1. 1 DATA QUALITY MANAGEMENT CONTROL (DQMC) PROGRAM TRICARE Data Quality Training Course 12 February 2008

2. 2 DQMC Program Briefing Purpose Provide an overview of the Data Quality Management Control (DQMC) Program in the Military Health System (MHS): Data quality concepts; Background of DQMC Program; Components of the DQMC Program; TMA Summary of Data Quality Commander’s Statement FY 2007 metrics; Inspections and External Audit statistics; Highlight current topics and ongoing issues; and Conclusion.

3. 3 DQMC Program Data Quality Concepts Attributes … Accuracy CompletenessConsistency Timeliness

4. 4 Why Worry about Data Quality? One reason is external scrutiny... DoD IG GAO Audit Agencies Congress DQMC Program Data Quality Concepts

5. 5 Problems with Information Technology (IT) Typically, Data Quality is formulated as an IT problem...  Some of our problems with data quality can be attributed to problems with Information Technology (IT);  Examples: – Errors in transmission of data; – Errors in processing data; – Unsynchronized databases; But …  The most difficult problems we face with data quality are not directly attributable to IT, nor readily fixed by IT solutions. DQMC Program Data Quality Concepts

6. 6 A few examples of non-Information Technology problems causing problems with data quality: Lack of standardized business rules and policies; Inconsistent choices of codes, weights and algorithms; Lack of adequate training and education; Lack of adequate local data quality assurance; and Failure to set and enforce tough performance expectations about data quality. DQMC Program Data Quality Concepts

7. 7 Our people have to understand both the business and the technology… Training & Education: Quality data requires more than training data-entry personnel;  Data Quality Training Course - aimed at DQ Managers (offered 3 times a year);  MEPRS Application & Data Improvement (MADI);  Working Information Systems to Determine Optimal Management (WISDOM); and  Physicians – Documentation and Coding. DQMC Program Data Quality Concepts

8. 8 Solutions to effectively fix data problems: Reasonable feedback for Commanders and Users, such as:  Metrics - Fast feedback to Commanders about the quality of their data;  Rapid availability of data for use; Best Practices – literature, forums; and Core competency. DQMC Program Data Quality Concepts

9. 9 DoD IG identified material management control weakness for MHS - Directed development of data quality assurance and management control program; 2 Specific Reports:  DoD IG report concerning the FY98 Retirement Liability Estimate;  GAO Medicare Subvention Demonstration report; ASD (HA) concurred with DoD IG material management control weakness findings; and ASD (HA) designated TMA Resource Management Steering Committee to oversee the development of an MHS DQ Management Control Program. DQMC Program Background MHS DQMC Program Implemented 01 Dec 2000 (FY 2001)

10. 10 DQMC Program Background Data Quality Management Control Development of DQMC involved multiple working groups to include major system representatives; DoD comptroller, DoD IG and GAO provided oversight in its development; Program has been staffed through the Services with substantial input from field (former Region 11 MTFs); and Policy Memorandum signed on 29 Nov 00 for implementation on 01 Dec 00. Subsequently updated by policy memorandums dated 09 May 01, 17 Oct 01, 05 Sep 02 and DoDI 6040.40 dated 26 Nov 02.

11. 11 Department of Defense INSTRUCTION Regulatory Guidance DODI 6040.40 Military Health System Data Quality Management Control Procedures 2 Enclosures: -DQMC Review List -DQ Commander’s Statement DQMC Program Background

12. 12 DQMC Program Components of Program DQMC Program improves data quality and ensures that the MTF receives credit for properly recording the workload. Data Quality Manager & Data Quality Assurance Team; DQMC Review List - Internal tool to assists MTFs monthly in identifying and correcting financial and clinical workload data problems. This list is prepared by the Data Quality Manager and Data Quality Assurance Team [Enclosure 1 of DODI 6040.40]; and Monthly Data Quality Commander’s Statement – Specific information from the DQMC Review List that the Commander approves for forwarding to Service DQ Managers and the TMA Management Control Program Manager [Enclosure 2 of DODI 6040.40].

13. 13 Critical Success Factors Active Leadership Involvement Data Quality Managers Data Reconciliation and Audits Use of Data/Metrics by the MTFs Timely Coding/End- Of-Day Processing Rapid Feedback File/Table Build Data Base Management DQMC Program Components of Program

14. 14 DQMC Program Components of the Program Commander’s Statements received from Services on the 10th of the month for the preceding month’s report. The “DQMC Commander’s Statement TMA Summary Sheet” along with supporting charts is constructed for briefs to both the Resource Management Steering Committee and TMA Senior Leadership and Service DSGs. (Briefed twice a year.) These charts along with an updated “Hard Spots List” are distributed to the Service DQMC POCs for their monthly meeting at TMA-MC&FS. Service and TMA-Wide issues are discussed and documented at these meetings. Mr. David Fisher – Director, Management Control & Financial Studies Division, Office of the Chief Financial Officer is the TMA POC Office of the Chief Financial Officer (TMA– OCFO) TMA-OCFO is responsible for

15. 15 TMA DQ Website http://www.tricare.mil/ocfo/mcfs/dqmcp.cfm;http://www.tricare.mil/ocfo/mcfs/dqmcp.cfm Metrics and Report; and Important reference materials. TMA DQ metrics Commander’s Statements:  Received by TMA from Services on the 10th of the month for the preceding month’s report. (Applies to the prior month’s data.) Used to create the TMA Service Trends spreadsheets; TMA Summary:  Constructed from the Service Trends and briefed to both the Resource Management Steering Committee and TMA Senior Leadership and Service DSGs twice a year; Posted on the DQMC website; and Monthly DCMC Program Working Group meetings:  Service DQMC POCs and TMA meet at TMA-MC&FS; and  Service and TMA wide issues discussed and documented. DQMC Program Service Metrics FY 2007

16. 16 DQMC Program Service Metrics FY 2007 The following “DQMC Commander’s Statement TMA Summary Sheet” summarizes results of the Data Quality Commander’s Statements submitted by each Service for July 07 (Data Month May 07); Metric Standards (colors) are as follows: Green - 95-100 Yellow - 80-94 Red - 0-79 Color coding generally moves from red to green as the fiscal year progresses and issues are ironed out.

17. 17 DQMC Program Service Metrics FY 2007 See TMA Summary Sheet handout - below is an example.

18. 18 DQMC Program Inspections/External Audits DoD IG inspected -- results (Apr 01-Oct 01) were published in a report signed 29 Aug 02. General Comments: Overall indifference toward the program; Lack of communication and timely feedback to identify shortfalls in performance; Inadequate preparation and training of the DQ Team for completion of the Control Review List; and Lack of monitoring to ensure proper implementation of the program.

19. 19 DQMC Program Inspections/External Audits DoD IG MTF Specific Comments: Responses to the Commander’s Statement and Control Review Lists are unreliable. Need audit / validation of responses in the Commander’s Statement / Review List; Lack of audit trail - no supporting documentation; Lack of accountability; Lack of training; and Inadequate dedication of resources to data quality.

20. 20 DQMC Program Inspections/External Audits The DOD IG Inspection raised concerns: Prevents Defense Health Program (DHP) and Office of Secretary of Defense (OSD) from receiving a “Clean Audit Opinion;” Puts future DHP funding in jeopardy; Puts Prospective Payment in jeopardy; Third Party Collections (TPC) placed in jeopardy; and Jeopardizes MTF Accrual Financing Reimbursement.

21. 21 DQMC Program Inspections/External Audits External Audit – 2002 Iowa Foundation The audit consisted of 50 sites, 11,254 cases; Unavailability of records (47%); Specific encounter not found in 9% of the records; Coded incorrectly, 27%; 70% over coded, 30% under coded; and Coded correctly, 17%. AdvanceMed ended up with similar results National Capitol Region (NCR) availability of records (9%).

22. 22 External MHS Coding Audit DQMC Program Inspections/External Audits

23. 23 External MHS Targeted Coding Audit DQMC Program Inspections/External Audits

24. 24 Source: Data is Post-Feedback % Records Correct from Final Report Coding Audit, Military Health System, 27 July 2007 by STI. Note: IP = DRG accuracy; OP and APV = E&M, CPT, and ICD-9 accuracy. N=30 N=29 N=26 N=30 N=24 N=30 N=23 N=30 External Coding Audit Results 2007 DQMC Program Inspections/External Audits

25. 25 These tables are excerpts from Final Report Coding Audit, Military Health System, 27 July 2007 by STI. DQMC Program Inspections/External Audits External Coding Audit Results 2007

26. 26 These tables are excerpts from Final Report Coding Audit, Military Health System, 27 July 2007 by STI. DQMC Program Inspections/External Audits External Coding Audit Results 2007

27. 27 Table 3-7, Individual MTF Accuracy-Naval Medical Center Portsmouth These tables are excerpts from Final Report Coding Audit, Military Health System, 27 July 2007 by STI. DQMC Program Inspections/External Audits External Coding Audit Results 2007

28. 28 Table 3-9, Individual MTF Accuracy-Walter Reed Army Medical Center These tables are excerpts from Final Report Coding Audit, Military Health System, 27 July 2007 by STI. DQMC Program Inspections/External Audits External Coding Audit Results 2007

29. 29 These tables are excerpts from Final Report Coding Audit, Military Health System, 27 July 2007 by STI. DQMC Program Inspections/External Audits External Coding Audit Results 2007

30. 30 These tables are excerpts from Final Report Coding Audit, Military Health System, 27 July 2007 by STI. DQMC Program Inspections/External Audits External Coding Audit Results 2007

31. 31 Table 3-15, Individual MTF Accuracy-Wright-Patterson Medical Center These tables are excerpts from Final Report Coding Audit, Military Health System, 27 July 2007 by STI. DQMC Program Inspections/External Audits External Coding Audit Results 2007

32. 32 DQMC Program Current Topics Some of the items currently being pursued: Training:  DQ Course;  Taught at Navy PAD, UBO/UBU and MEPRS Conferences;  Mini MADI / M2 Primer Course; Annual Data Quality Commanders’ Statement Update:  FY08 Additional clarification of Coding Audit criteria;  FY09 – formulating addition of Duplicate Records reporting from Review List; and Internal Compliance, External Evaluation:  MHS External Coding Audit Contract.

33. 33 DQMC Program Ongoing Issues Issues being pursued: MHS Trouble-Ticket Management (Tier 2 & 3):  AHLTA Implementation Issues;  EASi Deployment Issues; Central System Table Synchronization (e.g., CPT Table):  AHLTA, CCE, CHCS and EAS IV; Coding Accuracy:  Service Improvement Plans;  TMA External Coding Audits; DQ Course Training:  Added PPS, CCE, MERHCF and MHS Helpdesk; blocks to the DQ Course; and  M2 Corporate DQ Reports added.

34. 34 DQMC Program Conclusion There are many benefits to Data Quality: Records (with accurate documentation / coding):  Provide evidence of treatment and supports budget, reimbursement and billing;  Support training and education;  Facilitate quality assurance processes;  Provide the legal defense for patients, providers and the MHS; Availability of records provides the communications link between providers and continuity of care; and Credit for MTF quality work.

35. 35 Service DQ POCs Army Mr. Tim Bacon Telephone: (210) 295-8725 [DSN 421] joseph.t.bacon@us.army.mil Navy Ms. Jane Cunningham Telephone: (202) 762-0551 [DSN 762] jane.cunningham@med.navy.mil Air Force Ms. Michele Gowen, RHIA, CCS Telephone: (703) 681-6504 [DSN 761] michele.gowen@pentagon.af.mil@pentagon.af.mil DQMC Program Conclusion

36. 36 How Can You Help? Brief medical staff on command data  Executive Steering Committee  Department & Division Heads Develop Dashboards Provide feedback to staff Be well-Read/knowledgeable in data quality  Reporting  Analysis Network and share information DQMC Program Conclusion

37. 37 Questions Questions?