Public and Private
  Organizations

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How to Size Up Your Hospital Improved Public
Databases Let People Compare Practices and
OutcomesThe Importance of Looking Past the
Numbers By THEO FRANCISJuly 10,
2007 Page D1 Wall Street Journal Amid a broad
push to bring more accountability to the U.S.
health-care system, consumers have access to a
growing range of data on hospital quality. Just a
few years ago, only a handful of resources
offered such data -- some of it too broad to
apply to individual hospitals. But now, the
federal government, state agencies and a number
of private entities are stepping up their push
for greater "transparency" on hospital practices.
They are mining Medicare data and state records
and surveying hospitals to come up with
user-friendly databases to help consumers
comparison-shop for care. COMPARISON SHOPPING
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USA TODAY
Transparency provides better look at health
careBy Steve Sternberg, USA TODAY Shopping
around for a heart bypass operation? If you are,
you might be wondering about such things as the
hospital's bypass-surgery death rate, how long
you'll be in the hospital and how much the
surgery costs. Until recently, people routinely
endured life-and-death procedures without getting
the kind of answers they demand when buying a
home or car. That's beginning to change. Growing
amounts of information on hospital performance
are a mouse-click away, thanks to the Internet's
limitless capacity and a bold consensus that
transparency serves hospitals and
consumers. HOSPITAL DEATH RATESMedicine's
best-kept secret revealed "We're in the middle of
an amazing transformation," says Steve Corwin of
New York-Presbyterian Hospital.
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Know Your Hospital Information

• Ensure Its Consistency Throughout Hospital and
  All Outside Entities
• Hospitals Have Responsibility For Their Accurate,
  Complete, and Timely Information
• Resources Available
• Internally
• Externally COMPdata and Other Resources Your
  Hospital Utilizes

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Future Preparation

• Transparency Abounds
• Health Plan, Employer, Consumer, Patient,
  Government Oversight Roles
• Assess Culture Survey Tool Coming Soon
• Prepare for Short Term and Long Term Review of
  Your Hospital Performance