1. Direct Care Data TMA / WISDOM Excerpt 1 Direct Care Data in M2

2. Direct Care Data TMA / WISDOM Excerpt 2 Objectives Describe the characteristics of Direct Care Encounter-Level data files (Inpatient Admissions, Professional Encounters, Laboratory Ancillary, and Radiology Ancillary). Given a management purpose, select or avoid data elements of the direct care encounter data files in accordance with their applications and limitations. Describe appropriate use of cost and workload measures.

3. Direct Care Data TMA / WISDOM Excerpt 3 SIDR, SADR, and Ancillary Direct Care Data records –Only completed records –Most recent version of record –Detail and Summary Files SIDR (Inpatient Admissions): One record per MTF disposition. SADR (Professional Encounters): One record per MTF ambulatory encounter or inpatient professional service. Lab/Rad Ancillary: One record per entry into the CHCS system (per lab test or per radiology exam).

4. Direct Care Data TMA / WISDOM Excerpt 4 Direct Care Data Flow MDR SADR Monthly SIDR CHCS M2 At MTFs Weekly Lab/Rad Monthly

5. Direct Care Data TMA / WISDOM Excerpt 5 Location of Direct Care Data on M2 Ancillary SIDR SADR

6. Direct Care Data TMA / WISDOM Excerpt 6 Records in M2* *As of 2/9/07

7. Direct Care Data TMA / WISDOM Excerpt 7 Common M2 Data Elements for SIDR, SADR, and Ancillary Lab-Rad

8. Direct Care Data TMA / WISDOM Excerpt 8 Record ID / M2 Key Record ID: Unique number that identifies a record at an MTF (SIDR/SADR only). –Inpatient Admissions Detail: CHCS Patient Register Number (PRN) –Professional Encounters Detail: CHCS Appointment ID –Use in combination with Tmt DMIS ID M2 Key: Field in Ancillary that uniquely identifies a record.

9. Direct Care Data TMA / WISDOM Excerpt 9 Sponsor ID – Sponsor Social Security Number –Pseudo Sponsor ID. DEERS Dependent Suffix (DDS) – SIDR and SADR only –Relationship of patient to sponsor. –DDS is unique, but may not be consistent with FMP. Family Member Prefix (FMP) – SIDR, SADR, Ancillary –Relationship of patient to sponsor. –Coding scheme same as DDS, but values assigned differently for non-sponsors. –FMP uniquely assigned for data coming from CHCS, but not necessarily unique across CHCS Hosts. Patient Identification

10. Direct Care Data TMA / WISDOM Excerpt 10 Person ID –Electronic Data Interchange Person Number (EDI_PN) –Available in M2 in data FY02-present –Populated 95+% in SIDR in all FYs –Populated 99% in SADR for all FYs –Person ID considered HIPAA compliant

11. Direct Care Data TMA / WISDOM Excerpt 11 Patient Demographics Date of Birth (MM/DD/YYYY) Age: some have Age Group Code and Age Group Common Medicare Eligibility: –FY03+: A, B, C, N –FY02 and backwards: Y, N Gender Sponsor Pay Grade: Only for users with authorization to PHI Sponsor Rank Group Sponsor Service –Sponsor Service Aggregate on Ancillary as well

12. Direct Care Data TMA / WISDOM Excerpt 12 Sponsor Service

13. Direct Care Data TMA / WISDOM Excerpt 13 Beneficiary Category Patient Category (aka, PATCAT)  SIDR and SADR only (e.g., A11 = Army AD) Beneficiary Category: based on PATCAT  ACT, DA, DCO, DGR, DR, DS, GRD, IDG, IGR, NAT, OTH, RET, UNK  E.g., PATCAT A11 mapped to ACT  Dependent of Guard/Reserve (DGR) is identifiable Ben Cat Common:  4=Active Duty and Guard  1=Active Duty Family Member, including Guard  2=Retirees  3=All Others (including IDG and IGR)

14. Direct Care Data TMA / WISDOM Excerpt 14 Ben Cat Common

15. Direct Care Data TMA / WISDOM Excerpt 15 Enrollment Data Alternate Care Value (ACV) –TRICARE Program in which beneficiary is enrolled Values: Prime: A, E (and D if using FY02 & older data) Overseas Prime: B, F, H, J Plus: G, L Non-enrolled Active Duty: M (~10% in FY05 SADR) Blank or Null: not enrolled –USFHP should not be in data

16. Direct Care Data TMA / WISDOM Excerpt 16 Enrollment Data Enrollment Site: DMISID of enrollment at time care delivered, or “NONE”  Populated Enrollment Site does not mean beneficiary enrolled in Prime. (Could be Plus.) Enrollment Site Attributes If you offer TRICARE Plus, TRICARE Plus enrollees will be coded with your Enrollment Site as the DMIS ID  Filter on ACV to limit to Prime or Plus PCM ID: Primary Care Manager ID  Even though ACV shows they are enrolled, there are instances where PCM ID is blank

17. Direct Care Data TMA / WISDOM Excerpt 17 Provider Information Tmt DMIS ID & Attributes MEPRS Code of MTF department providing care –SADR: 1 MEPRS Code (1, 2, 3, or 4 places avail.) –SIDR: Up to 4 MEPRS Codes (2 & 3 places only)  Admitting, Dispositioning, Up to 2 Interim  If patient in more workcenters, info not in M2 –Lab/Rad: 1 MEPRS Code (3 and 4 places avail.) This is the “ordering” MEPRS

18. Direct Care Data TMA / WISDOM Excerpt 18 MEPRS Clinical Services (SIDR) Ex Clinical Service (MEPRS) Admit2nd3rdDisp 1AAA 2 ABCAEA 3AAAAAHABCABA 4AEAABCABAAAA

19. Direct Care Data TMA / WISDOM Excerpt 19 Geography Related Fields Beneficiary Zip Code: As in CHCS at time of service. –Beneficiary Region (01-16, AK, etc.) –Beneficiary HSSC Region (N, S, W, O) FY03+ HSSC = Health Services and Support Contract –Catchment Area/PRISM Area ID –Multi-Service Market Area (MSMA) fields –Market Area ID: Specific to TRO –TPR Flag: Indicates whether beneficiary resides in a TRICARE Prime Remote designated area

20. Direct Care Data TMA / WISDOM Excerpt 20 Diagnosis Codes ICD-9 CM diagnosis codes 8 codes in SIDR: Diagnosis 1 – Diagnosis 8, where Diagnosis 1 is the principle diagnosis 4 codes in SADR: Diagnosis 1 – Diagnosis 4 4 codes in Ancillary: Diagnosis 1 – Diagnosis 4, but currently no data available (placeholders) No decimal points To find records for beneficiaries with a particular condition, check all diagnosis code positions

21. Direct Care Data TMA / WISDOM Excerpt 21 Diagnosis Filter Example Diagnosis 1 matches pattern ‘250%’ OR Diagnosis 2 matches pattern ‘250%’ OR Etc.

22. Direct Care Data TMA / WISDOM Excerpt 22 Direct Care Inpatient Admissions

23. Direct Care Data TMA / WISDOM Excerpt 23 Each record represents the most recent version of hospital record for a patient dispositioned from an MTF –Only “completed” records are in M2 –MTFs collect other types of inpatient records but they are not included in M2 –Long Stay patients included in the M2 once discharged from the hospital (Note: inconsistent with Purchased Care data) Inpatient Admissions Detail

24. Direct Care Data TMA / WISDOM Excerpt 24 Reporting lag inherent in inpatient data collection –Requirement to complete SIDR w/in 30 days of disposition… Not always met –Lag can lead to incomplete data  Completion Factors computed at the Tmt DMISID/FM level based on # of SIDRs and dispositions reported in WWR  “Raw” = what has actually been received  “Total” = Raw estimated to completion, what is expected  “Total” not populated if data less than 40% complete –Use “Total” measures to account for missing data, as most management questions require

25. Direct Care Data TMA / WISDOM Excerpt 25 SIDR: Raw vs. Total Records* *As of 2/9/07 FYs can look “odd” because of non-DHP MTF reporting SIDRs for which there is no WWR

26. Direct Care Data TMA / WISDOM Excerpt 26 Procedure 1 – Procedure 8: ICD-9 CM –Codes are left justified and decimals not included. –Number of times a particular procedure was performed is also available DRG: TRICARE Diagnosis Related Group –Based on ICD-9 CM diagnosis & procedure codes. –One DRG per record –Can change across FYs (modified, deleted, etc.)

27. Direct Care Data TMA / WISDOM Excerpt 27 MDC: Major Diagnostic Category –25 codes for body system being treated –Based on primary diagnosis MDC is broadest grouping, retrieves records related to a diagnosis involving a body system. DRGs are more specific, ICD-9 CM diagnosis/procedure codes even more so

28. Direct Care Data TMA / WISDOM Excerpt 28  MDC 14 (Pregnancy, Childbirth, and the Puerperium)  DRG 371 (Cesarean Section w/o CC)  ICD-9 Diagnosis 65421 (Previous Cesarean Delivery) What to use? All OB care, not just deliveries?MDC Just deliveries?DRG Specific kind of delivery?Diagnosis Code

29. Direct Care Data TMA / WISDOM Excerpt 29 Preventable Admissions Does not mean the particular admission could be prevented Used as an access measure or to identify potential case management or enrollment Values based on type of care (asthma, bacterial pneumonia, cellulitis, etc…) Goal is low rates of these admissions for enrollees. These are not the Agency for Healthcare Research and Quality (AHRQ) Prevention Quality Indicators

30. Direct Care Data TMA / WISDOM Excerpt 30 Administrative Data Source of Admission: How patient arrived in hospital  Transfers into an MTF (4-8)  Admissions from ER (0)  Live Births (L)  Admissions from same day surgery (S)  Routine admission (1)

31. Direct Care Data TMA / WISDOM Excerpt 31 Source of Admission

32. Direct Care Data TMA / WISDOM Excerpt 32 Discharge Status Disposition Status Code – Transfer Out (02 – 05) – Left Against Medical Advice (07) – Death in Hospital (20) – Routine (01)

33. Direct Care Data TMA / WISDOM Excerpt 33 Disposition Status Code

34. Direct Care Data TMA / WISDOM Excerpt 34 Date Fields Admission Date: Use to stratify admissions (Note that patients still in hospital not in M2.) Service Date: Date of disposition FY/FM and CY/CM: year and month of disposition date

35. Direct Care Data TMA / WISDOM Excerpt 35 Cost and Workload Measures Raw and Total: –Most measures have both a “, Raw” and “, Total” –“Total” = Raw estimated to completion Disposition, Raw count: –Each record is a disposition –Set to 1 for all rows in table

36. Direct Care Data TMA / WISDOM Excerpt 36 Bed Days –Days as reported from MTF –Some inconsistencies in reporting (e.g., some MTFs have 0 bed days when admission date = disposition date) –Bed Days, Raw (and thus Total) have 0 (zero) days changed to 1 bed day –Bed Days of Record: the 0 bed days have not been changed –Many detailed bed day fields in M2 beyond total days. See Data Dictionary Cost and Workload Measures

37. Direct Care Data TMA / WISDOM Excerpt 37 Days by Clinical Service Work Center (Clinical Service)Days Adm2nd3 rd DispAdm2nd3 rd DispTotal AAA 44 AAAAFA 135 36 AACAABABCAAB2123 17 AAAAAHABBABC204613 Summing across the clinical bed days does not equal total bed days for the hospitalization

38. Direct Care Data TMA / WISDOM Excerpt 38 RWP: Relative Weighted Products –Intensity adjusted workload measure –Based on DRG weight (i.e., relative costliness of that DRG, hospital costs only), LOS, and other factors –RWP = DRG weight for most cases although Long Stay Outliers receive a little more for each day over the threshold; Short Stay Outliers receive a little less –BEST WORKLOAD MEASURE –Case Mix = RWP / DISP, where DRG is not 469 or 470 (ungroupable DRGs) Cost and Workload Measures

39. Direct Care Data TMA / WISDOM Excerpt 39 RWP Calculation DRGWgtALOSGMLOSSSTLSTPer Diem 109 Coronary Bypass w/o Cardic Cath 3.94316.25.72190.6918

40. Direct Care Data TMA / WISDOM Excerpt 40 Workload Measures Even though San Diego had double the number of dispositions than Walter Reed, Walter Reed actually expended more resources (CMI)

41. Direct Care Data TMA / WISDOM Excerpt 41 Top 10 DRGs (Dispositions) - FY06* *FY05 produces the same results

42. Direct Care Data TMA / WISDOM Excerpt 42 Top 10 DRGs (RWPs) – FY06* *FY05 produces the same results

43. Direct Care Data TMA / WISDOM Excerpt 43 Based on historical MEPRS data combined with direct care encounter records. Inflation applied (Patient Level Cost Allocation – or PLCA methodology) Incorporates hospital cost, as well as ancillaries, professional services and pharmacy Cost allocated to cases based on DRG weight, whether the patient had surgery, costliness of provider, and other key factors Cost Data

44. Direct Care Data TMA / WISDOM Excerpt 44 Full Cost vs. Variable Cost Full Cost: All portions of the hospital’s cost. All MEPRS “A” expenses which include Rx, salaries, supplies, etc Variable Cost: “Cost to do one more” All MEPRS “A” expenses identified as variable costs based on the Standard Expense Element Code (SEEC) Lights vs. Laundry FY05 and backwards: based on MEPRS expense data from respective FY FY06 and forward: based on FY05 MEPRS expense data, inflated to appropriate FY

45. Direct Care Data TMA / WISDOM Excerpt 45 Full Cost vs. Variable Cost Full and Variable Cost broken out by:  Direct (less salary): based on bed days  Support: based on bed days  Laboratory: based on laboratory weighted workload by DRG  Radiology: based on radiology weighted workload by DRG  Other Ancillary: based on RWP  Clinician Salary: based on professional weighted product  Other Salary: based on bed days  ICU: based on ICU days  Surgical: based on surgical DRG weight Sum of components equal Full Cost / Variable Cost Covered more thoroughly in other sections

46. Direct Care Data TMA / WISDOM Excerpt 46 Normative Data - Norms, Raw and Total CivilianMTFMTF Peer Bed DaysXXX DeathsXXX Variable CostNAXX Full CostNAXX For example, your MTF’s expected number of bed days vs. other MTFs or Civilian data

47. Direct Care Data TMA / WISDOM Excerpt 47 Questions ?