Medical Information Reporting for California MIRCal

1
Medical Information Reporting for California
(MIRCal)
2
Success Along the MIRCal Path

• Candace L. Diamond
• cdiamond_at_oshpd.ca.gov
• CASA Annual Conference 2005

3
Agenda

• Program Status
• Frequently Asked Questions
• Data Findings
• Future Enhancements

4
Voluntary Data Submissions
Thank you!

• Limited Timeframe Feb 16 - Mar 29, 2005
• Data from Oct-Dec 2004
• 94 Emergency Departments
• 94 Hospital-based Ambulatory Surgery Clinics
• 34 Freestanding Ambulatory Surgery Centers
• Win-Win!
• Facilities tested format mapping w/o pressure
• Personal attention training from PDS analysts
• Freestanding ASCs learned the MIRCal process
• We were able to do more testing with live data

5
Now Its Real Its Working

• Emergency Departments (ED)
• 340 approved reports
• 6 unreceivable reports
• Hospital-based Ambulatory Surgery
• 370 approved reports
• 62 unreceivable reports
• Freestanding Ambulatory Surgery Centers
• 439 approved reports
• 14 unreceivable reports

6
Report Periods Due Dates

• 1st Quarter January March
• due May 15th
• 2nd Quarter April June
• due August 14th
• 3rd Quarter July September
• due November 14th
• 4th Quarter October December
• due February 14th

7
Congratulations

• 809 ambulatory surgery facilities reported a
  total of 692,126 records
• Sutter North Procedure Center was the first
  freestanding licensed ambulatory surgery center
  to receive Approved status for their report on
  April 13th.

8
Data Exceptions

• Modification key is timing
• Non-compliance key is the plan to correct
• Variant Action key is valid data

9
Fees Penalties

• Required by law
• July 2005 fee collection based on ASC estimate
• Assessed at 50 cents per record
• Penalties for late or non-compliant reports
• 100 per day
• Penalty assessment begins with 3rd Quarter 2005
• Appeal process
• Test (early often) vs. Formal Submission
• Analysts provide assistance
• Extension days available (14 days)

10
FAQ 1

• What type of facilities are required to report AS
  data to MIRCal?
• a) Freestanding Ambulatory Surgery
• Centers (Certified)
• b) Freestanding Ambulatory Surgery
• Centers (Licensed as surgical clinic)
• c) Hospitals
• d) Both b and c

11
ASC Data Reporting to OSHPD
Medicare Certified ASCs
Licensed Surgical Clinics
Medi-Cal Certified ASCs
Other ASC Ownerships
12
Key Definitions

• Record An ambulatory surgery data record shall
  be submitted for each encounter during the
  quarterly reporting period in which at least one
  ambulatory surgery procedure was performed
• Procedure
• Surgical in nature
• Carries a procedural risk
• Carries an anesthetic risk
• Coded using CPT- 4 (no modifiers)

13
FAQ 2

• What procedure codes will OSHPD collect?
• CPT Codes 10000-69999
• CPT Codes 10000-69999, HCPCS G Codes
• CPT Codes 00100-99999
• CPT Codes 00100-99999, 0001T-9999T

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FAQ 3

• Can OSHPD crosswalk the HCPCS Level II G codes to
  HCPCS Level I CPT codes?
• Yes
• No

15
FAQ 4

• Can we report modifiers with CPT codes?
• Yes
• No

16
FAQ 5

• Do we report cancelled procedures?
• Yes, if the procedure was begun
• No
• Report every procedure whether it was begun
  or not.

17
E Codes

• External Cause of Injury Codes (E-Codes)
• Must be reported for the discharge or encounter
  during which the injury, poisoning and/or adverse
  effect was first diagnosed or treated
• E-Codes are assigned from the International
  Classification of Diseases, 9th Revision,
  Clinical Modification (ICD-9-CM) (E800 E999)
• Reporting medical/surgical misadventures and
  abnormal reaction codes (E870 E879) is optional

18
FAQ 6

• For an injury that was first diagnosed or
  treated, where is E code reported?
• First inpatient discharge
• First ED encounter
• First AS encounter
• First physician office
• Only a, b, or c, whichever occurs first

19
FAQ 7

• If an injured patient was first diagnosed in a
  doctors office and sent to Endoscopy ASC, who
  reports the E code?
• Doctors office
• Endoscopy ASC
• Not applicable

20
FAQ 8

• There is a staff change to accessing MIRCal
  system. What do I
  do?
• Permit other staff to access MIRCal for you.
• Wait to be contacted by MIRCal before updating
  the changes
• Contact the UAA to update the MIRCal system (User
  Access)
• All of the above

21
FAQ 9

• Where can I find licensing information?
• www.oshpd.ca.gov/ALIRTS/index.htm
• www.oshpd.ca.gov/hid/MIRCal/index/htm

22
Current Edits

• Blank and Invalid values
• Age greater than 120 years
• Date of Birth after Service Date
• Service Date outside report period
• HIV test result reported
• Duplicate diagnosis code
• Place of occurrence E-code missing

23
Future Edits?

• Illogical relationships between data elements
  (sex, dates, diagnoses, procedures)
• Illogical relationships between codes in a data
  element (all Medicare Part A?)

24
Jan-Mar 2005First Statewide Data for CA

• Number of Patient Records
• ED 2,137,740
• Hospital AS 253,712
• Freestanding ASCs 437,542
• Average Number of Extension Days Used
• ED 9 days
• Hospital AS 7 days
• Freestanding ASCs 7 days

25
Jan-Mar 2005Gender

• Hospital AS
• 244,353 Females
• 192,246 Males
• 2,785 Unknown
• 0 Invalid and Blank
• Freestanding ASCs
• 138,659 Females
• 108,639 Males
• 1,831 Unknown
• 3 Invalid and Blank

26
Jan-Mar 2005Race

• Hospital AS
• Highest 311,895 White (code
  R5)
• Lowest 2,726 Amer.Indian/Alaskan
  (code R1)
• Problem 24,834 Unknown Race
  (code 99)
• Freestanding ASCs
• Highest 122, 608 White
  (code R5)
• Lowest 809 Hawaiian/Pac.Islander
  (code R4)
• Problem 77,155 Unknown Race
  (code 99)

27
Jan-Mar 2005Ethnicity

• Hospital AS
• 87,650 Hispanic or Latino (code E1)
• 323,443 Non-Hispanic or Non-Latino (code E2)
• 28,275 Unknown Ethnicity (code 99)
• Freestanding ASCs
• 30,427 Hispanic or Latino (code E1)
• 122,866 Non-Hispanic or Non-Latino (code E2)
• 95,822 Unknown Ethnicity (code 99)

28
Jan-Mar 2005 Top 3 Diagnoses

• Hospital AS
• V76.51 Special Screening, Colon (15,645)
• 211.3 Benign Neoplasm, Colon (11,771)
• 366.9 Unspecified Cataract (10,511)
• Freestanding ASCs
• 211.3 Benign Neoplasm, Colon (19,448)
• 366.16 Senile Cataract, Nuclear (10,854)
• 562.10 Diverticulosis, Colon, (9,389)
• with no hemorrhage

29
Jan-Mar 2005Diagnoses (data quality)

• Hospital AS
• Valid - 739,116 Princ. Diagnoses
• 747,686 Other Diagnoses
• Blank - 241 Princ. Diagnoses
• Invalid - 27 Princ. Diagnoses
• 9 Other Diagnoses
• Freestanding ASCs
• Valid - 248,914 Princ. Diagnoses
• 166,363 Other Diagnoses
• Blank - 44 Princ. Diagnoses
• Invalid - 174 Princ. Diagnoses
• 144 Other Diagnoses

30
Jan-Mar 2005 Top 3 Procedures

• Hospital AS
• 45378 Colonoscopy (27,756)
• 66984 Cataract Extraction with intraocular
• lens insertion (25,223)
• 3. 43239 EGD with biopsy (21,441)
• Freestanding ASCs
• 45378 Colonoscopy (31,912)
• 66984 Cataract Extraction with intraocular
• lens insertion (27,180)
• 3. 43239 EGD with biopsy (17,963)

31
Jan-Mar 2005Procedures (data quality)

• Hospital AS
• Valid - 438,471 Princ. Procedures
• 453,975 Other Procedures
• Invalid - 152 Princ. Procedures
• 531 Other Procedures
• c) Blank - 761 Princ.
  Procedures
• Freestanding ASCs
• Valid - 248,913 Princ. Procedures
• 67,151 Other Procedures
• Invalid - 165 Princ. Procedures
• 50 Other Procedures
• Blank - 54 Princ. Procedures

32
Jan-Mar 2005 Top 3 External Causes of Injuries

• Hospital AS
• E928.9 Unspecified Accidents (2,263)
• E927. Overexertion (1,336)
• E888.9 Unspecified Falls (1,041)
• Freestanding ASCs
• E928.9 Unspecified Accidents (825)
• E927. Overexertion (528)
• E929.9 Late effect of Unspecified Accidents
  (124)

33
Jan-Mar 2005 External Causes of Injury Codes

• Hospital AS
• Valid 19,425 Princ. E Codes
• 19,132 Other E Codes
• Invalid - 3 Princ. E Codes
• 3 Other E Codes
• Freestanding ASCs
• Valid - 2,577 Princ. E Codes
• 2,416 Other E Codes
• Invalid - 21 Princ. E Codes
• 9 Other E Codes

34
Jan-Mar 2005 Place of Occurrence - as cause

• Hospital AS Principal E Code Position
• E849.0 Home 8
• E849.3 Industrial Places 1
• E849.4 Recreation Places 1
• E849.7 Residential Institution 14
• E849.9 Unspecified Place 16
• Freestanding ASCs Principal E Code Position
• E849.0 Home 2
• E849.3 Industrial Places 8
• E849.4 Recreation Places 2
• E849.6 Public Building 1
• E849.7 Residential Institution 1
• E849.9 Unspecified Place 15

35
Jan-Mar 2005 Place of Occurrence - unspecified

• Hospital AS Other E Codes
• E849.0 Home 3,942
• E849.3 Industrial Places 793
• E849.4 Recreation Places 1,472
• E849.7 Residential Institution 1,363
• E849.8 Other Specified Place 1,518
• E849.9 Unspecified Place 8,605
• Freestanding ASCs Other E Codes
• E849.0 Home 85
• E849.3 Industrial Places 938
• E849.4 Recreation Places 191
• E849.6 Public Building 184
• E849.7 Residential Institution 26
• E849.8 Other Specified Place 82
• E849.9 Unspecified Place 784

36
Jan-Mar 2005SSN data quality very good!

• Hospital AS
• Valid - 412,499
• Invalid - 257
• Unknown - 26,558
• Blank - 70
• Freestanding ASCs
• Valid - 223,096
• Invalid - 41
• Unknown - 25,899
• Blank - 96

37
Jan-Mar 2005 Top 3 Dispositions

• Hospital AS
• 422,760 - Home (code 01)
• 13,758 - Other (code 00)
• 1,121 - Medicare-certified SNF (code 03)
• Freestanding ASCs
• 240,231 - Home (code 01)
• 7,501 - Other (code 00)
• 585 - Blank/Missing (code - )
• Other Findings Deaths
• Hospital AS 47
• Freestanding ASCs 0

38
Jan-Mar 2005 Top 4 Payers

• Hospital AS
• 108,694 - HMO (code HM)
• 56,242 - Medicare Part A (code MA)
• 48,435 - PPO (code 12)
• 43,019 - Medi-Cal (code MC)
• Freestanding ASCs
• 60,406 - Medicare Part B (code MB)
• 36,794 - Blue Cross/Blue Shield (code BL)
• 32,727 - PPO (code 12)
• 26,062 - HMO (code HM)

39
Jan-Mar 2005 Questioned Payers

• Hospital AS
• 36,058 - Medicare Part B (code MB)
• 13,584 - Other (code 00)
• Freestanding ASCs
• 11,759 - Medicare Part A (code MA)
• 8,266 - Other (code 00)

40
Importance of Ambulatory Surgery Data

• Legislative staff, health planners, researchers,
  state agencies, insurers, media, and health
  facilities
• Growth and trends of ambulatory surgery
• Comparisons with hospital care
• Needs assessments, marketing, outcomes, report
  cards, access to healthcare, healthcare
  disparities

41
Data Availability

• Immediate Data Distribution Report
• Summaries on the Internet 15 days after approval
• Public data sets with sensitive data masked
• Custom reports from OSHPD
• HIRC_at_oshpd.ca.gov

42
MIRCal Resources

• Monthly updates to MIRCal Informational Web site
• Quick Notes publication
• Computer Based Training (CBT), Updated for ED
  AS December 2004
• ED AS Reporting Manual June 2005

43
MIRCal Web and E-mail

• MIRCal Web Site (Bookmark it today!!)
• http//www.oshpd.ca.gov/MIRCal
• Whats New, Presentations, FAQ, UAA Forms, CBT,
  Regulations, Quick Notes, Contact Information,
  etc.
• MIRCal E-mail mircal_at_oshpd.ca.gov

44
Questions and Answers
45
Thank you , CASA