Presentation on theme: "Objectives Describe CHCS"— Presentation transcript:
1 Objectives Describe CHCS Describe the major central repositories that include MTF dataBriefly describe the M2Identify common data quality problemsDescribe how M2 Standard Reports can be used to manage data qualityUse M2 DQ Standard ReportsOnly for attendees of hands-on session
2 And the number of discharges we can recapture is…….. The Data’s No Good!And the number of discharges we can recapture is……..At least I didn’t use it! Why fix it?Who cares if the data are bad! We just used the old dartboard method!Since the data is not good
3 Composite Health Care System Much longer briefing later in course on CHCSHigh level overview in this session!What is CHCS?Primary operational system used by MTFsUsed for day-to-day activities within the MTFAppointing, scheduling, registration, ordering of tests, referrals, etc..Importance of CHCS cannot be stressed enough!
4 Composite Health Care System CHCS is the starting point for nearly all MTF dataPoint of original captureReal-time dataMuch of the data in CHCS is captured simply because someone is doing their jobFor example, when provider orders a prescription in CHCS; a record of that is kept in the CHCS pharmacy file
5 Composite Health Care System CHCS has no central repositoryBuilt a very long time ago100+ separate systems!Significantly hampers usefulness of local dataRichness of CHCS data is a definite plus, but must remember that data are only localGreat for production type studies; not enough for person based work
6 Composite Healthcare System (CHCS) Access NCASan DiegoCo SpringsTidewaterNo connectivity between100+ separate systems!LandstuhlEtc….Pendleton
7 Example: MTFs on Eisenhower CHCS Host DMISIDName0047Eisenhower0237McPherson1230Camp Shelby1550TMC-4 Stockade7197TMC Connelly7239TMC SouthcomLocal CHCS queries only retrieve data for care provided at these MTFs!
8 Example: Inpatient Data Available at EAMC from CHCS Most of the days of care for EAMC area enrollees are not visible in CHCS
9 Composite Health Care System Data AvailabilitySeveral options for using CHCS Data:MUMPS Queries“Fileman” QueriesCACHEICDBVaries by MTF what can be doneLarger MTFs tend to have more optionsData also available in other central systems
10 CHCS Data Products Name Description Acronym Standard Inpatient Data RecordInpatient Hospital RecordsSIDRAppointmentAppointment records for outpatient visitsNone!ReferralReferrals for specialty careStandard Ambulatory Data RecordsOutpatient visit, t-con or inpatient rounds recordsSADRAncillary Lab and Rad and RxProcedure recordsWorldwide Workload ReportSummary workload dataWWR
11 CHCS & AHLTA AHLTA new capture system Intended to be an electronic health recordReplaces (sort of) CHCS Ambulatory Data ModuleUnlike ADM, AHLTA built to support provider’s activities (i.e. note taking, reviewing test results, etc)Overly complex architecture; system problems are commonAHLTA writes data to CHCS, which is the used to create a SADR (Called writeback)Still not used in all clinics
12 FLOW OF SADR MDR SADR file contains ADM & AHLTA information M2 SADR CCECHCS/ADMWritebackCDRPicture of CHCS Appt File; AHLTA, ADM, writeback & SADR> also CDR / CDMADM & AHLTA are used to capture ambulatory dataAPPTAHLTA
13 Use of AHLTA for Outpatient Care 10% of regular visits still not captured in AHLTAThese 10-20% are not b/c the AHLTA ER module works; it doesn’t. It’s there for the few MTFs that hire extra help and pay someone to hand-enter the ER visits into AHLTA, from the handwritten notes.10% of reg vis still missing are when AHLTA sys goes down and MTFs must revert to using ADM again.Very little usage in ER and Same Day Surgery Centers – more for office based care
14 Clinical Data Mart Clinical Data Mart Enables viewing of some of the more important data from the Clinical Data Repository (AHLTA)Structured database accessible through Web version of Business ObjectsPrimary source of data is CDR (and CHCS indirectly)Also receives nightly file from DEERSRole-based access; no worldwide access available currentlyNot complete enough for many purposes(Not focus of DQMC for that reason)Add a picture of m2.
15 Expense Accounting System (EAS) Repository EAS is the tri-Service financial system used at MTFsEAS is used to create MEPRS dataFull-Time Equivalent Staff (generally via DMHRS)Workload (via CHCS)Expense Information (via Service $$ system)MEPRS codesUsed in all MTF systemsData Availability:EAS RepositoryMDR/M2
16 Pharmacy Data Transaction Service Repository Online Drug Utilization Review SystemUsed by MTFs, Mail Order Contractor and Retail ContractorExcellent source of information about prescription drug usageData Availability:Through PDTS Business Objects SystemMDR/M2Reported automatically, when MTF does DUR check
17 MHS Data Repository “Home-grown” business data warehouse Developed outside normal IT processMDR receives and processes data from a wide variety of sourcesData feed managementFile BatchingData ProcessingFile Storage & ArchivingPreparation of Extracts for Data MartsWhat is the mdr
18 MDR Processing, File Storage & Limited Access Basic Data FlowData sent to MDR 24/7MDR Processing, File Storage & Limited AccessMEPRSMDR Feed NodeBatchesCHCSWeekly MonthlyDEERSClaimsM21500+ users access in M2Others
19 Preparation of MDR Files MDR is the “workhorse” – where most of the processing of data occurs. Generally includes:Archiving and StoragePerson Identification enhancementApplication of DEERS attributesAddition of market concepts (i.e. catchment)Addition of DMISID attributes (i.e. enrollment MTF Service, etc)Grouping (DRG, APC, etc)Addition of costs and weights (RVUs, RWPs)And much, much more………Other systems tend to “catch, store and show”Cleanest, most comprehensive source of data
20 The MHS Mart The “M2”: Very popular data mart Contains a subset of MDR dataMany data files from MTFs + other data, too!Significant functional involvement in development and maintenance1500+ users at all levels in the MHSAd-hoc querying or “Standard Reports”
21 Systems to use for Data Quality No one system will answer all your questions!Local systems:Best for real time or near real time management“How are we doing?”Corporate systems:MDR/M2 used for most major initiatives and by local MTFsImportant that data be right there!M2 Standard Reports are designed to assist with monitoring MTF DQ“How did we do?”
22 Systems to Use for DQ Mgmt M2 Reports:Many reports availableMost resemble or are exactly the required DQMC reportsSome on emerging DQ issuesEasy to useNeed only basic M2 knowledgeMust know your MTF DMISID to use MTF Level ReportsWill demonstrate throughout!Report documentation is in your notebooks
23 Data Quality Monitoring and Improvement MTF Data to Review in the context of data quality attributes:Standard Inpatient Data RecordsStandard Ambulatory Data RecordsPharmacy Data Transaction ServiceExpense Assignment System (MEPRS)MTF Lab and Rad
24 Attributes of Data Quality CompletenessDo I get all of the data that I need?TimelinessIs the data I need there when I need it?AccuracyIs the data correct, or at least “correct enough”?
26 Common Data Quality Items Why do you need complete data?
27 Common Data Quality Items Why do you need complete data?FY w/errorFY w/o error7,3877,727340 discharge records lost!
28 Why does it matter?Missing component of health history for beneficiariesLess budget at Service levelLess funds for MTFsAppearance of quality issuesUnderestimation of productivity and efficiencyImproper business planning; poor business case analysis
29 Common Data Quality Items Why can data be incomplete & what can you do about it?Simple lack of data captureIncomplete or erroneous transmission of dataImproper processing & handling
30 Lack of Data CaptureSome data are captured during the business processOften sent off automaticallyExample: Appointment fileDailyEnd of Day ProcessingPeriodic standardized data feedsReal-TimePatient CallReal Time Using CHCS to book appt
31 Lack of Data Capture Data captured during the business process CHCS tables:Updated in real time while MTF staff does their jobsNot generally used beyond local levelLack of central warehouse makes it difficultCHCS automated extracts:Appointment FileOutpatient Lab, Rad and Rx FilesReferral File
32 Lack of Data CaptureSome data are captured because a policy or guidance requires itUnified Biostatistical Utility (UBU) distributes health care coding policyExample: SIDR - Inpatient StaysExample: SADR - Completed outpatient visits and inpatient rounds
33 Lack of Data CaptureSome data are captured because a policy or guidance requires itMore comprehensive set of health care reporting in private sector; not reported = not paid!MHS decides whether “juice worth squeeze” since budget not entirely claim basedExamples of data not required:Inpatient Surgical CPT RecordsAmbulance Records
34 Lack of Data CaptureSome data are captured because a policy or guidance requires itPolicy gaps cause some problems analytically“Lack of Capture”: When policies are not followed – makes analysis harder!Incentives + Supporting Policy = Best availability of dataRecent improvements
35 Capture Requirements Worldwide Workload Report Earliest CHCS product with information about MTF care deliveryMonthly summary workload:Visits, Days, DispositionsYear, Month, MTF, MEPRS Code, Patient CategoryHistorical significance:Major determinant of payments to contractors in early TRICARE contracts (not today!)
36 Example WWR Data MTF CY/CM MEPRS Code Bencat Count Visits Adm Disp Bed Days0001200801BAADA66DR2220029AAARET9097339ACT5625247BDA5286542B MEPRS Code (Outpatient): VisitsA MEPRS Code (Inpatient): Adm, Disp and Days
37 Capture Requirements Worldwide Workload Report WWR is required by all Services for all of their active MTFsReports include one month of dataWhen WWR file is received, it is usually completeChanges occur at times; but not commonOften called “gold standard”
38 Capture Requirements Worldwide Workload Report Used to measure completeness of other MTF workload data sourcesReporting of WWR part of DQMC programSent to Service Agencies and then onto MDRMDRPASBAAFMSSANMIC
39 Capture Requirements Standard Inpatient Data Record Significance: One coded record per inpatient stayRoughly 250,000 per yearContains rich detailed data on each stayCan identify patient and providers; includes diagnosis, treatment and other administrative dataSignificance:Primary source for most inpatient data needs.
40 Some Sample Data from SIDR MTFReg NumPat IDAdm DateDisch DateDx 1DRG0125Pat #111/01/200811/03/2008V30003910117Pat #210/16/200810/17/20084912108810/21/200810/24/20082273300Many more data elements available on SIDR – hundreds of themMTF DMISID + Register Number (PRN) is the way to identify a unique record
41 Capture Requirements Standard Inpatient Data Record MTF Requirement since late 1980sAll inpatient stays must be codedStable data feedSent to MHS Data Repository / M2 and derivative systemsNo inpatient data sent to Clinical Data Repository or CDM
42 Capture Requirements Standard Inpatient Data Record Completion of a SIDR requires more effort than completion of WWRMuch more detailed reportCompleteness is not usually a problem, thoughWell established reporting process
43 Picture of SIDR flow SIDRs sent monthly from local CHCS hosts MDR M2 Assembled into one file and processed in MDRSent to M2CHCSMDRCHCSCHCSM2CHCS, etc
44 MDR Processing of SIDR MDR processing includes: Applying updates and adding new recordsRunning through DRG GrouperAdding RWPsAdding standardized patient informationAdding costs, PPS dataMany, many more thingsMDR enhancements are significantMakes the MDR/M2 SIDR files a very useful choice
45 Completeness of SIDR Data Required reporting element for DQMCMeasurement:Number of SIDRs / # dispositions reported in WWRExpressed as % CompleteCan easily be reviewed using M2 Corporate Documenttma.rm.dq.dcip.rept.comp.rep
50 Capture Requirements Standard Ambulatory Data Record Significance: Record of (some) provider workOne coded record per outpatient visit, telephone consult , and inpatient roundNo requirement for inpatient surgery SADRsRoughly 30 million per yearCan identify patient and providers; includes diagnosis, treatment and other administrative dataSignificance:Primary source for most ambulatory data needs.
51 Some Sample Data Fields from SADR MTFAppt ID NoPat IDAppt DateDiag 1E&M codeMEPRS Code0117Pat #110/31/20085640099283BIA0075Pat #210/09/2008724299441BAAMany more data elements available on SADR – hundreds of themMTF DMISID + Appt ID Number (IEN) is the way to identify a unique record
52 Capture Requirements Standard Ambulatory Data Record MTF Requirement since mid 1990sSignificant issues with completenessReporting compliance is part of the issue (more later on system issues)Sent to MHS Data Repository / M2 and derivative systemsSADR is not sent to Clinical Data Repository but some similar data is; more later
53 Capture Requirements Standard Ambulatory Data Record Completion of a SADR is entirely separate from WWRMuch more detailed reportMuch more complex processTwo different data collection systems (CHCS and AHLTA)
54 MDR Processing of SADR Fundamental part of MDR processing: Combination of Kept Appointment File and SADRAppointment file is automatically captured; where SADR requires additional effort at the MTFShould be a SADR for each kept appointmentIf there is an appointment record but no SADR, called an “inferred SADR”
55 Matching SADRs to Appointment Records APPT #1234567When ‘processing’ in MDR: Compare appt and SADR; record by record.Missing a SADR for Appt # 4.#4 will be in the MDR database as an ‘inferred SADR’.
56 Final MDR Data Set#Compliance StatusProvPatientClinicE&M1RealJONRMARYBAA992142JOE992133JANE4InferredNANN/A5AL6ROB7SARA99499Appt # 4 has no E&M because no SADR has been collected. This is an appointment-based record
57 MDR Processing of SADRIn addition to combining with appt data, MDR processing includes:Applying updates and adding new recordsCombining with appointment file to include records wRunning through APG/APC GrouperAdding RVUsAdding standardized patient informationAdding costs, PPS dataMany, many more thingsMDR enhancements are significantMakes the MDR/M2 SADR files a very useful choice
58 Completeness of SADR Data Two common ways to measureOfficial way is to compare WWR to SADRsMethod developed when appointment data was unavailableNot a precise matchWWR includes only those encounters deemed “count”; SADR includes all appoinments
59 Concept of a Count Visit Hash mark countingEarly days of MHSNo systems to use to report detailed dataCount visit used to discern between ‘real medical care’ and ‘not’Inconsistent useNot recommended for analytic purposes across MTFsUsed by many systemsNon-count visits DO earn RVUsSADRs are expected for both count and non-count visits!
60 3.5 Million Non-Count Visits worth almost 1 Million RVUs! All Encounters:N= 32 Million“Count OnlyN= 29 Million3.5 Million Non-Count Visits worth almost 1 Million RVUs!
61 Count VisitsCare delivered where primary provider is a general duty nurse – FY08MTF SvcCountNon-CountTotal% CountArmy197,324150,701348,02557%AF92,172243,254335,42627%Navy172,102156,667328,76952%461,598550,6221,012,22046%
62 Completeness of SADR Data with WWR Benchmark Required reporting element for DQMCMeasurement:Number of SADRs in B Clinics (and FBN) / # count visits reported in WWRExpressed as % CompleteShould be 100%Can easily be reviewed using M2 Corporate Documenttma.rm.dq.dcop.rep.comp.wwr.repCurrently, each report has only one year.Multi-year report under construction
63 Completeness of SADR Data with Appointment Benchmark Combination of kept appointments and SADR makes precise measurement of missing SADRs possible.Perfect compliance would be 100%No “Inferred” RecordsFinal MDR Data Set#Compliance StatusProvPatientClinicE&M1RealJONRMARYBAA992142JOE992133JANE4InferredNANN/A5AL
64 Completeness of SADR Data with Appointment Benchmark Not a required reporting element for DQMCBased on the ‘by record’ matchGives a better answer than official metricAnd is actionable since you can identify missing recordsMeasurement:Number of reported SADRs in B Clinics (and FBN) / # total kept appointments in same clinicsExpressed as % CompleteCan easily be reviewed using M2 Corporate DocumentReport Name: tma.rm.dq.dcop.rep.comp.apptbench.rep
65 Completed Outpatient Appointments with No SADRs Writeback Meltdown!Major Improvements in Compliance
66 SADR Completeness Action Report Provides record level report of missing SADRsIncludes MTF and Appointment Identifier so that MTF may retrieve information about missing record and fix the problem!Also includes estimate of lost PPS $$ due to lack of SADRPrompted filter report:Data not already run; user is prompted to enter MTF DMISID; then report runsCan easily be reviewed using M2 Corporate DocumentReport Name
72 Back to slice and dice to look at lost earnings by provider
73 “By Provider” list of missed earnings. Identifiers covered upEACH ROW IS A PROVIDER!…….The first provider listed needs to submit 300K worth of SADRs!
74 Back to slice and dice to look at which SADRs are missing.
75 “Record IDs” are the appointment IENs of the missing SADRs Use to find the missing records in ADM or AHLTA
76 MEPRS Expense Assignment System Summary Data Only Financial Accounting Tri-Service SystemExpensesWorkloadFull Time Equivalent Staff InfoSummary Data OnlyToo aggregated for most business questionsExtremely valuable as a basis for more sophisticated costing methodologiesOnly tri-Service source for FTE data
77 MEPRS Data Flow EAS IV Repository MDR (Large MEPRS dataset) (Full MEPRS dataset)Workload(CHCS)MDR (Large MEPRS dataset)Financial Data (STANFINS, STARS-FL, GAFS-R)EAS-Internet(Monthly Processing)Personnel Data (DMHRSi)(Nightly/Monthly Processing)Monthly MEPRS data due 45 days after month endM2 (Smaller MEPRS dataset)
78 MEPRS CompletenessMEPRS Policy requires submission of “MEPRS Package” from all fixed MTFsPreparation of MEPRS extract requires significant effortMEPRS Manager at each MTFMEPRS reporting is/has been problematic recentlyEAS-IDMHRSi
79 Example of Some MEPRS Data MTFMEPRS CodeFY/FMAvail Clin FTESBed DaysTotal ExpenseLab Expense0024AAAA2009012.89120295,1904,2330109BAAA6.88133,779MTF & MEPRS code identifies the reporting unitStaff info from DMHRS (usually)Workload from CHCS (usually)Expenses from Service System + MEPRS AlgorithmsEntire section on MEPRS later!
81 Common Data Quality Items Why do you need timely data?Steady trend until recent timeframesIncludes FY08 and part of FY09
82 Common Data Quality Items Why do you need timely data?Annual RecapFYDisp20064,30220074,25120083,862Missing data causes an artificial year to year trend
83 Why does it matter? Completeness & Timeliness have the same impacts Missing component of health history for beneficiariesLess budget at Service levelLess funds for MTFsAppearance of quality issuesUnderestimation of productivity and efficiencyImproper business planning; poor business care analysis
84 Timeliness Standards Data Type Standard/Note SIDR w/in 30 days of dischargeSADR 3 days for routine; 15 for APVWWR by 10th of monthMEPRS 45 days after month endsLab/Rad Auto sendPDTSAppointment Auto Send
85 Timeliness Timeliness Standards are best monitored locally CHCS, ADM and AHLTA speakers to presentBatch processing in MDR/M2 makes it an insufficient tool for monitoring timelinessVery useful for completeness, though
87 Accuracy Completeness and Timeliness: Analysts always prefer complete dataWhen not available, common to use historical/available data to estimate missing dataInaccurate data is much more difficult to work withCan lead to much more damage!Can’t always apply “workarounds”
88 AccuracyPrivate sector health care data is reported as part of a payment processCompleteness: Not claimed means not paid!Timeliness: Delays in submission mean delays in paymentAccuracy:Data elements used to determine payments can get providers in trouble if they are wrong!Code checking / bundling software used
89 Direct Care Direct Care SIDR and SADR: We don’t have the same stick as private sector!MHS uses policies for completeness and timeliness.Coding and Compliance Editor (CCE) for code edits(No bundling software at all)Coding audits required as part of DQMCSample size often too small to spot problemsSometimes, external auditors hiredSince data used for billing (Third Party Collections), bad coding could cause MTF problems, also
91 Direct Care SIDR and SADR M2 is a wonderful tool for analyzing accuracy of dataContains local record identifiers to enable ACTION!Standard Reports for accuracy:Ungroupable DRGs & APGSUnlisted Provider Specialty CodePotential Pharmacy Table ErrorsPotential Provider ID ErrorsAd-hoc possibilities are limitless
92 Ungroupable DRG Report DRG Grouping software:Assumes coding rules are followedAllows for all known or potentially possible combinations of diagnosis and procedure codesUngroupable DRG:Rules are not followed in some way; orDiagnosis and Procedures simply don’t make sense togetherUngroupable DRGs receive no PPS funds for the ServiceSignificant improvement since PPS!
93 M2 Ungroupable DRG Report Currently built with regular DRGstma.rm.dq.dcip.ungroupable.drgMS DRG report to be added soonIncludes:MTF Identifier & InformationDate of CarePatient Register Number (to find in CHCS)Bed DaysEstimated Cost of Care
94 Choose Corporate Documents Paste in a screen printFile, retrieve from, corporate documents….
95 Pick report name of interest and hit “Retrieve” Select:tma.rm.dq.dcip.ungroupable.drgPick report name of interest and hit “Retrieve”
96 Report is already filled with data Updated each month when SIDR Table is updatedReplace these slides.
97 “Record ID” is the patient registry number from CHCS. Bring to coders to fix!Replace these slides.
98 Fixing SIDRsThe reasons a DRG is “ungroupable” are not always clear. Some things to look at:Diagnosis and procedure codes may be unrelatedInformation needed by the grouper may be missing or miscodedAge and dates of service may be inconsistent.Check the medical record for coding accuracy.Check the date of birth, admission and discharge dates
99 M2 ad-hoc users can get details associated with problem records Limit to Tx DMISID and Record ID with ungroupable DRGsInclude data elements of interest from SIDR
101 Unlisted Provider Specialty on SADR Provider Specialty Code:Important to understand who delivered care“Catch all” specialty codes vs real codesNo specialty code = No PPS Earnings!M2 Report Name:tma.rm.dq.fy**.dcop.unspecified.provspecCodeDescription001 Family Practice Physician923Family Practice Clinic603Pediatric Nurse Practitioner520Independent Duty CorpsmanWho delivered the care when specialty is 923?
102 Improvement in Use of Specific Provider Specialty Code Power of Budget Incentives!
103 Invalid Provider IDsProvider ID is supposed to represent the person delivering careSome MTFs use “catch-all” IDsEasier to appoint, but makes it impossible to determine who did what!Report Name: tma.rm.dq.fy**.dcop.invalid.providPrompted filter report
104 Invalid Provider IDs Report is a list of workload by provider and MTF Sort by descending workloadAre the most productive providers reasonable?Are they real people?You CANNOT bill for “ER DOC”……… Lost TPOCS billings.Are the daily totals reasonable?Clean out provider table to remove these IDs as options.Discuss with clinic/appointing staff to ensure access is not harmed, though.
105 Daily Encounters by one provider at one MTF. Hundreds of daily encounters each day!Mostly physicals for AD~7 times the RVUs of other providers at this MTFShow a couple of examples
106 PDTS Data MTF Pharmacy Data is heavily used! Pharmacy is the #2 product line in the MHSData comes from Pharmacy Data Transaction ServiceWeekly extract to the MDRSample Pharmacy Data from an MTFMTFProduct NameIssue DateDays SupplyQuantityPerson IDOrdering Clinic0089Oxycodone10/01/20083010#1BIANexium60#2FCCTotal Pharmacy Costs for DHP106
107 PDTS Data Flow CHCS Hosts PDTS Web Interface Warehouse Retail PDTS MDR Mail OrderWeeklyM2Paper Claims
108 PDTS Data Quality Issues Direct Care Pharmacy Data has some problemsNot fixable by MTFCHCS National Drug Code may not be rightWill hold the proper drug, but may indicate incorrect vendor, etcCHCS Pharmacy Table:Improper definitions of default units of measure (e.g. birth control pills; 28 pills or 1 pack?)Pricing is wrong (rounding problems, drug code problem and unit dose problem!)(MDR does not CHCS prices – too poor of quality)Total Pharmacy Costs for DHP
109 Most Expensive Drug Report When improper units of measure are in CHCS pharmacy tables, data is wrongEasy to identify by looking at most and least expensive drugs and doing a reasonability testReport Name: tma.rm.dq.fy**.pdtsrx.directcare.rxcost.repPrompted filter report
110 Advair at $660 per script!Asthma medication is not that expensive!Problems with pre-defined units and NDC.
111 Ad-Hoc Use of M2Robust capabilities of M2 Ad-Hoc (Full Client) Business Object Tool:Allows ad-hoc queries – you decide the question!Allows combination of data filesCan write one query to use as a “filter” in anotherCan create new variablesCan link variablesCan bring in external data files and use with M2 data (i.e. link, filter, combine, etc)Very powerful and easy to useWhat follows is the use of M2 for ad-hoc analysis and identification of data issues.
112 Accuracy ProblemUsed SIDR TableVery bad data – 367 day stay for a routine c-section!Probably mistyped either the admission or the disposition date.Record ID is the PRN
113 Standard Inpatient Data Record LOS errors affect RWP assignment, usually.RWP is the DRG Relative WeightUnless patient stays “too long” or “too short”Outliers defined as length of stay outside two standard deviations from the mean.For outlier cases, RWP is adjusted based on how different actual LOS is from mean.In this case:RWP should likely have been:RWP was:
114 Used Radiology TableBig Holes in the middle of FY07 (completeness)
115 Ad-Hoc Report with MEPRS data at one MTF (beware monthly data!) FYFMDispositionsBed DaysTotal ExpAvailable Clinician FTEsAvailable RN FTEs2007124$184,4941.06$161,3620.993$190,9980.9412$311,3241.415$148,3201.18611$337,5491.447$119,8290.9889$194,9731.35$300,1481.5910$286,2481.2613$344,0880.42$261,2161.790.16Costs less to treat patients than to not treat patients!
116 Ad-Hoc Report with MEPRS data at one MTF (beware monthly data!) FYFMDispositionsBed DaysTotal ExpAvailable Clinician FTEsAvailable RN FTEs200711023$56,5150.1621322$62,1970.32314$157,6620.0649$64,3720.795811$29,8140.126$39,6350.1727$50,3790.021740$102,0420.561536$137,3710.4$34,9401216$35,1850.2730$89,789
117 Ad-Hoc Report with M2 MEPRS Note how much larger rx is in Sep 07 compared with prior months
118 Ad-Hoc Report with Monthly MEPRS from MDR FYFMDispositionsBed DaysTotal Exp2007145200$5,639,371.42240188($3,010,001.83)344224$1,362,895.50455374$1,137,152.31551318$868,267.19666321$991,846.967145$602,137.168151$764,113.54931144$660,709.34
119 AD-Hoc Report with M2 Monthly MEPRS (Beware Across Service Lines) MEPRS CodeArmy MTFsAF MTFsNavy MTFsAll MTFsBCA - Family Planning3,180,30414512,774BCB - Gynecology80,121,68381,008,784123,864,534926,449BCC - Obstetrics81,448,76331,887,059532,385BCD - Breast Care1,182,7183817,066,99325,010BCX - OB/GYN Cost Pool-2,109Grand Total664,253358,628473,7371,496,618