1. 2010 UBO/UBU Conference. Title: DQMC Review List and DQ Statement Roundtable Session: T-4-1330

2. Objectives Purpose of the Data Quality Management Control (DQMC) Review List and Data Quality (DQ) Statement Roundtable – Increase community awareness Background and history TRICARE Management Activity (TMA) Data Quality Management Control (DQMC) Program – TMA comments – Service comments – Discuss issues 2

3. DQMC Background & History Why Worry about Data Quality? One reason is external scrutiny... DoD IG GAO Audit Agencies Congress 3

4. DQMC Background & History TMA DQMC Program improves data quality and ensures that the Military Treatment Facility (MTF) receives credit for properly recorded workload Governed by DoDI 6040.40, updated annually 4

5. DQMC Background & History Typically, data quality is formulated as an information technology (IT) problem – Errors in transmission – Errors in processing – Unsynchronized databases But our most difficult problems with data quality are often not directly attributable to IT, nor readily fixed by IT solutions – Standardization of business rules and policies across Services, between agencies – Inconsistency of choices for codes, weights, and algorithms – Expectations of low data quality 5

6. DQMC Background & History Data Quality Management Control (DQMC) Program was created to alleviate Department of Defense (DoD) Inspector General’s (IG) identification of material management control weaknesses within the Military Health System (MHS) – DoD IG report concerning the fiscal year (FY) 1998 Retirement Liability Estimate – Government Accountability Office (GAO) Medicare Subvention Demonstration report Elements of the DQMC Program – TMA DQMC Program, collaboration between TMA POC and 3 Service POCs – Policy Memorandum (29 Nov 2000) – DoDI 6040.40 (26 Nov 2002) updated annually DQMC Review List Data Quality Statement 6

7. DQMC Background & History Start with the DQMC Review List – Enclosure 1 of DODI 6040.40 Monthly DQ Statement – Subset of DQMC Review List sent to Service DQ managers and the TMA DQMC Program Manager Enclosure 2 of DODI 6040.40 – Commander approval – Used to create TMA Summary Tri-Service view of data Briefed to both the Resource Management Steering Committee (RMSC) and to TMA Senior Leadership and Service Deputy Surgeons General (DSGs) (CFOIC), twice per year 7

8. DQMC Background & History How are these metrics used? – Timely feedback to the Commanders about the quality of their data – Discussed monthly at DQMC Workgroup meetings Service DQ POCs and TMA meet at TMA-MC&FS Service and TMA wide issues discussed and documented – Posted on the TMA-OCFO, MC&FS – Web site, DQMC Webpage http://www.tricare.mil/ocfo/mcfs/dqmcp.cfm Metrics & Reports Important reference material 8

9. TMA Comments Example of the TMA Summary Sheet 9

10. TMA Comments Metric Standards (colors) are as follows: Green – 95-100 Yellow – 80-94 Red – 0-79 Except for 9e, which is Green for 80 and above 11a does not have a standard – no color Metric colors – Generally move from red status to green status over the fiscal year, indicates data quality matures over the year – Sometimes “RED” is good, revealing a system wide problem – Sometimes there is no coloring to indicate a new question or one for which a goal is not yet established 10

11. 11 TMA Comments Example of TMA Summary – FY11 Metric Questions

12. 12 TMA Comments Example of TMA Summary – FY11 Metric Questions (cont’d)

13. TMA Comments Initiatives for this year – Clarified questions for tri-Service uniformity in answers – Consolidated DD Form 2569 (other health insurance) related questions into one (DQ Statement Q8) with sample separate from Coding audit; only includes Non-AD records – Calculate Service-level and Region-level metrics based on counts rather than an average of MTF statistics; the Service-level metric is now weighted toward the larger MTFs (Except for Q5, 6, and 7, which are calculated as an average of averages) 13

14. Data Quality Management Control (DQMC) Program Review – Other Health Insurance (OHI), DD Form 2569 Currently no Army-wide solution for development of an electronic DD Form 2569 Army sites using a contracted vendor to identify beneficiaries with OHI have reported increase in beneficiaries identified with OHI Army sites using outside vendor report increased revenue collections Army Medical Command considering several different models for Third Party Collections Northern Regional Medical Command has directed that MTFs within this region use civilian contract company to identify individuals with Other Health Insurance 14 Army Comments

15. 15 – Coding Army using Code Auditing and Reporting Application (CARA) Coding audits conducted under Patient Administration Systems and Biostatistics Activity (PASBA) oversight Auditing approximately 12,500 outpatient encounters per month, and mediating results with MTFs CARA coding results will be incorporated into Army Production Based Adjustment Model CARA results are used by all Army MTFs to populate monthly DQMC Program DQ Statements Army Comments (cont’d)

16. 16 – DQMC Program Changes for Army New Web-based application, to include Web-based Review List Maintained three Army-only questions to DQ Statement Completed and submitted inpatient records for the month Unfiled loose documents on active duty, or individuals retired more than 30 days Unfiled loose documents on non-active duty individuals Enhanced report creation capability Web-based application permits MTFs to regenerate comments from month-to-month without having to copy and paste Army Comments (cont’d)

17. Navy Comments Navy Medicine FY11 DQMC Goals Improve data transmission metrics to meet deadline 100% for 10 of the 12 reporting months Improve DD FM 2569 collection in all three medical record categories Achieve 95% in all DQMC Readiness Categories by the March 2011 data month Region command DQMC submission will improve to be 100% compliant 10 of the 12 reporting months 17

18. Navy Comments (cont’d) Highlighted Changes in FY11 DMHRSi: 100% compliance (or provide an appropriate justification) to process in EAS DD Form 2569: Sample separate from Coding audit; only includes Non-AD records 7 POMI questions added (Navy Medicine unique) Non-Compliant metrics must use standard format in comment section Regional and Service-level metrics based on raw data – Larger MTFs have greater impact, on average 18

19. Navy Comments (cont’d) FY 10 DQMC Outpatient Coding Accuracy Improvement Areas: INCREASE Sample Size Minimum of 30 records only provides a 90% confidence level…coding accuracy goals are 95% Evaluation & Management (E&M) Coding : 31% of incorrect E&M due to incorrect category, (i.e., New vs. Established) 23% due to lack of documentation to support the E&M 31% workload loss; under-coded or the code was not reported Diagnosis (ICD-9) Coding: 29% were not the correct first listed diagnosis Other factors were incorrect linking of procedures and/or DX order Procedure (CPT) Coding: 44%workload loss; documentation supported a procedure that was not coded 19

20. Navy Comments (cont’d) Check it out! MHS Coding Audit Guidelines Appendix F? – Defines Purpose, Business Rules, – Audit Assessment (Based on Coded Data from MHS Central Database) Medical record audits include ICD-9-CM diagnoses, the first listed E&M, and CPT/HCPCS procedure codes. No entry in the E&M field will be used for APV encounters unless an E&M service is provided that is significantly separate from the service provided. Linkage of diagnosis to CPT/HCPCS, modifiers and second or third listed E&M will not be addressed at this time since these data elements do not pass through to the SADR and therefore are not available in an MHS central database – Instructions for Auditing 20

21. Navy Comments (cont’d) DD FM 2569s 21

22. Navy Comments DD Form 2569 Metric In a random review of Non-Active Duty medical records/encounters from the data month, looking for the DD Form 2569s (electronic or hardcopy), the Uniform Business Office staff determined the following percentages from a minimum sample size of 30 records/encounters…. c) What percentage of completed and current (signed within the past 12 months) DD Form 2569s (TPC Insurance Info) is available for audit (Non-Active Duty encounters only)? (See DoD 6010.15-M, MTF UBO Manual) 22

23. 2010 UBO/UBU Conference 23 Navy Comments Successful Data Quality Programs REQUIRE TEAMwork!

24. Air Force Comments AFI 41-120, “Medical Resource Operations” revision will include a DQ Chapter MTF Feedback on Review List and Statement questions DQ Team User’s Guide (TUG) – Formalized publication – Primary AF guidance to support AF DQATs – Excel  format/expanded to cover the entire Review List, not just the statement questions (quick reference) – Clarification, background, formulas, data sources, performance thresholds for all DQ Review List Questions 24

25. Air Force Comments DQ TUG sample 25

26. Air Force Comments AFMOA Current DQ Statement Issues – Quality…comments…review levels…performance MTF Support: Vector Check, one-on-one, DCO, Conferences, and Bi-monthly telecons (AF Breakout) AF Patient File Data Quality Initiative extended eDQ – Electronic DQ Review List/Statement – Automation – Benefits – Status 26

27. AF Comments – Health Service Inspection 2011 DQ Requirements 27 Document List Data Quality Manager appointment letter Commander’s DQ Statements and DQMC Review List (previous 12 months – DoDI 6040.40 requires these be maintained for the previous 5 years) DQ Assurance Team meeting minutes (previous 2 years). Element 3.2.2. Checklist The MTF/CC appointed a DQ Manager and Alternate who are responsible for accomplishing DQMC activities – Completes the DQMC Review List monthly – DQ Manager briefs DQMC Review List and Financial and Workload Data Reconciliation and validation results monthly to the MTF Executive Committee

28. 28 A DQ Assurance Team was established (or an existing structure was tasked) and met monthly to monitor financial and clinical workload DQ assurance and management controls Team members included, as a minimum, the DQM, MEPRS Manager, Budget Analyst, RMO, Medical CIO, GPMs, and Patient Administration DQAT developed/monitored corrective action plans for all negative findings on the DQMC Review List DQAT members read/complied with DODI 6040.40 and AF DQ Team User’s Guide Maintain DQMC summary supportive documentation for all DQMC Review List questions AF Comments – Health Service Inspection 2011 DQ Requirements (cont’d)

29. Air Force Comments CHCS Provider File initiative 29

30. Air Force Comments 30 Data Quality Umbrella Data Quality Foundation

31. 31 Are you providing the DQ Manager at your MTF the information needed? – DQMC Review List applicable to UBO A.6, A.7, B.4, C.8, E – DQMC Review List applicable to UBU A.5, A.7, B.4, B.6, C.2, C.5, C.6, C.7, E – DQMC Review List applicable to MEPRS A.7, B.4, C.1, C.3, C.9, E What are the pitfalls to collecting updated DD Form 2569s (Other Heath Information (OHI)) – Civilian clinics won’t treat without full insurance information, including OHI Roundtable Topics

32. DQ Statement Metrics – FY 2010 data Roundtable Topics 32

33. DQ Statement Metrics – FY 2010 data Roundtable Topics 33

34. 34 Late tables. Are you coding when you shouldn’t be? Are you attempting to bill? – FY10 International Classification of Diseases, 9 th Edition (ICD-9) code table updates were delayed – Must wait for the table update before completing Standard Inpatient Data Records (SIDRs) and grouping Roundtable Topics

35. DQ Statement Metrics – FY 2010 data Roundtable Topics 35

36. Roundtable Topics What are your success stories? 36