ed and as data reporting oshpd healthcare information division patient data section may 23, 2005

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ED and AS Data Reporting OSHPD Healthcare Information Division Patient Data Section May 23, 2005

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Page 1: ED and AS Data Reporting OSHPD Healthcare Information Division Patient Data Section May 23, 2005

ED and AS Data Reporting

OSHPD

Healthcare Information Division

Patient Data Section

May 23, 2005

Page 2: ED and AS Data Reporting OSHPD Healthcare Information Division Patient Data Section May 23, 2005

Agenda

Announcements Frequently Asked Questions Preliminary Data Findings

Page 3: ED and AS Data Reporting OSHPD Healthcare Information Division Patient Data Section May 23, 2005

Hospital IP Data

Hospital ED Data

Hospital AS Data Freestanding ASC Data

Patient Data Reporting to OSHPD

Page 4: ED and AS Data Reporting OSHPD Healthcare Information Division Patient Data Section May 23, 2005

FAQ # 1

What is the first ED and AS Reporting Period?

a) Jan – Jun 2005

b) Jan – Mar 2005

c) Apr – Jun 2005

d) Nov – Dec 2004

Page 5: ED and AS Data Reporting OSHPD Healthcare Information Division Patient Data Section May 23, 2005

FAQ # 2

What is the due date for the first ED and AS Reporting Period?

a) February 14, 2005

b) February 15, 2005

c) May 15, 2005

d) September 30, 2005

Page 6: ED and AS Data Reporting OSHPD Healthcare Information Division Patient Data Section May 23, 2005

FAQ # 3

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) Hospitalsd) Both b and c

Page 7: ED and AS Data Reporting OSHPD Healthcare Information Division Patient Data Section May 23, 2005

ASC Data Reporting to OSHPD

Licensed Surgical Clinics

Medi-Cal Certified ASCs

Medicare Certified ASCs

Other ASC Ownerships

Page 8: ED and AS Data Reporting OSHPD Healthcare Information Division Patient Data Section May 23, 2005

FAQ # 4

What type of hospitals are required to report ED records?

a) Hospitals with EDs

b) Hospitals and Urgent Care (not EDs)

c) Freestanding Urgent Care Centers

d) All of the above

Page 9: ED and AS Data Reporting OSHPD Healthcare Information Division Patient Data Section May 23, 2005

DHS PERMITS

STAND-BY SERVICES

BASIC SERVICES

COMPREHENSIVE SERVICES

Emergency Departments

Page 10: ED and AS Data Reporting OSHPD Healthcare Information Division Patient Data Section May 23, 2005

FAQ # 5

What are all locations that are required for reporting AS procedures?

a) OR, Radiology, Cardiac Cath Lab, ASC

b) OR, Day Surgery, Cardiac Cath Lab, ASC

c) OR, Ambulatory Surgery Rooms, ED, ASC

d) OR, AS Rooms, Endoscopy Units, Cardiac Cath Lab, or Freestanding ASC

Page 11: ED and AS Data Reporting OSHPD Healthcare Information Division Patient Data Section May 23, 2005

AS Patient Data Reporting to OSHPD

Ambulatory Surgery Room

Cardiac Cath Lab

Endoscopy Unit

General Operating Room

Freestanding ASC

Page 12: ED and AS Data Reporting OSHPD Healthcare Information Division Patient Data Section May 23, 2005

FAQ # 6

Do hospitals report invasive AS procedures done in locations other than general OR, ambulatory surgery room, endoscopy units, or cardiac cath lab?

a) Yes

b) No

c) Sometimes (if part of ED record)

Page 13: ED and AS Data Reporting OSHPD Healthcare Information Division Patient Data Section May 23, 2005

FAQ # 7

What ED records must be reported?

a) Only ED encounters with procedures

b) Only ED encounters without procedures

c) All ED encounters, including LWBS

d) All ED encounters, including discontinued care

Page 14: ED and AS Data Reporting OSHPD Healthcare Information Division Patient Data Section May 23, 2005

FAQ # 8

Is the ED and AS format the same as IP format?

a) Yes

b) No

Page 15: ED and AS Data Reporting OSHPD Healthcare Information Division Patient Data Section May 23, 2005

FAQ # 9

What service date do we report if ED patient came in on May 23rd and stayed overnight?

a) May 23

b) May 24

Page 16: ED and AS Data Reporting OSHPD Healthcare Information Division Patient Data Section May 23, 2005

FAQ # 10

What service date do we report if AS patient came in on May 23 and sent home on May 24?

a) May 24

b) May 23

Page 17: ED and AS Data Reporting OSHPD Healthcare Information Division Patient Data Section May 23, 2005

FAQ # 11

What admit date do we report if an AS patient came in on May 23 and was admitted to the same hospital on May 24?

a) May 24

b) May 23

Page 18: ED and AS Data Reporting OSHPD Healthcare Information Division Patient Data Section May 23, 2005

FAQ # 12

Our hospital has to combine observation records with ED records. What do we report?

a) The combined record

b) ED record

c) Observation record

Page 19: ED and AS Data Reporting OSHPD Healthcare Information Division Patient Data Section May 23, 2005

FAQ # 13

Our hospital has to separate observation records from ED records. What do we report?

a) The combined record

b) ED record

c) Observation record

Page 20: ED and AS Data Reporting OSHPD Healthcare Information Division Patient Data Section May 23, 2005

FAQ # 14

When ED or AS patient is moved to observation, the record is replaced as an observation record. How do we report?

a) If treated in ED, report as ED record.

b) If treated in AS, report as AS record.

c) Do not report.

d) Either a or b.

Page 21: ED and AS Data Reporting OSHPD Healthcare Information Division Patient Data Section May 23, 2005

FAQ # 15

For an injury that was first diagnosed or treated, where is E code reported?

a) First inpatient discharge

b) First ED encounter

c) First AS encounter

d) First physician office

e) Only a, b, or c, whichever occurs first

Page 22: ED and AS Data Reporting OSHPD Healthcare Information Division Patient Data Section May 23, 2005

FAQ # 16

If the patient comes from ED of acute hospital A and admitted to another hospital B, who reports the E codes?

a) ED of acute hospital A

b) Hospital B

Page 23: ED and AS Data Reporting OSHPD Healthcare Information Division Patient Data Section May 23, 2005

FAQ # 17

If a patient fell from a hospital bed in a psych facility A, the attending physician first diagnosed and ordered the patient to be transferred to hospital B, who reports the E code?

a) Psych facility A

b) Hospital B

Page 24: ED and AS Data Reporting OSHPD Healthcare Information Division Patient Data Section May 23, 2005

FAQ # 18

If a patient has a drug reaction that was first diagnosed or treated during the encounter or stay, who reports the E code?

a) Psych facility

b) Rehab facility

c) ED encounter

d) AS encounter

e) Any of the above, whichever occurs first

Page 25: ED and AS Data Reporting OSHPD Healthcare Information Division Patient Data Section May 23, 2005

FAQ # 19

If an injured patient was first diagnosed in a doctor office and sent to Endoscopy Unit, who reports the E code?

a) Doctor’s office

b) Endoscopy Unit

c) Not applicable

Page 26: ED and AS Data Reporting OSHPD Healthcare Information Division Patient Data Section May 23, 2005

FAQ # 20

What procedure codes will OSHPD collect?

a) CPT Codes 10000-69999

b) CPT Codes 10000-69999, HCPCS G Codes

c) CPT Codes 00100-99999

d) CPT Codes 00100-99999, 0001T-9999T

Page 27: ED and AS Data Reporting OSHPD Healthcare Information Division Patient Data Section May 23, 2005

FAQ # 21

Can OSHPD crosswalk the HCPCS Level II G codes to HCPCS Level I CPT codes?

a) Yes

b) No

Page 28: ED and AS Data Reporting OSHPD Healthcare Information Division Patient Data Section May 23, 2005

FAQ # 22

Can we report modifiers with CPT codes?

a) Yes

b) No

Page 29: ED and AS Data Reporting OSHPD Healthcare Information Division Patient Data Section May 23, 2005

FAQ # 23

Do we report cancelled procedures?

a) Yes, if the procedure was begun

b) No

c) Report all procedures whether it began or not.

Page 30: ED and AS Data Reporting OSHPD Healthcare Information Division Patient Data Section May 23, 2005

FAQ # 24

What types of crosswalk of data elements should we be looking at?

a) Your crosswalk

b) Our crosswalk

Your crosswalk of in-house codes to OSHPD.

Our crosswalk of IP codes to ED & AS codes.

Page 31: ED and AS Data Reporting OSHPD Healthcare Information Division Patient Data Section May 23, 2005

FAQ # 25

Will OSHPD change the IP data elements to the national standards?

a) Yes

b) No

c) Later

Page 32: ED and AS Data Reporting OSHPD Healthcare Information Division Patient Data Section May 23, 2005

FAQ # 26

What is the number of extension days allowed for 2005?

a) 45 days

b) 28 days

c) 14 days

d) 7 days

Page 33: ED and AS Data Reporting OSHPD Healthcare Information Division Patient Data Section May 23, 2005

FAQ # 27

There is a hospital staff change to accessing MIRCal system. What do I do?

a) Permit other staff to access MIRCal for you.

b) Wait to be contacted by MIRCal before updating the changes

c) Contact the UAA to update the MIRCal system (User Access)

d) All of the above

Page 34: ED and AS Data Reporting OSHPD Healthcare Information Division Patient Data Section May 23, 2005

FAQ # 28 www.oshpd.ca.gov/hid/MIRCal/index.htm

Where can I find the Quick Notes, Due Dates, Regulations, System Requirements, FAQs, Data Elements, and Reporting Manual?

a) MIRCal Stars for IP or ED or ASb) Resourcesc) Laws and Regulationsd) All of the above

Page 35: ED and AS Data Reporting OSHPD Healthcare Information Division Patient Data Section May 23, 2005

FAQ # 29

Where can I find licensing information?

a) www.oshpd.ca.gov/ALIRTS/index.htm

b) www.oshpd.ca.gov/hid/MIRCal/index/htm

Page 36: ED and AS Data Reporting OSHPD Healthcare Information Division Patient Data Section May 23, 2005

Future Edits?

Illogical relationships between data elements (sex, dates, diagnoses, procedures)

Illogical relationships between codes in a data element (all Medicare?)

Page 37: ED and AS Data Reporting OSHPD Healthcare Information Division Patient Data Section May 23, 2005

Voluntary Data Submissions (Thank you!)

Timeframe: February 16 through March 29 Number of voluntary submissions of Oct-Dec 2004 data

94 ED 94 Hospital-based AS 34 Freestanding ASCs

Win-Win for all! Facilities tested format structures & mapping w/o pressures Facilities received personal training from PD analysts Freestanding ASCs learned the MIRCal process better We were able to further our testing with ‘live’ data – thank you!

Page 38: ED and AS Data Reporting OSHPD Healthcare Information Division Patient Data Section May 23, 2005

Preliminary Data Submissions

January – March 2005 MIRCal Opened April 11th

Gathered preliminary data findings from those facilities who were approved or below error tolerance level (ETL) between April 11th through May 16th.

Remember, this preliminary data does not have all facilities’ data that are still being submitted or corrected.

Page 39: ED and AS Data Reporting OSHPD Healthcare Information Division Patient Data Section May 23, 2005

Preliminary Data Submissions As of May 16th

Emergency Departments (ED)a) 235 approved data

b) 109 remaining for submission or approval

Hospital-based Ambulatory Surgerya) 256 approved data

b) 133 remaining for submission or approval

Freestanding Ambulatory Surgery Centersa) 329 approved data

b) 120 remaining for submission or approval

Page 40: ED and AS Data Reporting OSHPD Healthcare Information Division Patient Data Section May 23, 2005

Preliminary Data Submissions (Based on approved data or below ETL)

Number of Patient Recordsa) ED 1,520,340b) Hospital AS 387,754c) Freestanding ASCs 282,182

Average Number of Extension Days Useda) ED 7 daysb) AS 7 days

Page 41: ED and AS Data Reporting OSHPD Healthcare Information Division Patient Data Section May 23, 2005

Preliminary Data Findings – 1st Qtr ‘05 (gathered from April 11 – May 16)

Number of Outpatients by Gendera) ED

o 807,431 Femaleso 696,477 Maleso 16,395 Unknowno 37 Invalid and Blank

b) ASo 300,510 Femaleso 235,293 Maleso 3,500 Unknowno 8 Invalid and Blank

Page 42: ED and AS Data Reporting OSHPD Healthcare Information Division Patient Data Section May 23, 2005

Preliminary Data Findings – 1st Qtr ‘05 (gathered from April 11 – May 16)

Racea) ED

o Highest: 947,290 White (R5)o Lowest: 12,991 Hawaiian/Pac.Islander (R4)

b) ASo Highest: 350,416 White (R5)o Lowest: 3,180 Amer.Indian/Alaskan (R1)

Page 43: ED and AS Data Reporting OSHPD Healthcare Information Division Patient Data Section May 23, 2005

Preliminary Data Findings – 1st Qtr ‘05 (gathered from April 11 – May 16)

ED Diagnosisa) Valid - 1,518,884 Princ. Diagnoses

1,310,676 Other Diagnosesb) Blank - 1,400 Princ. Diagnosesc) Invalid - 57 Princ. Diagnoses

47 Other Diagnoses

AS Diagnosisa) Valid - 538,933 Princ. Diagnoses

727,355 Other Diagnosesb) Blank - 231 Princ. Diagnosesc) Invalid - 148 Princ. Diagnoses

98 Other Diagnoses Top three diagnoses – Unknown at this time

Page 44: ED and AS Data Reporting OSHPD Healthcare Information Division Patient Data Section May 23, 2005

Preliminary Data Findings – 1st Qtr ‘05 (gathered from April 11 – May 16)

ED Procedures a) Valid - 648,694 Princ. Procedures

1,341,023 Other Proceduresb) Invalid - 491 Princ. Procedures

531 Other Procedures

AS Proceduresa) Valid - 538,485 Princ. Procedures

428,011 Other Proceduresb) Invalid - 230 Princ. Procedures

428 Other Proceduresc) Blank - 598 Princ. Procedures

Top three procedures – Unknown at this time

Page 45: ED and AS Data Reporting OSHPD Healthcare Information Division Patient Data Section May 23, 2005

Preliminary Data Findings – 1st Qtr ‘05 (gathered from April 11 – May 16)

ED Cause of Injuries a) Valid - 356,486 Princ. E Codes

351,780 Other E Codesb) Invalid - 7 Princ. E Codes

6 Other E Codes

AS Cause of Injuries a) Valid - 17,562 Princ. E Codes

17,186 Other E Codes

b) Invalid - 15 Princ. E Codes 3 Other E Codes

Top three causes – Unknown at this time

Page 46: ED and AS Data Reporting OSHPD Healthcare Information Division Patient Data Section May 23, 2005

Preliminary Data Findings – 1st Qtr ‘05 (gathered from April 11 – May 16)

Social Security Numbersa) ED

o Valid - 1,215,040o Invalid - 1,491 o Unknown - 303,443o Blank - 366

b) ASo Valid - 500,970o Invalid - 250o Unknown - 37,960o Blank - 133

Page 47: ED and AS Data Reporting OSHPD Healthcare Information Division Patient Data Section May 23, 2005

Preliminary Data Findings – 1st Qtr ‘05 (gathered from April 11 – May 16)

Top Three ED Dispositions1. 1,391,404 - Home (code 01)2. 48,026 - Other (code 00)3. 39,688 - AMA or Discontinued Care (code 07)

Top Three AS Dispositions1. 516,372 - Home (code 01)2. 19,278 - Other (code 00)3. 1,087 - Medicare-certified SNF (code 03)

Deaths (as of May 16th)ED 3,500 AS 39

Page 48: ED and AS Data Reporting OSHPD Healthcare Information Division Patient Data Section May 23, 2005

Preliminary Data Findings – 1st Qtr ‘05 (gathered from April 11 – May 16)

Top Four ED Payers1. 398,633 - Medi-Cal (code MC)

2. 255,339 - Self-Pay (code 09)

3. 233,838 - HMO (code HM)

4. 106,900 - PPO (code 12)

Top Four AS Payers1. 105,352 - HMO (code HM)

2. 75,826 - Medicare Part B (code MB)

3. 65,303 - PPO (code 12)

4. 55,702 - Blue Cross/Blue Shield (BL)

Page 49: ED and AS Data Reporting OSHPD Healthcare Information Division Patient Data Section May 23, 2005

Possible Data Needs

Possible Ideas

a) Public Data Sets

b) Top Five Reasons to EDs

c) Top Five Procedures in AS Facilities

d) Volume load in EDs or AS Facilities

e) Clusters of Cardiac Cath Procs in Certain Counties

f) Clusters of Auto Accidents in Certain Counties

g) Quick Notes – Preliminary Data Snapshots

Page 50: ED and AS Data Reporting OSHPD Healthcare Information Division Patient Data Section May 23, 2005

Your Data Needs?

How do you want the data to work for you? Dissemination Plans

– Facility Profile Report– Aggregate Reports of Frequency of Diagnosis and

Procedure codes

Timeline: After 2nd Quarter report period (April-June) Your feedback and suggestions needed [email protected]