Texas Hospital Association

October 2013

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PDS News
News from THA's Patient Data System
Patient Data System, Another Data Product of the Texas Hospital Association
 
checkmark Inside This Issue Fall 2013
PPX Required in Outpatient Files

Data File Enhancements and Changes in Q2 2013 Files

Upcoming Webinar: Severity and Risk Adjustment Explained
 

New! Outpatient Executive Reports

ICD-10-CM and ICD-10-PCS Implementation Plan

Rural Provider Exemption Repeal

Hospital Emergency Department Data Collection
 

Discharge Disposition Status

Vendor Software Change Fee

THCIC Data Collection Workshop Notes
 

 
PPX Required in Outpatient Files
The principal procedure code is a required data element for hospitals enrolled in the PDS Outpatient Data Collection Solution. Even though the PPX is not necessary to satisfy Texas Health Care Information Collection rules, it is a critical data element in the PDS outpatient program, which is designed to provide data for analysis as well as assist hospitals with compliance. Outpatient records submitted to Truven Health Analytics for the PDS outpatient program will be flagged with an error if the PPX is not included.

The PPX is necessary to classify outpatient records appropriately, and it provides added value to the data products made available to PDS clients through Truven Health. Adding the PPX to outpatient records makes it possible to assign each record to the proper clinical service category for a variety of Truven Health’s deliverables, including Market Expert State Data Analyst and the downloadable outpatient database of individual patient records.

The outpatient PPX should be located in the same place as the inpatient PPX for hospitals using the Texas 5200 format: field 412, numeric, right justified, position 2367 to 2374. Hospitals using the Tx837i format should locate PPX in the 2300 loop, HI segment (Principal Procedure Information), element HI01-2. Additional procedure codes (“Other Procedure”) can still be submitted in the SV2 segment of the 837; however, the PPX should not be duplicated in the SV2 segment.

The audit requiring the PPX (px021 – “Principal Procedure is Blank or Zero. Other Procedures Reported”) will continue to fire as a fatal error on any outpatient batches submitted to Truven Health. These errors will be noted on your data quality report.

If you have questions about the placement or use of the PPX, please contact your client support specialist at Truven Health.

 
Data File Enhancements and Changes in Q2 2013 Files
The following changes have been made to the upcoming release of your second quarter 2013 hospital data files. Some of these changes may require modifications by the user or programming to import or analyze the data in these files.

Additions to the file:

  • The Truven Health Analytics standard payer code has been added to the end of the payer.txt, payercoderef.txt and payersubcoderef.txt files. This will assist with analysis of multistate data sets.
  • Hospital address and hospital city have been added to the hospitalref.txt file.

Changes to the file:

  • The patient control number field has been expanded to allow for 50 characters. This will affect the patientregistration.txt and phi.txt files.
  • The race and ethnicity fields have been expanded to allow for three characters. This will affect the patientregistration.txt, raceref and ethnicityref.txt files.
  • The asource and atype fields have been expanded to allow for three characters. This will affect the patientregistration.txt, atyperef.txt and asourceref.txt files.
  • Payer code fields have been expanded to allow for five characters. This will affect the patientregistration.txt, payer.txt, payercoderef.txt and payersubcoderef.txt files.
 
Upcoming Webinar: Severity and Risk Adjustment Explained
David Foster, Ph.D., lead scientist with the Center for Healthcare Analytics for Truven Health Analytics, will present a webinar on understanding risk-adjusted modeling on Wednesday, Oct. 30, from noon to 1 p.m. Central. Foster is the designer and developer of predictive or risk-adjustment models, including those incorporating Present on Admission diagnostic information and anticipated transition to ICD-10.

Severity and Risk Adjustment Explained will focus on how the risk adjustment method attempts to account for all factors, other than the health care intervention itself or process of care (i.e., what was done to the patient), that may explain variation in patient outcomes.

After viewing the webinar, you will be able to:

  • Know what risk adjustment does and why it’s necessary;
  • Be familiar with the underlying calibration data, the Truven Projected Inpatient Data Base, and the significance of normative data in adjustment methodologies;
  • Learn which patient factors are taken into account for risk adjustment;
  • Know what the facility- and discharge-level exclusions are for Truven adjustment methodologies; and
  • Be able to see how the Truven mortality methodology performs against other mortality methodologies in terms of predictive accuracy.

This webinar is designed for data reviewers and submitters; quality management and financial analysts; market researchers; and others interested in learning about the methodologies behind the Texas Hospital Association Patient Data System.

Register now at the THA website.

 
New! Outpatient Executive Reports
The current economic environment is enhancing the need to control costs and improve quality. The ability to identify profitable outpatient services can help guide a hospital’s strategic direction.

To help you streamline your outpatient services, the Texas Hospital Association Patient Data System is expanding its suite of data products to include Care Comparison Outpatient Executive Reports through partner Truven Health Analytics. These new reports will provide valuable information on:

  • Service Line Volume: the number of outpatient procedures performed by your hospital categorized by clinical and technical service line categories;
  • Top Procedure Volume: a list of the highest-volume and highest-charge outpatient procedures performed by your hospital;
  • Market Share: a list of the highest-volume and highest-charge outpatient procedures performed by your hospital and market share percentage compared to other acute-care facilities in your market (top competitors are named in the report);
  • Calculation of Charges and Estimated Costs: the sum total of actual charges submitted by the facility but not those of competing hospitals (costs are estimated for each hospital based on cost-to-charge ratios calculated from the hospital’s most recent Medicare cost report); and
  • Comparison of Estimated Costs to Benchmarks: comparisons of estimated costs per case for the hospital to established benchmarks. Significant differences between actual and benchmarks costs are highlighted.

You’ll receive Care Comparison Outpatient Executive Reports quarterly by email, with the most current data available for your hospital and your market presented in an executive dashboard that shows a series of easy-to-read reports.

For a limited time only, you can take advantage of pricing discounts available for advance purchase. This offer expires Dec. 31. For pricing and more information, contact Tim Logan at Truven Health Analytics at 615/778-6362.

 
ICD-10-CM and ICD-10-PCS Implementation Plan
Below are notes from the monthly update call from the Texas Health Care Information Collection held on Sept. 24.
  1. Oct. 1, 2014, is the deadline for transition to ICD-10-CM (diagnosis codes) and ICD-10-PCS (procedure codes). The date is firm.
    1. THCIC/System13 plan to begin accepting and processing claims data with ICD-10-CM and ICD-10-PCS codes with discharge or statement through dates of Oct. 1, 2014, and later.
    2. Claims with discharge or statement through dates prior to Oct. 1, 2014, will need to still be in ICD-9-CM (diagnosis and procedure codes).
    3. THCIC will be creating and releasing general equivalence mappings between ICD-9-CM codes and ICD-10-CM and ICD-10-PCS codes for THCIC data conversions for the data.
      1. THCIC staff are still discussing how 2014 data will be displayed for reports and how any trending reports will be displayed.
      2. Staff are looking into what the federal government and other states are doing on the general equivalence mappings and whether there is a possibility to create a 1-to-1 conversion for forward and backward mappings since this would be best if possible; otherwise, any mappings would have multiple caveats that must accompany the data and will create confusion.
  2. March 1, 2015, is the first deadline by rule for submission of fourth quarter 2014 data.
    1. There currently is no anticipated change for this due date at this time.
    2. If circumstances occur that require a change or modification of submission correction or certification processes or the deadline for Q4 2014 data, THCIC will notify the facilities via the numbered letters as quickly as possible.

Don’t miss out on a related upcoming webinar from the Texas Hospital Association and Texas Healthcare Trustees. Putting Together the Pieces to Create an Effective ICD-10 Program will be offered Oct. 29 from noon to 1 p.m. Central. For more information, go to the THA website.

If you need help with the ICD-10 changeover process, contact Matt Kruse at 512/465-1558.

 
Rural Provider Exemption Repeal
In the past, a health care provider may have qualified for an exemption from reporting data to the Texas Health Care Information Collection if it met certain criteria.

Hospitals currently exempt from reporting data to THCIC now will have to submit inpatient and outpatient (surgical and radiological events) data as well as emergency department data. The first quarter this may apply to would be the fourth quarter of 2014, which coincides with the ICD-10-CM and ICD-10-PCS start date of Oct. 1, 2014, for the U.S.

In order to avoid duplicative use of information technology services for those rural facilities due to the implementation deadline of ICD-10, THCIC staff anticipates the collection of data inpatient discharges and the select outpatient services from rural facilities (hospitals and ambulatory surgery centers) will begin Jan. 1, 2015. It still will be in conjunction with the ED rules and data collection.

If you are an exempt hospital and would like to learn more about how the Texas Hospital Association can help you prepare for data submittal in 2014, contact Matt Kruse at 512/465-1558.

 
Hospital Emergency Department Data Collection
The Texas Legislature provided funding for the Texas Health Care Information Collection to collect hospital-based emergency department data. Texas Department of State Health Services staff anticipate the collection of the ED data to begin with discharges/dates of service on or after Jan. 1, 2015. This is due to the implementation of ICD-10-CM and ICD-10-PCS on Oct. 1, 2014. It is anticipated the rules will be adopted by Oct. 1, 2014, to meet the required 90-day adoption deadline prior to collecting new data elements (HSC, §108.009(b)).

The ED rules will require hospital (emergency department) patients that have the following revenue codes to be submitted: 0450, 0451, 0452, 0456 and 0459. The ED rules only affect hospitals and will require submission of ED patient data using the modified ANSI 837 institutional claim guides for THCIC purposes in order to reduce the burden on the hospitals by using the existing operational outpatient system.

 
Discharge Disposition Status
The National Uniform Billing Committee added several codes to the discharge status code set (form locator 17). These additional codes are effective with discharges on or after Oct. 1, 2013.

Prior to submission of this data, please check with your finance and information systems departments to ensure that your data submission will be up-to-date with the appropriate code values. In doing so, your hospital’s data submission will avoid errors. In the event the data submission contains invalid content values, those values will be identified in the submission’s data quality report.

Effective dates and descriptions may be found on the UB-04 change implementation calendar.

The new discharge code values are listed below.

Code Long Description
69 Discharged/transferred to a designated disaster alternative care site
81 Discharged to home or self-care with a planned acute-care hospital inpatient readmission
82 Discharged/transferred to a short term general hospital for inpatient care with a planned acute-care hospital inpatient readmission
83 Discharged/transferred to a skilled nursing facility with Medicare certification with a planned acute-care hospital inpatient readmission
84 Discharged/transferred to a facility that provides custodial or supportive care with a planned acute-care hospital inpatient readmission
85 Discharged/transferred to a designated cancer center or children’s hospital with a planned acute-care hospital inpatient readmission
86 Discharged/transferred to home under care of organized home health service organization with planned acute-care hospital inpatient readmission
87 Discharged/transferred to court/law enforcement with a planned acute-care hospital inpatient readmission
88 Discharged/transferred to federal health care facility with a planned acute-care hospital inpatient readmission
89 Discharged/transferred to a hospital-based Medicare approved swing bed with a planned acute-care hospital inpatient readmission
90 Discharged/transferred to an inpatient rehabilitation facility including rehabilitation distinct part units of a hospital with a planned acute-care hospital inpatient readmission
91 Discharged/transferred to a Medicare certified long term care hospital with a planned acute-care hospital inpatient readmission
92 Discharged/transferred to a nursing facility certified under Medicaid but not certified under Medicare with a planned acute-care hospital inpatient readmission
93 Discharged/transferred to a psychiatric distinct part unit of a hospital with a planned acute-care hospital inpatient readmission
94 Discharged/transferred to a critical access hospital with a planned acute-care hospital inpatient readmission
95 Discharged/transferred to another type of health care institution not defined elsewhere in this code list with a planned acute-care hospital inpatient readmission
 
Vendor Software Change Fee Required
If your hospital changes hospital information system vendors or upgrades to a new version of the software you use for submission to the Texas Hospital Association Patient Data System, you should notify your client support specialist at Truven Health Analytics as soon as you learn of the change. It most likely will require a new implementation that could take several weeks to several months depending on your hospital resources.

Due to the time-sensitive nature of data submission and the deadlines enforced by the Texas Health Care Information Collection, the fee for new implementation is $2,000. Please allow time for a letter of agreement to be signed and an updated profile to be created.

 
THCIC Data Collection Workshop Notes
Each month, the Texas Health Care Information Collection holds a workshop to discuss and communicate new information regarding THCIC. Download and review the notes from the workshop that was held on Sept. 24.
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According to Texas Government Code 305.027, portions of this material may be considered “legislative advertising.” Authorization for its publication is made by John Hawkins, Texas Hospital Association, 1108 Lavaca, Suite 700, Austin, Texas, 78701-2180.