LATEST NEWS
Coding Changes Coming There are several big changes coming soon for hospitals taking part in the Texas Hospital Association Patient Data System and submitting data to the Texas Health Care Information Collection. Modifications to record formats in advance of the ICD-10 transition are the primary driver of these changes, and all PDS hospitals, whether using the Texas 2400, HCFA 1450v6 or ANSI 837 format, will have to make some adjustments.
The THCIC is moving from the 837 4010A1 Institutional Claim to the 5010, which contains expanded field sizes, codes changes and deletions, and usage changes (required/situational). Current 837 users will need to upgrade from the 4010 to the 5010 to remain compliant. Texas 2400 and HCFA1450v6 users will be transitioned to the new Texas 5200 record to remain compliant, and Thomson Reuters will convert those files into the 5010 for THCIC submission.
The ICD-10 coding system has been looming on the horizon for quite a few years and will replace ICD-9 in October 2013. The ICD-10 system utilizes longer diagnosis and procedure codes that enable specific diagnoses and procedure details on claims to produce more accurate payments and fewer reviews and denials. The Texas 5200 and ANSI 5010 formats will make it possible for records to carry the longer ICD-10 codes.
The next two articles in this newsletter contain more details on the submission format changes. One is directed at current users of the 837 Version 4010 record, who must convert to the 5010. The other article is for Texas 2400 and HCFA 1450v6 users, both of whom will transition to the Texas 5200 by next August.
837 Submitters Transition to 5010 The Texas Health Care Information Council has announced the transition from version 4010 of the 837 electronic claim to version 5010 for all 1Q2012 discharges. The new format is part of the transition to the ICD-10 coding system, which takes effect in 2013. State-reporting hospitals in the Texas Hospital Association Patient Data System that use the 837 must adapt their file formats to meet these new 5010 requirements. THCIC will require hospitals to submit data using version 5010 starting June 1, 2012.
Thomson Reuters will accept test files of version 5010 IP and OP formats starting Nov. 1. THA and Thomson Reuters have set a goal of April 2012 to complete testing and implementation of the 5010 for 837 clients.
Unlike the current version 4010/4010A1, version 5010 accommodates ICD-10 codes and must be in place before the changeover to ICD-10 can occur. The 5010 change is being implemented well before the ICD-10 implementation date to allow adequate testing and implementation time.
The Centers for Medicare & Medicaid Services has compiled an excellent side-by-side comparison document indicating where codes have changed or moved, and whether usage (required/situational) has changed. The document provides a complete diagram of the new 5010 format and shows, for example, where new segments for Admitting Diagnosis, Patient Reason for Visit and External Cause of Injury reside.
The Texas PDS team of hospital support specialists will be available to work with individual 837 facilities as needed to assist with the transition. Upon successful completion of the testing cycle next April, 837 hospitals will be compliant with THCIC 5010 requirements and prepared to accommodate ICD-10 coding in 2013.
New Format Replaces Texas 2400 and HCFA 1450 PDS hospitals using the Texas 2400 or HCFA 1450v6 also will be moving to a new file format in preparation for the onset of ICD-10. The Texas 5200 file will replace both the 2400 and the 1450v6 formats, with testing scheduled to begin in March 2012.
The transition to the Texas 5200 is necessary because neither the 2400 nor the 1450v6 are ICD-10 compliant and their structures prohibit the addition of new spaces to accommodate longer ICD-10 codes. The Texas 5200 is designed to handle the seven-digit numbers of ICD-10 diagnosis and procedure codes, accommodates more secondary codes for higher specificity, and is compatible with a variety of Thomson Reuters analytical products, eliminating the burden of separate data submissions.
Once the Texas 5200 format is implemented, Thomson Reuters will convert the data into the correct 5010 format for THCIC submission. The Texas 5200 format will be published in September, followed by a series of pre-recorded training webinars in late October. The deadline for completing the transition to the Texas 5200 is Aug. 1, 2012. As with the 837 upgrade to the 5010, moving to this new format will keep hospitals compliant with THCIC 5010 requirements and accommodate the ICD-10 codes coming two years from now.
Present on Admission Audits Upgraded Thomson Reuters is introducing additional audits for the Present on Admission indicator. The new audits will match more closely the audits of the Texas Health Care Information Collection and should reduce the number of errors that have been firing on the POA field in PDS data submissions.
Currently there is one POA audit that checks for the existence of a valid POA code, but it does not check for “appropriateness.” This audit – dx005 – will be replaced with four new audits that will check to see if the diagnosis codes and E-codes (submitted as principal or other diagnosis codes) are exempt from POA reporting.
The new audits are:
- dx009 (diagnosis code indicates exempt from POA reporting but submitted POA value is not = 1);
- dx010 (diagnosis code indicates exempt from POA reporting but submitted POA value is = 1);
- ex011 (external cause code indicates not exempt from POA reporting but submitted POA is = 1); and
- ex012 (external cause codes indicates exempt from POA reporting but submitted POA is not = 1).
The new audits will be put in place beginning with data submitted after Aug. 30 and will remain in effect until the THCIC moves to the 5010 format for 2012 discharges.
THCIC Payer Code Changes When the Texas Health Care Information Collection begins using the new 5010 record format for 1Q2012 discharges, all PDS hospitals – whether using the Texas 2400, HCFA 1450v6 or ANSI 837 format – will need to adjust the payer codes they are using to accommodate some THCIC payer code additions and deletions.
Under the new 5010 format, the following THCIC payer codes will become invalid:
- 09 – Self Pay (Self Pay to be grouped under code ZZ – Mutually Defined Unknown);
- 10 – Central Certification; and
- LI – Liability.
THCIC has added the following new payer codes for use in the 5010 format:
- FI – Federal Employees Program; and
- 17 – Dental Maintenance Organization.
These new and deleted payer codes are not reflected in the current “THCIC 837 Technical Specifications for Hospital (Inpatient)” or “THCIC Outpatient 837 Technical Specifications” documents on the THCIC website. The payer codes contained in those manuals are still valid. To find a listing of the new payer codes that take effect in June 2012, click here. The payer code listings are found on pages 73 and 155.
Quality in Brief
Decision-Support Tools Raise Doubts in Patients: Most clinicians would agree that evidence-based decision-support tools have the potential to improve quality, but patients’ perception of the tool – and the physicians who use them – might be a barrier to adoption. Studies indicate that patients are skeptical of doctors who need a computer to help them make a diagnosis and that physicians don’t want to be seen as being too reliant on technology. In one study, waiting room patients were read scenarios about physicians who used decision support and heeded the recommendation or ignored it in favor of a less aggressive or more aggressive treatment. The physician who used no decision aid was always deemed to have the highest diagnostic ability. In a similar study involving tech-savvy computer science students, they also preferred physicians who relied on intuition instead of computer aids. Patients seem to object to doctors typing questions into a computer and reading the answer back to them, and physicians are reluctant to adopt computer-based aids for fear of losing the respect of patients and colleagues. Adoption by physicians is inevitable, given the push by employers and insurers to lower costs using technology and the ease of use evidence-based medicine tools will have compared to journal articles and text resources. Eventually, patients won’t be able to tell whether doctors are using a computer to make the diagnostic decision because EBM data and decision-support tools will be embedded into electronic medical records. (1)
EHRs Present Issues for Small Practices: It’s no secret that small physician practices are less likely than large practices and hospitals to adopt and use electronic health record systems. Incentive programs help drive EHR adoption, but small practices lag behind and face a steeper climb to get to meaningful use. Nearly 60 percent of physicians work in practices with four or fewer doctors, and 65 percent of U.S. physician visits occur at these small practices. Fewer than 2 percent of physicians in a small practice reported having a fully functional EHR, and 5 percent reported having a basic system. Doctors in small practices were more likely to report financial barriers to EHR adoption. A more significant difference among small and large practices is concern about obsolescence: Small practices have limited funds and want to make sure what they get will not go obsolete in the near future. Doctors from small practices were not any more likely to report general resistance or concerns about productivity as barriers to EHR adoption. However, there are large gaps in the use of individual EHR functions, such as clinical notes and prescribing. Many small practices that have figured out how to pay for and install an EHR haven’t been able to overcome the next barrier, which is figuring out how to use the system in their practice. (2)
ED Diversion Affects Mortality Rates: Heart attack patients have a higher risk of dying within a year if the closest emergency department is on diversion on the day they get sick. Normally, if 100 heart attack patients are admitted to the ED with heart attack, 29 of them are likely to die within a year under normal operations. But if those same 100 patients had a heart attack on a day when their closest hospital ED was on diversion, the number who would die would go up to 32 percent, an additional three deaths that are potentially avoidable if the patients weren’t subject to longer transport times. Higher rates of 30- and 90-day mortality also occurred in patients who experienced diversion, but the difference was not as large as the one-year mortality increase. Additional deaths occur not just in the patients who were diverted but also in other heart attack patients who went to that hospital the same day or patients already under treatment at hospitals that accepted diverted patients. The study also indicates that the problems extend to stroke and pneumonia patients, where it’s important to get treatment early. When hospitals are crowded, door-to-balloon time is longer, time to pain medication is longer, and time to administer antibiotics is longer. (3)
Patient Surveys Good Predictor of Quality: When researchers compared patient satisfaction surveys and clinical performance measures for patients of heart attack, heart failure and pneumonia, they found high satisfaction scores were more closely linked with high-quality hospital care than clinical measures. In addition, hospitals that scored highly on patient satisfaction with discharge planning tended to have the lowest readmission rates for all three conditions. The patient survey used in the analysis also asked if hospital staff asked patients if they would have help after leaving the hospital and if they received information in writing about symptoms or health problems to look for after discharge. The findings seem to support the use of patient-reported information to complement objective clinical measures when assessing quality. Hospitals have devoted substantial resources to improving clinical performance measures for heart failure, but there has been little reduction in readmission rates or costs during the last four years. Patient perceptions about hospital care in general, and discharge planning specifically, may provide an important new tool for measuring and increasing the quality of care. Good communication with nurses was the strongest driver of patient satisfaction, with tasty food and attractive rooms low on the list. “Patient satisfaction is less about trying to make patients happy and more about increasing the quality of their interactions with hospital staff, especially nurses and physicians,” said one of the researchers. (4)
Sources: 1) Gienna Shaw, “Does Decision Support Make Docs Look Dumb?” HealthLeaders Media, 4/14/11; 2) Kate Ackerman, “When It Comes to EHR Adoption, Practice Size Matters,” iHealthBeat, 5/17/11; Rao, DesRoches, Donelan, Campbell, Miralles and Jha, “Electronic Health Records in Small Physician Practices,” JAMIA, May 2011; 3) Cheryl Clark, “ED Diversion Raises Heart Attack Mortality,” HealthLeaders Media, 6/14/11; Shen and Hsia, “Association between Ambulance Diversion and Survival among Patients with Acute Myocardial Infarction,” JAMA, 6/12/11; 4) Duke University’s Fuqua School of Business, news release, 2/14/11; Boulding, Glickman, Manary, Schulman and Staelin, “Relationship between Patient Satisfaction with Inpatient Care and Hospital Readmission within 30 Days,” The American Journal of Managed Care, January 2011.
Health Care by the Numbers
About 500,000 knee-replacement surgeries are performed annually in U.S. hospitals. Knee replacement constitutes about 65 percent of all joint-replacement surgeries and is expected to increase at least 600 percent in the next 20 years. (1)
The U.S. spent $17.4 billion, or one of every $20 in hospital costs, in 2008 on delivery-related complications. The most common complications were umbilical cord problems and perineal lacerations, at 23.3 percent and 15.8 percent, respectively. (2)
Hospitalization for septicemia or sepsis as a principal diagnosis grew from 326,000 in 2000 to 727,000 in 2008. In the same time span, the rate of the hospitalization also more than doubled from 11.6 per 10,000 population to 24 per 10,000 and cost an estimated $14.6 billion to treat. (3)
As many as 12 percent of the drug prescriptions sent electronically to pharmacies contain errors, a rate that matches handwritten orders for medicine from physicians. The analysis of 3,850 computer-generated prescriptions over a four-week period found 452 errors, including 163 that could harm the patient. (4)
More than one in four of the 117,000 new jobs created in the U.S. in July were in health care. The industry created 31,300 new jobs in July and 170,900 in the first seven months of 2011, which accounts for 18.4 percent of non-farm payroll additions so far this year. (5)
Researchers found that 66 percent of young adults aged 18 to 26 have a regular place of care and 90 percent of those had visited their health care provider at least once in the past year. The majority of those visits (59 percent) were for regular exams or preventive services; 9 percent were for the management of a chronic condition. (6)
In 2008, 6.4 percent of all emergency department visits occurred in rural areas. About 51 percent of rural EDs are in critical access hospitals. About 44 percent of adult visits to rural EDs were either paid by Medicaid (28 percent) or uncompensated/billed to uninsured patients (16.5 percent). Sprains and strains, contusions, abdominal pain, headache and back problems were the most frequently treated conditions. (7)
Sources: 1) Joe Cantlupe, “Knee-Replacement Needs,” HealthLeaders Media, 7/13/11; 2) Cheryl Clark, “5% of Hospital Costs Attributed to Maternal Care,” HealthLeaders Media, 5/20/11; 3) John Commins, “CDC: Sepsis Cost $14.6B in 2008,” HealthLeaders Media, 6/22/11; 4) Michelle Fay Cortez, “Errors Occur in 12% of Electronic Drug Prescriptions Matching Handwritten,” Bloomberg News, 6/29/11; 5) John Commins, “Healthcare Sector Drives U.S. Job Growth,” HealthLeaders Media, 8/8/11; 6) Margaret Dick Tocknell, “3 in 4 Young Adults Go to Doctor’s Office for Routine Care,” HealthLeaders Media, 6/15/11; 7) Alexandra Wilson Pecci, “Why Rural EDs Are Struggling to Survive,” HealthLeaders Media, 6/29/11.
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