Title: Data Quality
1Data Quality
- Tips and Tricks
- Wendy Funk
- Kennell and Associates
- wfunk_at_kennellinc.com
2Objectives
- List several important MHS initiatives that rely
upon good MTF data - Identify the major MTF-level data products
- Identify common MHS Data Problems
- 4. Utilize M2 Standard Reports to analyze DQ
issues
3Transformation of the MHS into a data-driven
enterprise!
Then Rudimentary funding Closed
organization Production-focused
Now Productivity Population Health PPS
Business Plans Balanced Scorecard MCS Contracts /
TFL
4Data-Based Clinical Initiatives
5Data-Based Clinical Initiatives
- Disease Management Initiatives
- Asthma and Congestive Heart Failure
- Identification of high-risk patients using SIDR,
SADR and Claims data - Pop-Health Portal
- Preparation of action lists for providers or
primary care managers - Uses SIDR, SADR, Lab, Rad, PDTS and Claims
- HEDIS measurement, other clinical work
6Data-Based Clinical Initiatives
- Pharmacy Utilization Review
- Pharmacy Data Transaction Service (PDTS) does
real-time UR for MHS eligibles - Online since 2001
- (MTF Rx, Retail, TMOP, Paper Claims)
- Significant achievement for the MHS!
Good coding person identification
7Data-Based Funding Initiatives
8Data-Based Funding
- Prospective Payment System
- OM budgets service level
- Built-up from Business Plans with adjustments
later (HA later in course!) - Based on workload from SIDR and SADR
- Uses private sector pricing - does not rely on
MTF costs
Coding on SIDR SADR are important!
9Data-Based Funding
- Prospective Payment System
- Inpatient Earning are based on days for mental
health, and RWPs for all other care - Ambulatory earnings are based on RVUs and
provider specialty code - Pay attention to procedure and diagnosis codes,
provider specialty - PPS Policy continues to evolve.
10Inpatient PPS Earnings Example
MTFs code the SIDR SADR
HA Applies PPS Rates
MDR adds RVUs and RWPs
11Data-Based Funding
- GWOT Funding
- Additional funding on top of DHP to cover new
benefits for guard/reserve - NDAA 2004 extended period of coverage for
GWOT-activated members families - Early eligibility, screening period and extended
transitional assistance - Significant increase in eligible population
12 November 2004
New Way
Extra TAMP 2-4 months
Early Elg 60 days
Screen
Mobilization Period
Routine TAMP
Old Way
Mobilization Period
Routine TAMP
Lengthened period of eligibility!!!
13Growth in Guard and Reserve Population
14Watch it Grow!
- Includes all eligibles sponsored by
guard/reserve including sponsors
15Data-Based Funding
- GWOT Guard/Reserve
- The DHP earns money from the GWOT fund based on
SIDR, SADR, PDTS, and claims data - Direct care costs are measured using Patient
Level Cost Allocation (PLCA) costing methodology - GWOT Guard/Reserve data in M2
16Data-Based Funding
- TRICARE Reserve Select
- Allows GWOT activated guard/reserve to purchase
eligiblity after completion of TAMP. - Same access priority as ADFM, but no Prime.
- Must agree to continued service and must pay
premiums - Funding using same basic process as NDAA 2004
benefits
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18Data-Based Funding
- TRICARE for Life
- Separate fund provides for to care for Non-AD
/ ADFM Medicare eligibles - Medicare Eligible Retiree Health Care Fund
(MERHCF) - MTF (earnings) based on SIDR, SADR, PDTS.
- Medicare Eligibility from DEERS (from CMS)
- More from Mr. Moss later in course
19SIDR and SADR Full Costs for Medicare Eligibles
20Other Funding
- Third Party Collections
- CMAC for outpatient and ancillaries
- DRG based billing for inpatient
- Billing based on CHCS or AHLTA coding
- Venture Capital MISSY
- Extra funding available through TMA for CHAMPUS
Recapture - Models require MTF SIDR, SADR and EASIV.
21External Business Data
22Data-Based Contracts
- T-Next TRICARE Managed Care Support Contracts
- 3 U.S. At-Risk contracts
- Enrollment Processing and PCM Assignment
- Claims Payment
- Managed Care Much More!
- Ongoing provision by TMA of SIDR, SADR, PDTS,
Claims and DEERS data
23Data-Based Contracts
- TRICARE Global Remote, TRICARE Overseas Prime,
TRICARE for Life - Claims
- TRICARE Retail Pharmacy
- Claims PDTS
- TRICARE Mail Order Pharmacy
- Claims PDTS
24Data-Based Contracts
- TRICARE Dual Eligible Fiscal Intermediary
Contract (MERHCF) - Claims
- Designated Provider
- Managed Care (Health Care)
- Enrollment
- Capitated with Risk Adjustment
25Focus on Data Quality
26Data Quality and the MHS
- TRICARE Senior Prime
- Very poor audits
- DoD Financial Statement Problems
- Poor data quality cited
- Data problems cited repeatedly with MCS Contract
disputes
Significant focus on DQ at TMA and Services.
27Data Quality and the MHS
- Data Quality Management Control
- Data Quality Managers
- Data Quality Course
- Data Quality IPT (Functional)
- Commanders statements and review lists
- Data Quality Standard Reports for M2
28Data Quality and the MHS
- Redesign of IM/IT Process
- Functional responsibility for business rules
- Requirements vetted through IM (Services, HA/TMA,
DEERS, Others) - Requirements documented
- Significant re-engineering of data feeds
- Reduce burden on the source systems
- Process it once, ship it out where needed!
29Inpatient Data Record Flow 10/98
30Inpatient Data Record Flow4/99
31Inpatient Data Record FlowToday
Data Mart
M
T
F
C
H
C
Data Mart
S
Simplicity.
32Basic Information Systems
33Types of Systems
- MHS is a complex business
- Deliver healthcare
- Process Claims
- Managed Care
- Complex data needs multiple ways to view the
business - More than 9 million eligibles terrabytes of data
34Types of Systems
Type Purpose Periodicity Quality Example
Transactional Run the business Real-Time No time to "clean" CHCS
Data Warehouse Store, process Batch Fix and standardize MDR
Data Mart Use the data Batch Receives data from warehouse M2
35Types of Systems
Real-Time
Periodic Updates
Transactional
Warehouse
Data Mart
36Types of Systems
- Quality
- Real time systems are harder to fix
- Must often stop the real-time mission to correct
known errors - Usually too big a price to pay for a business
Cleaning is usually designed into warehouse
functions
37Types of Systems
- Using the data
- Transactional systems are not generally designed
for analysis purposes - Data Warehouses are generally used by skilled
programmers with significant data expertise - Data Marts are designed for analytical purposes
generally, intended to be easy to use
38Types of Systems
- MHS operates a complex set of systems to meet
different business requirements - New systems are generally built with routine
systems models (transactional, warehouse, mart) - Older systems arent that way!
39Types of Systems
- MHS Data Repository
- MHS Business Data Warehouse
- Receives data from transactional systems and
other data marts - Processes, cleans, archives
- Limited access
- MDR provides data to most other corporate
business systems - Services and External Entities as well
40Types of Systems
- The M2
- Data Mart
- Contains a subset of MDR data
- Contains many data files from MTFs
- Significant functional involvement in development
and maintenance - 1100 users at all levels in the MHS
- Ad-hoc querying or Corporate Reports
41Types of Systems
- The M2
- M2 contains a family of corporate reports
designed for data quality enhancements - Reports are written to resemble DQ metrics
wherever possible - Additional reports about important data problems
are also included - Report documentation is provided in your handouts
42Types of Systems
- The M2
- Most DQ reports contain data for all MTFs
- Some have prompted filters (you tell M2 your DMIS
ID and hit run) - Reports will be updated as data files are updated
- Can also be modified and/or updated by the M2
user - Examples use the reports!
- Help Desk info provided in previous presentation
43- Remainder of Presentation
- Description of systems
- Output data files
- DQ Issues or Considerations
- Use of M2 Corporate Reports to aid in DQ
Management at the MTF
44 45MTF Data Environment
- Many systems at each MTF
- Service specific systems
- TMA Systems
- Service Systems provide data to some TMA Systems
- Personnel
- Financial
46MTF Data World!
- Composite Health Care System (CHCS)
- Primary operational system supporting MTFs
- Hospital Management / Administration
- Clinical Coding
- Communicates with DEERS, other MTF-level
systems - 100 separate systems with no common database
- Extremely important to MTF operations
-
47CHCS
- Data captured as a part of doing business
-
Appointing Registration Admitting Billing
(Inpat) Ordering Ancillaries Utilization
Review Workload Capture Etc
Real time data store about health care delivery,
revenues, providers, patients, clinics and wards,
etc
LOCAL DATA ONLY!
48MTF Data World!
- Composite Health Care System (CHCS)
- Legacy Status
- Much of the functionality of CHCS is being
built in other systems - Enrollment Processing, Primary Care Manager
Assignments now done with DEERS Online Enrollment
System (DOES) - Deployment of AHLTA is underway to replace the
ambulatory data module and enhance clinical data - Referral, Appointing underway
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50CHCS is the local Hub
Financial
CHCS
Pharmacy
DEERS
AHLTA
Billing
51CHCS Files and Tables
- CHCS contains many tables and files (i.e.
patient, appointment, enrollment, etc) - Users can query CHCS, but it isnt easy!
- CHCS is not generally available centrally
- CHCS databases only contain records for the
local area. - CHCS provides many standardized extracts to
external systems
52CHCS Data Quality
- Several CHCS extracts are important to the DQ
program - Important to care for data in CHCS
- MTF will run smoother!
- All other systems that receive CHCS data will
benefit - CHCS and Data Quality
53CHCS Configuration Management
- Configuration Management
- Version control
- Applies to software and code sets
- Avoid problems by ensuring that you are running
the correct versions - If not, problems can occur!
54CHCS and Data Quality
- Software Maintenance Updates
- Changes in CHCS can affect all systems that
receive data from it - Software testing assumes users have most recent
versions operating - Sites with older software can get surprised
with interface problems
55Symptoms of CM Problems
- Whole types of information missing from a
record - Enrollment data
- Provider data
- Patient data
- May suggest an interface problem
- Check with affected systems administrators
56Symptoms of CM Problems
- Large numbers of rejections of data being sent
from one system to another - If one systems receives a code from another
that it isnt expecting, it may reject records - Some systems allow hand-jamming of data when
this happens! - Check with S.A.
57Avoiding CM Problems
- Follow Service guidance for updates to software
and tables - Plan for releases of new software coordinate
among all systems affected - Document procedures
- Monitor implementation
- Use available resources (Help Desk, Service POCs,
Peers, Interface Control Documents)
58CHCS and Data Quality
- Provider Tables
- Pseudo provider IDs (anyprov, pttech, erdoc, etc)
- Duplicate providers
- 910 series providers (identify a clinic, but not
the provider - PCM Tables
59CHCS and Data Quality
- Duplicate Records in Patient Registry
- Records will be very similar, but not exactly
the same - Will cause improper exchange of data between
systems, etc.. - CHCS has utilities to clean up duplicate
records - Plan to run routinely. Monitor. Record.
60CHCS Data Products in the MDR
Name Description Acronym
Standard Inpatient Data Record Inpatient Hospital Records SIDR
Standard Ambulatory Data Records Outpatient visit, t-con or inpatient rounds records SADR
Appointment Appointment records for outpatient visits None!
Ancillary Lab and Rad and Rx Procedure records None!
Worldwide Workload Report Summary workload data WWR
HL-7 also provided to EI/DS, but not in MDR due
to quality concerns
61Standard Inpatient Data Record
- Records about hospital stays
- MTF care (generally)
- Created from data collected during the stay, and
from existing files/tables in CHCS - Forwarded by MTFs to Service and TMA
- Processed in MHS Data Repository and sent to M2
for use. - Very important data file. Focus of several DQ
Checklist Items
62Standard Inpatient Data Record
- Information on the SIDR
- Patient Identifier and Demographics
- Sponsor Information
- Diagnosis and Procedure Codes
- Admission Disposition Dates, LOS
- Encoder/Grouper DRG
- Enrollment Information from DEERS check at time
of admission - Administrative data, etc
63Standard Inpatient Data Record
- MDR Processing of SIDR
- Person identification standardization
- Application of DEERS attributes (including
application of retroactive changes) GWOT data - DRG Grouping
- Weighting and Costing
- Encoder/Grouper DRG
- Additional field derivations
- Application of update records
- Preparation of data for M2
64Standard Inpatient Data Record
- Important Uses
- Disease Management, Case Management
- Prospective Payment System and Business Plans
- Balanced Scorecard
- Medicare Eligible Retiree Healthcare Fund
- Guard/Reserve GWOT Funding
- Venture Capital, Resource Sharing
- Etc..
65Important Data
Key Data Elements Why
Patient ID DEERS App, Disease Case Mgmt, MERHCF, GWOT, PPS, Balanced Score Card, Billing
Patient Category Code Assignment of Beneficiary Category, Billing
Diagnosis Codes Procedure Codes DRG assignment, RWPs, identification of records for certain conditions or procedures, billing
Admission and Discharge Dates Length of stay, RWPs, billing
Work Centers Application of Costs, MERHCF, GWOT
66Standard Inpatient Data Record
- Data Issues
- Completeness or Timeliness completed records
due 30 days after disposition - IMC Checklist Item
- Standard Report available comparing SIDRs
reported for each MTF to Worldwide Workload
Dispositions - Should be 100 except for most recent months
- Check M2 data status table for timing to
interpret properly
67Compliance and Timeliness Report
- tma.rm.dq.fyxx.dcip.rept.comp
- Updated once per month
- Within a few days of M2 update
- Can be updated by users also
MTF Attributes FY FM SIDR Dispositions
WWR Dispositions Complete
68Inpatient Reporting Compliance30 Day Standard
69Use Report to Identify Holes
7030 Day Reporting Compliance?
These probably should look like the others!
71Clinical Coding
- Records in M2 are available at detailed level
- One record per stay
- Record identifiers are shared with CHCS
- Tmt DMISID Patient Register Number
- PRN is called Record ID in M2
- Allows MTF staff to find records that need fixing!
72Ungroupable DRG Report Examples
- One sign of a poorly coded record (usually) is an
ungroupable DRG! (469 470) - Ungroupable DRGs are significant because they are
not counted for most purposes!
MTF Attributes FY FM Patient Register Number
Bed Days Estimated Full Cost
73After logging into M2 Users go to the path
File Retrieve from Corporate Documents
74Box pops up with all reports. Move cursor to
report of interest and click retrieve
Select tma.rm.dq.fy05.dcip.ungroupable.drg
75Includes all MTFs. To limit to your MTF, use
SLICE AND DICE The L taking a nap!
76Slice and Dice Panel Rearrange Sort
Filter Totals Etc Etc..
77Rearrange Data to summarize by fiscal year, limit
to one DMISID
78After selecting one DMISID you see a filter on
the data element. Note the calculator which will
give a grand total.
79This MTF had an estimated 116K in ungroupable
DRGs. This care earns nothing under PPS, TRICARE
for Life or GWOT Funds (This is one record where
the coder didnt list the weight of the
baby!) Drill down to find the bad cases!
80- Back to slice and dice
- Add record ID into the report
- This is one case!
- The record ID is the CHCS Patient Registry
Number. - Can be used to pull up THIS case in CHCS.
- If you fix and resubmit, it will show up in the
data!
81Standard Inpatient Data Record
- Looking at Length of Stay
- Query your MTF
- Admission and Disposition Date
- DRG
- Not a standard report, but not hard
- If you limit to long lengths of stay, you can
easily find errors
82Probably mistyped either the admission or the
disposition date. This is a delivery with a
length of stay greater than one year. Record ID
is the PRN
83Standard Inpatient Data Record
- Whats the RWP Impact on coding like that?
- First, whats an RWP?
- Basis of earnings for PPS, GWOT, TFL, etc
- Very important
- Depends on DRG and Length of Stay
- Primarily!
- DRG Weight Relative hospital costliness of that
DRG compared with all others
84Standard Inpatient Data Record
- RWP DRG Weight if length of stay is normal
- Otherwise /- credit depending on length of
stay - In this case
- RWP should likely have been 0.55
- RWP was 98.38
85Standard Ambulatory Data Record
- Not really an ambulatory record!
- Ambulatory Care (Office, ER, Same Day Surgery)
- Inpatient Rounds
- Telephone Consults
- MHS does not generally capture inpatient
procedure provider records, unlike private sector - (Hospital record is captured, but not a separate
provider piece causes problems with studying
productivity and billing) - Very important data file. Focus of several DQ
Checklist Items
86Standard Ambulatory Data Record
- Information on the SADR
- Patient Identifier and Demographics
- Sponsor Information
- Diagnosis and CPT Procedure Codes, Clinic
- Service Date
- Type of Appt
- Enrollment Information from DEERS check at time
of admission - Administrative data, etc
- Provider Specialty Code
87Standard Ambulatory Data Record
- Major Pieces of Information not on the SADR
- Units of Service and Modifiers associated with
each procedure code - Collected in ADM or AHLTA
- Not yet forwarded in the SADR
- Leads to a system-wide understatement of workload
- Change request underway
- All SADRs since OIB began will be reharvested
88Standard Ambulatory Data Record
- MDR Processing of SADR
- Due to lack of completeness of SADRs, appointment
records are used to enhance the SADR data file. - For each kept appointment, if a SADR exists, it
is used. - If a SADR is not collected, then the appointment
record is used to create an inferred SADR. - When/if a SADR finally shows up, the inferred
SADR is removed and the real SADR kept.
89Standard Ambulatory Data Record
- MDR Processing of SADR
- Match to appointment records, include SADRs and
kept appointments w/o a SADR - Application of DEERS attributes (including
application of retroactive changes) GWOT data - Weighting and Costing including estimation on
inferred records. - Person identification standardization
- Additional field derivations
- Application of update records
- Preparation of data for M2
90Standard Ambulatory Data Record
- Important Uses
- Disease Management, Case Management
- Prospective Payment System and Business Plans
- Balanced Scorecard
- Medicare Eligible Retiree Healthcare Fund
- Guard/Reserve GWOT Funding
- Venture Capital, Resource Sharing
- Etc..
91Important Data
Key Data Elements Why
Patient ID DEERS App, Disease Case Mgmt, MERHCF, GWOT, PPS, Balanced Score Card, Billing
Patient Category Code Assignment of Beneficiary Category, Billing
Diagnosis Codes Procedure Codes APG/APC assignment, RVUs, identification of records for certain conditions or procedures, billing
Provider ID Specialty RVU assignment, provider productivity, practice patterns, etc
Work Centers Application of Costs, MERHCF, GWOT
92Standard Ambulatory Data Record
- Data Issues
- Completeness or Timeliness completed records
w/in 3 days for non APV, 15 for APV - IMC Checklist Item
- Significant issue with SADR
- Very large numbers of historical SADRs are
missing - Compliance has improved but is still an issue
- New appointment records offer excellent
opportunities for managing compliance!
93Standard Ambulatory Data Record
- Compliance
- IMC Checklist Item
- Two methods for monitoring compliance
- Two Corporate Reports available for measuring
compliance - SADRWWR Comparison
- SADRAppointment Comparison
94Compliance and Timeliness Report
- tma.rm.dq.fy05.dcop.rep.comp.wwr
- Updated once per month
- Within a few days of M2 WWR update
- Can be updated by users also
MTF Attributes FY FM SADR Encounters
WWR Count Visits Ratio of SADR WWR
95Standard Ambulatory Data Record
- Compliance
- Imprecise match
- WWR visits are a subset of SADR encounters
- WWR includes only those visits that the local MTF
determines count - SADR includes all encounters
- Metric should be greater than 100
96All Encounters N 31 Million
Count Only N 29 Million
2 Million Non-Count Ambulatory Visits!
97Greater than 100 complete --- Is this good or
bad?
Built from corporate report in M2
98Compliance and Timeliness Report
- tma.rm.dq.fy05.dcop.rep.comp.appt
- Updated once per month
- Within a few days of M2 Appointment update
- Can be updated by users also
MTF Attributes FY FM Captured SADRs
Inferred SADRs of SADRs captured
99Standard Ambulatory Data Record
- Compliance
- Record level match
- Report is limited to ambulatory records, t-cons
and hearing conservation clinic. - More precise methodology
- Action report for drill to appointment ID,
provider or clinic level - Be cautious with very recent data check data
status table in M2 for timing info
100Slice and Dice
101Include year, month and percent complete to chart
out compliance metric
102Less than 100 when compared with appointments
103Swap out percent complete with number of
encounters, to see how many are missing
104Number of incomplete SADRS from FY05
105Back to slice and dice to see which clinics are
missing the most SADRs
106Clinics with the most missing SADRS Two MEPRS
Codes make up half of whats missing!
Clinic Missing SADRs of Total Missing
Primary Care 248,664 24
Family Practice 232,662 23
Pediatrics 66,930 6
All Other Clinics 484,458 47
Total Missing (05) 1,032,714 100
107Compliance Action Report
- tma.rm.dq.fy05.dcop.rep.comp.actionrep
- Updated once per month
- Within a few days of M2 Appointment update
- Can be updated by users also
MTF FY FM Provider ID Clinic
Appointment ID Missing Encounters Lost PPS
Earnings
108Standard Ambulatory Data Record
- Action Report -- Compliance
- Record ID is appointment ID same as in CHCS,
ADM, AHLTA, etc.. - Provider ID MEPRS Code are from appointment
record - Number of encounter is actual missing records
- PPS Earnings estimated by applying PPS rates to
estimated RVUs for the case (based on avg. RVUs
in that clinic, SDS or not, and type of provider)
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110Will result in a list of missing records. Record
ID is the Appointment IEN. Can be used to
retrieve records in the source system. Sorted by
descending PPS earnings low hanging fruit.
111(No Transcript)
112Use provider ID to determine impact of lost
earnings under PPS.
113Sorted list of estimated financial impact of
missing SADRs. By provider ID
114Include Record ID to assist in locating record
that needs completing.
115List of providers and their missing appointment
IDs.
116Standard Ambulatory Data Record
- Clinical Coding
- Very important poor coding can have serious
consequences - Coding problems have been cited repeatedly by
auditors - Check for ungroupables
- Evaluate coding with SADR in M2 can see
diagnosis and procedure codes.
117Ungroupable APG Report
- tma.rm.dq.fy05.dcop.ungroupable.apg
- Prompted report
- You enter your DMISID and hit run!
MTF FY FM
Appointment ID Number of Encounters Full Cost
118Review of coding practice using M2
- Record level data allows for detailed analysis of
coding practice - UBU Coding Guidelines published in TRICARE
website - Clinical coding is what drives RVU assignment
- Policy changes
- Staffing changes
- Impacts of missing records -- no count really
does count. But not coded doesnt count at all!
119How are RVUs assigned?
- Done in the MDR
- Match SADR to MHS Weight table
- Will soon be in M2
- For each procedure, assign work RVU from weight
table unless - EM code on the same record as a significant
procedure - Unspecified provider specialty (depends on the
RVU field) - Some RVU fields use slight modifications to these
rules.
120Proc Code Description RVU
EM 99203 Office Visit 1.34
1 92225 Ophthalmoscopy 0.38
2 92015 Determination of Refraction 0.38
3 76519 Ultrasound 0.54
4
Simple RVUs for this record Simple RVUs for this record Simple RVUs for this record 2.64
121How are RVUs assigned?
- MHS Weight Table
- Mostly contains CMS weights
- Modified for unique MHS reporting of pre and post
operative visits - Some additions for things CMS doesnt cover
- Units of Service is a critical missing data
elements in RVU assignment. - Serves as a multiplier in RVU assignment logic.
- PT, Mental Health, Dermatology, others
122- Typical MHS-coded same day surgery
- Separate records for pre-op, post-op and surg
- Private sector RVUs include the pre and post op
work! - MHS weight table modified so that the procedure
record only gets the weight for the procedure
pre and post ops earn weight separately.
123Standard Ambulatory Data Record
- Provider Information
- Provider identifiers are only unique to each CHCS
Host - Provider Table in CHCS
- Name, specialty, HIPAA taxonomy, etc.
- Some historic problems with names specialties
- Important for productivity analysis, billing,
provider profiling, etc. - 2 corporate reports in M2
124Unspecified Provider Specialty
- tma.rm.dq.fy05.dcop.unspecified.provspec
- Updated once per month
- Within a few days of M2 Appointment update
- Can be updated by users also
MTF Attributes FY FM MEPRS Code
w/ unspecified specialty w/o unspecified
specialty unspecified specialty
125- PPS announces future plans to discontinue
crediting SADRs with unspecified provider
specialties (910-999) - SAIC patch written for CHCS
- Significant Improvements made in FY05
126Standard Ambulatory Data Record
- Invalid Provider IDs
- Catch-all identifiers used in some clinics
- ER Doc, PT tech, Card clinic, any provider, etc.
- Usually not too difficult to find because these
IDs generally hold a large amount of workload - M2 report sorts RVUs by provider. Can review the
list to see if any obvious problems appear.
127Invalid Provider IDs
- tma.rm.dq.fy05.dcop.invalid.provid
- Updated once per month
- Within a few days of M2 Appointment update
- Can be updated by users also
MTF Attributes FY FM Provider ID
RVUs
128Invalid Provider IDs
- Report is a list of workload by provider and MTF
- Sort by descending workload
- Are the most productive providers reasonable?
- Are they real people?
- You CANNOT bill for ER DOC Lost TPOCS
billings. - Clean out provider table to remove these IDs as
options. - Discuss with clinic/appointing staff to ensure
access is not harmed, though.
129- Provider ID NUROBS
- Almost 3 times the RVUs of any other provider at
that MTF - Is this a real provider? Or perhaps an
observation unit?
130Other Important MTF Data
Pharmacy
MEPRS
Lab and Rad
131Other Important MTF Data
- MEPRS
- Financial FTE Reporting
- Covered later in the course
- Lab and Rad Data
- One record per outpatient procedure
- FY2005
- New data source. Only recently available.
- More to come as data matures
132Other Important MTF Data
- Pharmacy Data Transaction Service (PDTS)
- Drug Utilization Review system
- Real-time communications between PDTS and CHCS
- CHCS sends prescription info PDTS responds with
DUR advice - Data files from PDTS contain data that originates
in CHCS
133- Rx ordered at MTF in CHCS
- Information stored in Rx file locally
- Real time DUR Check
- PDTS receives DUR requests from MTFs (and TMOP
and Trrx) - Checks against rx history files to determine
whether its okay to dispense - Responds back to Pharmacies with go or no go
Source for MEPRS
Source for MDR/M2 PDTS Data Table
134Pharmacy and the MHS
- Growing Demand
- New expensive drugs
- Aging population
- Influx of new beneficiaries
- Startling inflation in pharmaceutical industry
- 2 product line in MHS
- Extremely important management issue
135Pharmacy Data Transaction Service
- MTF Pharmacy data from PDTS is used for many
important purposes - Medicare Accrual Fund, GWOT funding
- PPS does not use pharmacy currently.
- Very significant issues in cost data from CHCS on
individual dispensing records.
136Pharmacy Data Transaction Service
- Pre-defined Units and Drug Codes dont always go
together. - Ex. Birth control pills dispensed in a pack of
28. Is this a unit of 1 or 28? - Rounding issues and bulk issues
- Local pricing is not reliable
- PDTS re-prices everything unless the MTF has set
the local pricing flag to yes.
137Most Expensive Drug Report
- tma.rm.dq.fy05.rx.mostexp.drugs
- Updated once per month
- Toward the end of the month
- Can be updated by users also
MTF Attributes NDC Name Cost
Days Supply Cost per Day
138This MTF has its local pricing flag on. These
prices came from MTF Asthma medication is not
that expensive! Problems with pre-defined units
and NDC.
139Pharmacy Data Transaction Service
- Pre-defined Units and Drug Codes dont always go
together. - Ex. Birth control pills dispensed in a pack of
28. Is this a unit of 1 or 28? - Rounding issues and bulk issues
- Local pricing is not reliable
- PDTS re-prices everything unless the MTF has set
the local pricing flag to yes.
140Wrap Up
- M2 is a useful part of a data quality managers
tool-kit - Provides a good source for record level data
- Uses the same record identifiers as the source
systems, to allow things to get fixed faster - Contains lots of different data files from the
MTF - Corporate Reports are easy to use.
- Real time tools are still helpful and needed
141Wrap Up
- WISDOM Course for training
- Need more than software training
- Most important to understand the underlying data
- For M2 accounts
- 1-800-600-9332
- Be sure to inquire about other standardized
reports and such when other speakers present!
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