2010 UBO/UBU Conference Health Budgets & Financial Policy 1 Briefing: DQ Statement Roundtable Date: 25 March 2010 Time: 1010–1200

2010 UBO/UBU Conference Turning Knowledge Into Action 2 Objectives Purpose of the DQMC Review List and DQ Statement Roundtable – Increase community awareness Background and history TMA Data Quality Management Control (DQMC) Program – Introduce Service initiatives – Discuss issues

2010 UBO/UBU Conference Turning Knowledge Into Action DQMC Background & History Why Worry about Data Quality? One reason is external scrutiny... DoD IG GAO Audit Agencies Congress 3

2010 UBO/UBU Conference Turning Knowledge Into Action DQMC Background & History TMA DQMC Program improves data quality and ensures that the MTF receives credit for properly recorded workload. 4

2010 UBO/UBU Conference Turning Knowledge Into Action 5 DQMC Background & History Typically Data Quality is formulated as an IT problem – Errors in transmission – Errors in processing – Unsynchronized databases But our most difficult problems with data quality are often not directly attributable to IT, nor readily fixed by IT solutions – Standardization of business rules and policies across Services, between agencies – Inconsistency of choices for codes, weights, and algorithms – Expectations of low data quality

2010 UBO/UBU Conference Turning Knowledge Into Action 6 DQMC Background & History Data Quality Management Control (DQMC) Program was created to alleviate DoD IG’s identification of material management control weaknesses within MHS – DoD IG report concerning the FY 1998 Retirement Liability Estimate – GAO Medicare Subvention Demonstration report Elements of the DQMC Program – TMA DQMC Program, collaboration between TMA POC 3 Service POCs – Policy Memorandum (29 Nov 2000) – DoDI (26 Nov 2002) updated annually DQMC Review List Data Quality Statement

2010 UBO/UBU Conference Turning Knowledge Into Action 7 DQMC Background & History Start with the DQMC Review List – Enclosure 1 of DODI Monthly Data Quality Statement – Subset of DQMC Review List sent to Service DQ managers and the TMA DQMC Program Manager [Enclosure 2 of DODI ] – Commander approval – Used to create TMA Summary Tri-Service view of data Briefed to both the Resource Management Steering Committee (RMSC) and TMA Senior Leadership and Service DSGs (CFOIC), twice a year

2010 UBO/UBU Conference Turning Knowledge Into Action 8 DQMC Background & History How are these metrics used? – Timely feedback to the Commanders about the quality of their data – Discussed monthly at DQMC Workgroup meetings Service DQ POCs and TMA meet at TMA-MC&FS Service and TMA wide issues discussed and documented – Posted on the TMA – OCFO, MC&FS – Web site, DQMC Web page Metrics & Reports Important reference material

2010 UBO/UBU Conference Turning Knowledge Into Action 9 TMA Comments Example of the TMA Summary Sheet

2010 UBO/UBU Conference Turning Knowledge Into Action 10 TMA Comments Metric Standards (colors) are as follows: Green – Yellow – Red – 0-79 Except for 8e and 9, which is Green for 80 and above 3c, 3d, and 10a do not yet have a standard – no color Metric colors – Generally move from red status to green status over the fiscal year, indicates data quality matures over the year – Sometimes “RED” is good, revealing a system-wide problem – Sometimes there is no coloring to indicate a new question or one for which a goal is not yet established

2010 UBO/UBU Conference Turning Knowledge Into Action 11 Example of TMA Summary – FY10 Metric Questions

2010 UBO/UBU Conference Turning Knowledge Into Action 12 Example of TMA Summary – FY10 Metric Questions

2010 UBO/UBU Conference Turning Knowledge Into Action 13 TMA Comments TMA Initiatives this year – Added DMHRSi questions (DQ Statement 3d and 3e) – Clarified existing questions to strive for tri-Service uniformity in answers – Removed one question DQ Statement question 1a – close every clinic Replaced with what was 1b – close every record

2010 UBO/UBU Conference Turning Knowledge Into Action 14 Army Comments Data Quality Management Control (DQMC) Program Review – Defense Medical Human Resources System- internet (DMHRS-i) MTFs submitting MEPRS data without 100% of personnel timecards. DMHRS-i allows for Medical Command level review of what MTFs are submitting for timecards. Army MTFs will be penalized under Performance Based Adjustment Measures for not meeting monthly MEPRS submission date. Penalty is $10.00 per available FTE per reporting month.

2010 UBO/UBU Conference Turning Knowledge Into Action 15 Army Comments – Other Health Insurance (OHI), DD Form 2569 Currently no Army wide solution for development of an electronic DD Form Army sites using a contracted vendor to identify beneficiaries with OHI have reported increase in beneficiaries identified with OHI. Army sites using outside vendor reporting increased revenue collections. Army Medical Command considering several different models for Third Party Collections.

2010 UBO/UBU Conference Turning Knowledge Into Action 16 Army Comments – Coding Army using Code Auditing and Reporting Application (CARA). Coding audits conducted under Patient Administration Systems and Biostatistics Activity (PASBA) oversight. CARA coding results will be incorporated into Army Production Based Adjustment Model. CARA results will be used by all Army MTFs to populate DQMC Program DQ Statement. – DQMC Program Changes for Army New Web-based application, to include Web-based Review List. Added three Army-only questions to DQ Statement.

2010 UBO/UBU Conference Turning Knowledge Into Action Navy Comments References – Navy FY10 DQMC Guidance 10% Improvement Required in DDFM 2569 Collection for Outpatient Encounters – Inpatient and APV Records DDFM 2569 Required on Admission, MANMED Chapter: ???? – Coding Timeliness, Coding Accuracy Audit policy is in concert with Patient Administration Standard Audit Guidelines 17

2010 UBO/UBU Conference Turning Knowledge Into Action Navy Comments Data Quality Assurance Teams at all levels – BUMED Program Manager, Provide Policy – Regions: NCA, NMW, NME Monitor Execution, Training/Assist Visits – MTF Program Execution and Reporting – NMSC NAVMISSA/EDQ Web site and IT Support 18

2010 UBO/UBU Conference Turning Knowledge Into Action 19 Although improving, Red is Red Drilling down to some MTFs shows the opposite Navy Comments

2010 UBO/UBU Conference Turning Knowledge Into Action What Can You Do to Improve Stop doing the MINIMUM Requirement Enhance your local program Use technology to help Report Accurately Use the comments section to report. Don’t just explain the issue It’s up to you to fix or request help Don’t be afraid to be Red It simply means “we have an issue” Sometimes you have to lose a battle to win the war 20 Navy Comments

2010 UBO/UBU Conference Turning Knowledge Into Action Air Force Comments – HAF AF Organizational Structure – HAF (policy) – AFMOA (execution) Data Quality Manager’s User Guide (MUG) – Primary AF guidance to support AF DQ Manager’s – Clarification of all DQ Statement Questions 21

2010 UBO/UBU Conference Turning Knowledge Into Action 22 Air Force Comments – AFMOA DQ Foundation DQ Umbrella

2010 UBO/UBU Conference Turning Knowledge Into Action 23 Roundtable Topics Are you providing the DQ Manager at your MTF the information needed? – DQMC Review List applicable to UBO A.6, B.4, C.5, C.6, C.7, E – DQMC Review List applicable to UBU A.5, B.4, B.6, C.2, C.5, C.6, C.7, E What are the pitfalls to collecting updated DD-2569s (Other Heath Information (OHI)) – Civilian clinics won’t treat without full insurance information, including OHI

2010 UBO/UBU Conference Turning Knowledge Into Action Roundtable Topics DQ Statement Metrics – FY 2009 data 24

2010 UBO/UBU Conference Turning Knowledge Into Action Roundtable Topics DQ Statement Metrics – FY 2009 data 25

2010 UBO/UBU Conference Turning Knowledge Into Action 26 Roundtable Topics Late tables. Are you coding when you shouldn’t be? Are you attempting to bill? – FY10 ICD-9 code table updates were delayed – Must wait for the table update before completing SIDRs and grouping

2010 UBO/UBU Conference Turning Knowledge Into Action Roundtable Topics DQ Statement Metrics – FY 2009 data 27

2010 UBO/UBU Conference Turning Knowledge Into Action Roundtable Topics What are your success stories? 28