care management toolkits

Care Management Toolkits

Cindy Gebremariam, RN Product Manager, Care Management

Dan Parker, PMP Product Manager, Midas+ Live

TJ McGreevy Product Management Specialist

Muffie Gallardo, CPCS, CPMSM Product Management Specialist

Care Management Toolkits

• AHRQ PSO Event Reporting

• NHSN SSI Toolkit

• NHSN CLABSI/CAUTI Toolkit

• PA Referral Toolkits – EHR and Accretive

• EHR Integrated RAC Appeals

• AHA RACTrac

- 2 - 2013 Midas+ User Symposium

Acronyms • AHRQ Agency for Healthcare Research and Quality

• PSO Patient Safety Organization

• HERF Healthcare Event Reporting Form

• PIF Patient Information Form

• SIR Summary of Initial Report

• NHSN National Healthcare Safety Network

• SSI Surgical Site Infection

• CLABSI Central Line Associated Blood Stream Infection

• CAUTI Catheter Associated Urinary Tract Infection

• MDRO Multi-drug Resistant Organism

• CDI Clostridium difficile Infection

• PA Physician Advisor

• EHR Executive Health Resources

• CMS Centers for Medicare and Medicaid Services

• ALJ Administrative Law Judge

• AHA American Hospital Association

• RAC Recovery Audit Contractor


Why a Toolkit?

• Standardized data collection and submission model

• Report data to third-parties in prescribed format

• Available for CM versions 8.0 and newer

• Toolkit revisions and/or updates are provided as indicated


Concept • A custom set of Focus Studies, Dictionaries, and

Standard Reports

• Enables the hospital to electronically submit Patient Safety Event reports to their PSO

• Meets specifications created by AHRQ for Common Formats for Patient Safety Event Reporting

AHRQ PSO Event Reporting


Components

• Focus Studies for reporting Safety Events to a PSO using AHRQ Common Formats

• Virtual Worklist Target for SmarTrack, to auto-create a PSO Focus Episode and auto-populate selected fields from a qualifying Risk Event

• Special Mapper Focus for translating data from Risk into specified PSO Focus fields

• PSO File Extraction utility launched by Standard Report

• Distributed Dictionaries for PSO data collection



Process

• Users enter data in Risk (module or RDE)

• Qualifying Events generate Worklist entries…and

• Focus episode is auto-created with mapped and copied data from Risk

• Users update and complete Focus Study

• Designated Events are flagged to send to PSO

• Standard Report generates extraction files

• Files are stored in application root (midshare)

• Files are uploaded to PSO




Risk RDE can be used to report safety events remotely.


Risk Event function is populated via Remote Data Entry.



Then, the qualified Risk Event notifications appear on a Worklist…



…and the PSO Event Focus is automatically created with

Risk Event data automatically populating applicable fields.



Some additional data is delivered to fields on other tabs.



Event-specific data is entered by PSO Toolkit users.



Data not delivered automatically will be entered by a user.



The PSO Mapper is used to translate data in Risk to…

AHRQ Common Formats terminology.



Extraction File is created for selected Facilities and PSOs.



Extraction File is stored in the application directory.



CDA-format files meet AHRQ Common Formats 1.1 & 1.2 specifications.




Reports are to be transmitted as prescribed by your PSO.


Future Directions

• AHRQ Common Formats updates

• v1.2 ready for distribution

• v2.0 in development

• Distributed Indicators, Profiles, and ReporTrack reports

• Enhanced mapping

• Streamlined data submission



NHSN SSI Reporting

Concept • Starting in January of 2012 CMS implemented a mandatory reporting

requirement for surgical procedures and SSI through the NHSN.

• To assist clients in reporting Midas+ created the SSI toolkit to

leverage the surgery and infection control modules within Care

Management.

• The toolkit allows for the collection of surgical procedure data from

the surgery module and infection information from the infection

control module.

• The goal of the toolkit is to allow the collection of all procedure data

through the surgery interface, without the interaction of a user.

Infection information requires Infection Preventionist review and

approval for submission.


NHSN SSI Reporting Components • User fields within the Surgery module collect procedure information.

These fields are updated through the surgery interface.

• User fields within the Infection Control module collect infection

information. These infections are linked through standard functionality

to the attributable surgical procedure in the surgery module. This

linkage is communicated through the toolkit to NHSN.

• A standard report that creates the files necessary for upload to NHSN.

These files contain both the procedures and infections.

• A process focus study called the Mapper that allows for the declaration

of which surgical procedure groups will be reported and allows for

mapping your terms to NHSN terms when they are received through

the interface.

• Distributed Dictionaries for NHSN data collection.


NHSN SSI Reporting Surgery User Fields – Procedures


NHSN SSI Reporting Infection Control User Fields – Infections


NHSN SSI Reporting Process Focus Study – Mapper


NHSN SSI Reporting

Future Directions • Midas+ values client feedback on the toolkit and uses that

feedback to make improvements

• As NHSN improves their reporting process the toolkit will be

updated as well


NHSN CLABSI/CAUTI Toolkit

Concept

• Beginning in January 2011, CMS implemented a

mandatory reporting requirement for central line-associated

bloodstream infections (CLABSI) through the National

Healthcare Safety Network (NHSN).

• On January 1, 2012, CMS implemented a mandatory

reporting requirement for catheter-associated urinary tract

infections (CAUTI) through NHSN.

• The toolkit supports Care Management users in the

collection and extraction of CLABSI and CAUTI data to

meet these mandatory requirements with electronic data

submission.


NHSN CLABSI/CAUTI Toolkit Components

• An encounter-level Focus Study that gathers the CLABSI

and CAUTI event data.

• A process-level Focus Study that gathers in a single form,

denominator information for all reporting locations.

• A process-level Focus Study for mapping facility locations

to those defined by NHSN.

• A set of dictionaries that supply the terms and associated

codes that match those terms to those from NHSN.

• A standard report that generates a data extraction file

suitable for upload to NHSN.



Future Directions

• Midas+ is currently working on adding MDRO/CDI and

LabID reporting abilities to the CLABSI/CAUTI Toolkit.

• Midas+ will continue to monitor NHSN reporting

requirements and evaluate the feasibility of further

expansion of this toolkit.


PA Referral Toolkits

Executive Health Resources

Accretive PAS®

Two separate toolkits:


Concept

• A real-time, electronic interface between Midas+ and

third-party vendors to manage the External Physician

Advisor referral process

• Provides status updates

• Enables the electronic receipt and attachment of the

Determination letter to the Hospital Case Management

– Concurrent Review (HCM-CR) in Midas+



Components • A set of distributed User Fields

• Unique to contracted vendor

• Positioned on a separate sub-tab under the Episode User Field tab in HCM-CR

• 3 Dictionaries

• Referral Reason

• Status Update

• Disposition




Process

• The referral is initiated in HCM-CR

• 40+ data elements are sent to the vendor via the

interface

• The external PA reviews the case

• Vendor may have been given access to medical record

by facility

• Status updates, final disposition, and letter are sent via

the interface

• The letter is attached to the HCM-CR episode


PA Referral Toolkits Executive Health Resources


PA Referral Toolkits Accretive PAS®


Referral is sent to

external PA when

you click SAVE

PA Referral Toolkits Initiating a Referral


Outbound Transaction • Transmission Date and Time

• Unique Identifier

• Midas+ Facility Code

• Patient Name

• Patient’s MRN/Universal ID

• Patient DOB

• Patient Sex

• Facility ID (Vendor specific code)

• Encounter Type:Type

• Principal Payer Type

• Principal Payer Name

• Insurance ID#

• Account Number

• Start Date

• End Date

• Attending Physician’s Contact Info

• Current Location/Room Number

• HCM Diagnoses

• HCM Procedures

• Comments

• Review Date/Time

• Care Date

• Reviewer’s Contact Info

• Level of Care

• PA Referral Date/Time

• Referral Reason

• Reviewer’s Contact Information

• Original Referral Initiated Manually flag

(if applicable)

• Faxing Additional Information (yes or no)



Comments



Inbound Transaction

• Status Updates

• Status Dates/Times

• Disposition

• Disposition Dates/Times

• Vendor Comments

• Final letter



Status Updates and Disposition



Future Directions

• Dependent on feedback from clients and vendors



EHR-Integrated RAC Appeals

Concept

• A bi-directional interface developed by Midas+ and EHR to

assist clients who contract with EHR to manage their RAC

appeals process

• Enables the automatic daily exchange of appeals

information and status updates between the client and EHR


Components

• Encounter level Focus study – Midas+ EHR Appeal

• Hospital tab

• EHR tab

• Distributed dictionary with terms relevant to the RAC

appeals process

• Automated daily transmission of data between Midas+

and EHR



Process • The client initiates the process by completing the Hospital tab

• Data is automatically transmitted to EHR from Midas+ on a

nightly basis

• Updates are automatically transmitted to Midas+ from EHR on a

nightly basis

• The Midas+ system’s logic runs once nightly in a batch process to

send data to and receive status updates from EHR

• Updates received from EHR populate fields on the EHR tab in

the MIDAS+ EHR APPEAL Focus Study

• Clients may choose to create a SmarTrack Worklist to monitor

this activity



EHR-Integrated RAC Appeals Hospital Tab


EHR-Integrated RAC Appeals EHR Tab


Future Directions

• Will include the ability to send Documents to EHR in the

outbound transaction

• Attain Platinum level certification with EHR

• Dependent on feedback from clients and EHR



AHA RACTrac Reporting

Concept

• In response to the CMS RAC Program, the AHA has

created RACTrac. This web-based survey tool allows the

AHA to aggregate RAC data that can later be used to

educate CMS and Congress on the impact of RACs on

hospitals across the United States.

• To assist clients Midas+ created the AHA RACTrac toolkit.

• The toolkit allows for the collection of RAC denial

information that can be electronically reported to the AHA

RACTrac web application.


AHA RACTrac Reporting

Components

• An Encounter Focus Study that is used to enter information

on all denial types. The MIDAS+ AHA RACTRAC focus

study collects the information that is needed by AHA.

• A Process Focus Study, called MIDAS+ AHA RACTRAC

INCEPTION, that is used to collect denial information from

the inception of your RACTrac reporting program.

• A standard report that creates the file necessary for upload

to the RACTrac online application.

• Distributed Dictionaries for AHA RACTRac data collection


AHA RACTrac Reporting Encounter Focus Study – MIDAS+ AHA RACTRAC


AHA RACTrac Reporting Process Focus Study – MIDAS+ AHA RACTRAC INCEPTION


AHA RACTRac Reporting

Future Directions

• Midas+ values client feedback on the toolkit and uses that

feedback to make improvements

• As AHA modifies their reporting process the toolkit will be

updated as well


Toolkit Documentation


Thank you for attending.

Questions?

Cindy Gebremariam

Product Manager, Care Management

[email protected]

Dan Parker

Product Manager, Midas+ Live

[email protected]

TJ McGreevy

Product Management Specialist

[email protected]

Muffie Gallardo

Product Management Specialist

[email protected]
