LATEST NEWS
5200 Format Training and Resources Available
Hospitals making the transition from the 2400 and 1450 formats to the Texas 5200 have three new resources at their disposal to help them get a handle on the new data submission configuration. A recorded training session has been posted in the Thomson Reuters Advantage Community that will familiarize users with the TX5200 format, create awareness of critical dates and deadlines, and supply some additional resources. A series of slides outlining TX5200 basics and offering technical tips accompanies the recording and can be downloaded for continued reference.
To access the recording, log in to the AC and go to the THA Patient Data System Forum. The recording and slides are located in the ICD-10 folder.
In addition to the slides and recorded training, Thomson Reuters will host biweekly question-and-answer sessions via conference call starting Dec. 22 at 9 a.m. Central. The call-in number for the sessions is 877/384-0533, and the pass code is 26769740. The next call will be Jan. 5, and they will continue every two weeks through July 19. They all will begin at 9 a.m. Central.
Hospitals can begin submitting TX5200 test files in March and should complete testing by Aug. 1. The slides and recorded training session will help users prepare for testing by offering tips on field formatting, justification, and how to handle decimal points and negative numbers. They also offer detailed information about the correct use and placement of HCPCS/CPT codes for principal and secondary procedures.
The switch to the TX5200 will not change the Texas Health Care Information Collection data submission process. Once the new format is implemented, Thomson Reuters will convert the data into the correct 5010 format for THCIC submission. The deadline for completing the transition to the TX5200 is Aug. 1. As with the 837 upgrade to the 5010, the TX5200 will keep hospitals compliant with THCIC 5010 requirements and accommodate the ICD-10 codes coming two years from now.
Access to the Advantage Community site is complimentary for PDS clients licensed to use Thomson Reuters products. Registration is simple and requires only your name, facility name, email address and the name of the Thomson Reuters product (Care Comparison) you use.
The specifications for the TX5200 and the slides that accompany the recorded training also can be accessed through the THA website.
To further assist with the transition, a revised data submission manual with detailed instructions for submitting individual data fields will be published in the near future.
Transit Data Submission Site Upgraded Transit, the new PDS data submission site introduced in April 2011, streamlines the data submission process and permits quicker data processing and turnaround. Now, Transit is being made even better through the addition of online sign-offs and easier access to data quality reports and error summaries.
When visiting the site, users will find a new Transit launch page that takes them directly to the login screen. The “Secure Transport” button is no longer available.
When the site overhaul is finished, it will be easier to download data quality reports and error files, speeding up corrections and data turnaround. Transit will provide the status of data quality reports and indicate if the DQR is pending, approved or rejected. If no approval is required for the DQR, that will be indicated. This new DQR functionality will be rolled out in phases, so not all users will have DQR download privileges immediately. Hospitals will be notified by their client support specialists when this function is available to them. In the meantime, hospitals should continue to download their DQRs from the secure Hydra website.
Another Transit improvement makes each hospital’s error file (called Errors All File) available in a text format in a separate zipped file. This file contains details for those records where any warning or fatal audit is flagged.
Transit has moved the sign-off process online and reduced the steps required to approve or reject data. When submissions and corrections are complete and sign-off is requested, approval or rejection now can be accomplished online without the need for a separate email.
If a historical review is in order, data submission contacts can see their file download history and check recent activity, including reports on all successful downloads.
Transition to 5010 for 837 Submitters
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.
Thomson Reuters currently is accepting test files of version 5010 IP and OP formats and has set a goal of April 2012 to complete testing and implementation of the 5010 for 837 clients.
To assist with this 837 move to a new format, Thomson Reuters will host biweekly question-and-answer sessions via conference call starting Dec. 22 at 9 a.m. Central. The call-in number for the sessions is 877/384-0533, and the passcode is 26769740. The next call will be Jan. 5, and they will continue every two weeks through July 19. They all will begin at 9 a.m. Central.
The biweekly call-in sessions are open to hospitals moving to the TX5200 and those 837 hospitals making the transition from 4010 to 5010.
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.
Six Ways to Drive Patient Volume and Revenue In today’s competitive environment, hospitals need to market themselves just as much as any other organization. Here are some golden rules to help ensure marketing dollars are well spent and produce results, courtesy of John Luginbill, chief executive officer of The Heavyweights, an Indiana-based health care marketing firm.
- Spend money to make money. Spend wisely. Many hospitals and health care systems make the mistake of promoting their “star” facilities or programs. It’s a waste of money to promote something that’s already doing well. The better strategy is to focus on programs that need more help and are likely to show bigger gains if your campaign is effective.
- Coordinate efforts vertically. Think in terms of what’s coming up. Timing is everything, and the communications department should be the hub of the hospital and know which emerging departments need promotion. Try keeping a calendar of campaigns that correspond to events happening at your organization. This will allow the communications team to be proactive instead of reactive when planning campaigns.
- Target pre-episodic patients. Does your health care system or hospital have billboards centered on heart attacks? Chances are most people who have a heart attack didn’t know they were going to have one – thus, your billboard didn’t capture their attention. A better approach is one that relates to the viewer’s current health or determines if they are at risk of developing a serious medical condition.
- Master media mix, message and movement. Health care is a machine constantly churning out clichéd claims to fame such as “best,” “top” or “excellence.” A marketing message needs to show instead of tell how value affects the patient. Marketing without a call to action is like a cookie without milk; the audience is left craving something that’s missing. “Awareness” is an empty calorie word with little return. Focus more on action and measurable results.
- Opt-in marketing is not optional. The key to driving volume is engaging patients about their health. Risk assessments can be productive tools for engaging patients and leading them toward opt-in opportunities. Risk assessments break down like this: If 25,000 people take it, 5,000 will be at risk, 1,000 will ask to be contacted and 500 will need a procedure. On average, 2 percent of risk assessments result in a procedure.
- Capitalize on co-risk. Only 5 percent of the U.S. population is responsible for 50 percent of health care costs. The best way to do business is with existing clients, and marketing should target the needs of hospital frequent flyers. When patients are at risk for one procedure, make sure your marketing gives patients links to other resources they may need in the future.
Source: Anna Webster, “6 Ways to Drive Patient Volume, Revenue,” HealthLeaders Media, 10/12/11.
THA 2012 Annual Conference and Expo
Rapidly Approaching
If you haven’t registered for the Texas Hospital Association 2012 Annual Conference and Expo, what are you waiting for? With such highly regarded speakers as Mike Leavitt, three-term governor of Utah and former U.S. Secretary of Health and Human Services, and Thomas Suehs, executive commissioner of the Texas Health and Human Services Commission, and such sessions as “The Impact of Clinical Pharmacy Services on Quality Measures” and “Value-Based Purchasing: From Rules to Nursing Reality,” the conference has something to offer for everyone. To view the full agenda and register, go to the THA website.
Quality in Brief
Inexperienced Stent Operators Show Higher Mortality Rates: Physicians who have little experience with carotid artery stenting have higher rates of 30-day mortality than seasoned operators. A recent study also showed that more than 70 percent of the operators performed fewer than six procedures annually, the volume associated with the highest risk of patient death. Patients of operators who performed 6-11 procedures a year had a 1.9 percent 30-day mortality, those whose operators performed 12-23 procedures a year had a 1.6 percent mortality, and those whose operators performed 24 or more procedures a year had a 1.4 percent mortality. Novice operators also were less likely to use an embolic protection device, which is a filter or balloon placed inside the artery to prevent particles from escaping and causing neurological damage. The study noted that there is no professionally agreed upon standard for training requirements on the number of stenting procedures one must do under supervision before becoming the primary practitioner on the case. An accompanying editorial noted that in clinical practice, mortality rates seem to be more than twice the rate than that of the clinical trial that led the FDA to approve carotid artery stents surgery in 2004. “Relatively high complication rates in real-world practice substantially reduces and perhaps completely eliminates any long-term expected benefits of revascularization, especially among asymptomatic patients who have much less to gain from the procedure,” said the editorial. (1)
Same-Day Discharge for PCI Cuts Costs: Hospitals could dramatically improve patient flow and save money by discharging low-risk elective percutaneous coronary intervention patients 12 hours earlier rather than keeping them through the night. A new study shows that same-day discharge after a five- or six-hour recovery from PCI is safe for the lowest-risk group of patients. The current practice is to send fewer than 2 percent of patients in this category home on the same day. The research estimated that 20 percent of patients now kept overnight could be discharged much earlier, freeing up bed space and labor for other, sicker patients. The research model proposes that an elective patient who has a successful PCI, doesn’t require prolonged intravenous medication, has someone to go home to, has all their medications, and is educated on what to look for makes an ideal candidate for same-day discharge. PCI is increasingly performed through the wrist (radially), which reduces the risk of bleeding. As recently as 18 months ago, only 3 percent were done through the wrist, a rate that is now 10-15 percent. Medicare reimburses hospitals for overnight patients at the same rate as someone who stays only 10 to 12 hours. The study authors predicted that patient experience scores likely will go up for patients who don’t have to spend the night in the hospital. (2)
Engage Nurses to Raise Patient Safety Scores: Most hospitals have quality, safety and infection prevention professionals working on quality measures and patient outcome scores. Their efforts could be meaningless unless nurses and other clinical staff are engaged in the improvement process. Top-down approaches to culture change are typically unsuccessful. This is one reason scores start creeping down after a successful quality improvement effort has come and gone. If nurses aren’t engaged in the process, they have less inclination to remain on a directed path. Front-line staff should be engaged and empowered to act to make cultural change permanent. New procedures or processes are more likely to be met with acceptance and become part of everyday practice when the caregivers are involved in the design. Empowering employees involves giving them a level of responsibility and knowledge that is vital to achieving quality patient care in a financially healthy organization. Nursing staff should seek out and embrace ownership of the new metrics and take an active role in quality improvement efforts. The financial imperative today is such that hospitals can’t afford for nurses not to be engaged wholly. Value-based purchasing, for example, could be a game changer, and hospitals must make wholesale transformations to succeed. That means an end to thinking patient safety and quality belong to a department and a realization that it belongs to nurses and every other person employed in the organization. (3)
Sources: 1) Cheryl Clark, “Stenting’s Steep Learning Curve Linked to High Mortality Rates,” HealthLeaders Media, 9/30/11; Nallamothu, Gurm, Ting, Goodney, Rogers, Curtis, Dimick, Bates, Krumholz and Birkmeyer, “Operator Experience and Carotid Stenting Outcomes in Medicare Beneficiaries,” JAMA, 9/28/11; Ethan Halm, M.D., “Carotid Stenting at the Crossroads,” JAMA, 9/28/11; 2) Cheryl Clark, “Same-Day Discharge for Elective PCI Patients Cuts Hospital Costs,” HealthLeaders Media, 10/5/11; Rao, Kaltenback, Weintraub, Roe, Brindis, Rumsfeld and Peterson, “Prevalence and Outcomes of Same-Day Discharge After Elective Percutaneous Coronary Intervention Among Older Patients,” JAMA, 10/5/11; 3) Rebecca Hendren, “Engage Nurses to Raise Your Patient Safety Scores,” HealthLeaders Media, 10/25/11.
Health Care by the Numbers
The use of CT scans during emergency department visits grew from 3.2 percent in 1996 to 13.9 percent in 2007, an increase of 330 percent. ED visits increased only 30 percent during this span, but the adjusted rate of hospitalization or transfer after a scan decreased from 26 percent to 12.1 percent, or by about half. (1)
As recently as the late 1990s, there were only five or six joint M.D./M.B.A. degree programs at the nation’s universities. Today there are 65. (2)
In 2004, 87 percent of surgical patients in high-performing hospitals received appropriate care to prevent complications, while only 49 percent received such care at low-performing hospitals. By 2009, those numbers increased to 98 percent of patients at top performers and all the way up to 90 percent for the lowest group. The bottom groups’ score in 2009 is now higher than the top groups’ score was in 2004. (3)
Drug deaths in 2009 outnumbered traffic fatalities in the United States for the first time since the government started tracking drug-induced deaths in 1979. There were 37,485 fatalities from prescription drug overdoses, most commonly from OxyContin, Vicodin, Xanax, Soma, and newcomer Fentanyl, which is 100 times more powerful than morphine. (4)
The number of hospitals ready to meet Stage 1 of meaningful use jumped 16 percent from February to September. In those seven months, the percentage of well-positioned U.S. hospitals went from 25 percent to 41 percent. As of Sept. 30, the Centers for Medicare & Medicaid Services reported 2,215 eligible hospitals had registered for Medicare and Medicaid electronic health record incentive programs, and 564 had received payment for meeting Stage 1 criteria. (5)
Three types of common health care-associated infections are in decline. Central line-associated bloodstream infections decreased 33 percent between 2010 and the three-year period of 2006 to 2008. Catheter-associated urinary tract infections declined 7 percent between 2009 and 2010. Surgical-site infections went down 10 percent in 2010 compared to 2006 to 2008. However, C. Difficile infections resisted prevention efforts, with an increase of 1.1 percent compared with 2008 and a projected increase of 6.8 percent for 2010. (6)
Sources: 1) Cheryl Clark, “Rise in CT Use in ED Curbs Admissions, Transfers,” HealthLeaders Media, 8/11/11; 2) Milt Freudenheim, “Adjusting, More M.D.s Add M.B.A.,” The New York Times, 9/5/11; 3) Maureen McKinney, “Ailing Health System,” Modern Healthcare, 10/24/11; The Commonwealth Fund, Why Not the Best? Results from the National Scorecard on U.S. Health System Performance, 2011; 4) Lisa Girion, Scott Glover and Doug Smith, “Drug Deaths Now Outnumber Traffic Fatalities in U.S., Data Show,” Los Angeles Times, 9/17/11; 5) CMIO, 11/3/11; HIMSS Analytics Report, Summary of Meaningful Use Readiness; 6) Cheryl Clark, “MRSA Down, C. Difficile Up Slightly, Says CDC,” HealthLeaders Media, 10/20/11; Centers for Disease Control and Prevention National Safety Healthcare Network.
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