Medical Information Reporting for California (MIRCal)

Success Along the MIRCal Path Candace L. Diamond CASA Annual Conference 2005

Agenda Program Status Frequently Asked Questions Data Findings Future Enhancements

Voluntary Data Submissions Limited Timeframe: Feb 16 - Mar 29, 2005 Data from Oct-Dec 2004 a)94 Emergency Departments b)94 Hospital-based Ambulatory Surgery Clinics c)34 Freestanding Ambulatory Surgery Centers Win-Win! a)Facilities tested format & mapping w/o pressure b)Personal attention & training from PDS analysts c)Freestanding ASCs learned the MIRCal process d)We were able to do more testing with ‘live’ data Thank you!

Now It’s Real & It’s Working Emergency Departments (ED) a)340 approved reports b) 6 unreceivable reports Hospital-based Ambulatory Surgery a)370 approved reports b) 62 unreceivable reports Freestanding Ambulatory Surgery Centers a)439 approved reports b) 14 unreceivable reports

Report Periods & Due Dates 1 st Quarter: January – March due May 15 th 2 nd Quarter: April – June due August 14 th 3 rd Quarter: July – September due November 14 th 4 th Quarter: October – December due February 14 th

Congratulations 809 ambulatory surgery facilities reported a total of 692,126 records Sutter North Procedure Center was the first freestanding licensed ambulatory surgery center to receive “Approved” status for their report on April 13 th.

Data Exceptions Modification key is timing Non-compliance key is the plan to correct Variant Action key is valid data

Fees & Penalties Required by law July 2005 fee collection based on ASC estimate Assessed at 50 cents per record Penalties for late or non-compliant reports = $100 per day Penalty assessment begins with 3 rd Quarter 2005 Appeal process Test (early & often) vs. Formal Submission Analysts provide assistance Extension days available (14 days)

FAQ # 1 What type of facilities are required to report AS data to MIRCal? a) Freestanding Ambulatory Surgery Centers (Certified) b) Freestanding Ambulatory Surgery Centers (Licensed as surgical clinic) c) Hospitals d) Both b and c

ASC Data Reporting to OSHPD Licensed Surgical Clinics Medi-Cal Certified ASCs Medicare Certified ASCs Other ASC Ownerships

Key Definitions Record: An ambulatory surgery data record shall be submitted for each encounter during the quarterly reporting period in which at least one ambulatory surgery procedure was performed Procedure: Surgical in nature Carries a procedural risk Carries an anesthetic risk Coded using CPT- 4 (no modifiers)

FAQ # 2 What procedure codes will OSHPD collect? a)CPT Codes b)CPT Codes , HCPCS G Codes c)CPT Codes d)CPT Codes , 0001T-9999T

FAQ # 3 Can OSHPD crosswalk the HCPCS Level II G codes to HCPCS Level I CPT codes? a)Yes b)No

FAQ # 4 Can we report modifiers with CPT codes? a) Yes b) No

FAQ # 5 Do we report cancelled procedures? a) Yes, if the procedure was begun b) No c) Report every procedure whether it was begun or not.

E Codes External Cause of Injury Codes (E-Codes) Must be reported for the discharge or encounter during which the injury, poisoning and/or adverse effect was first diagnosed or treated E-Codes are assigned from the International Classification of Diseases, 9 th Revision, Clinical Modification (ICD-9-CM) (E800 – E999) Reporting medical/surgical misadventures and abnormal reaction codes (E870 – E879) is optional

FAQ # 6 For an injury that was first diagnosed or treated, where is E code reported? a) First inpatient discharge b) First ED encounter c) First AS encounter d) First physician office e) Only a, b, or c, whichever occurs first

FAQ # 7 If an injured patient was first diagnosed in a doctor’s office and sent to Endoscopy ASC, who reports the E code? a) Doctor’s office b) Endoscopy ASC c) Not applicable

FAQ # 8 There is a staff change to accessing MIRCal system. What do I do? a)Permit other staff to access MIRCal for you. b)Wait to be contacted by MIRCal before updating the changes c)Contact the UAA to update the MIRCal system (User Access) d) All of the above

FAQ # 9 Where can I find licensing information? a) b)

Current Edits Blank and Invalid values Age greater than 120 years Date of Birth after Service Date Service Date outside report period HIV test result reported Duplicate diagnosis code Place of occurrence E-code missing

Future Edits? Illogical relationships between data elements (sex, dates, diagnoses, procedures) Illogical relationships between codes in a data element (all Medicare Part A?)

Jan-Mar 2005 First Statewide Data for CA Number of Patient Records a)ED 2,137,740 b)Hospital AS 253,712 c)Freestanding ASCs 437,542 Average Number of Extension Days Used a)ED 9 days b)Hospital AS 7 days c)Freestanding ASCs 7 days

Jan-Mar 2005 Gender Hospital AS 244,353 Females 192,246 Males 2,785 Unknown 0 Invalid and Blank Freestanding ASCs 138,659 Females 108,639 Males 1,831 Unknown 3 Invalid and Blank

Jan-Mar 2005 Race Hospital AS Highest: 311,895 White (code R5) Lowest: 2,726 Amer.Indian/Alaskan (code R1) Problem: 24,834 Unknown Race (code 99) Freestanding ASCs Highest: 122, 608 White (code R5) Lowest: 809 Hawaiian/Pac.Islander (code R4) Problem: 77,155 Unknown Race (code 99)

Jan-Mar 2005 Ethnicity Hospital AS 87,650 Hispanic or Latino (code E1) 323,443 Non-Hispanic or Non-Latino (code E2) 28,275 Unknown Ethnicity (code 99) Freestanding ASCs 30,427 Hispanic or Latino (code E1) 122,866 Non-Hispanic or Non-Latino (code E2) 95,822 Unknown Ethnicity (code 99)

Jan-Mar 2005 Top 3 Diagnoses Hospital AS 1.V76.51 Special Screening, Colon (15,645) Benign Neoplasm, Colon (11,771) Unspecified Cataract (10,511) Freestanding ASCs Benign Neoplasm, Colon (19,448) Senile Cataract, Nuclear (10,854) Diverticulosis, Colon, (9,389) with no hemorrhage

Jan-Mar 2005 Diagnoses (data quality) Hospital AS a)Valid -739,116 Princ. Diagnoses 747,686 Other Diagnoses b)Blank Princ. Diagnoses c)Invalid - 27 Princ. Diagnoses 9 Other Diagnoses Freestanding ASCs a)Valid - 248,914 Princ. Diagnoses 166,363 Other Diagnoses b)Blank - 44 Princ. Diagnoses c)Invalid Princ. Diagnoses 144 Other Diagnoses

Jan-Mar 2005 Top 3 Procedures Hospital AS Colonoscopy (27,756) Cataract Extraction with intraocular lens insertion (25,223) EGD with biopsy (21,441) Freestanding ASCs Colonoscopy (31,912) Cataract Extraction with intraocular lens insertion (27,180) EGD with biopsy (17,963)

Jan-Mar 2005 Procedures (data quality) Hospital AS a)Valid - 438,471 Princ. Procedures 453,975 Other Procedures b)Invalid Princ. Procedures 531 Other Procedures c) Blank Princ. Procedures Freestanding ASCs a)Valid - 248,913 Princ. Procedures 67,151 Other Procedures b)Invalid Princ. Procedures 50 Other Procedures c)Blank - 54 Princ. Procedures

Jan-Mar 2005 Top 3 External Causes of Injuries Hospital AS 1.E928.9 Unspecified Accidents (2,263) 2.E927. Overexertion (1,336) 3.E888.9 Unspecified Falls (1,041) Freestanding ASCs 1.E928.9 Unspecified Accidents (825) 2.E927. Overexertion (528) 3.E929.9 Late effect of Unspecified Accidents (124)

Jan-Mar 2005 External Causes of Injury Codes Hospital AS a)Valid 19,425 Princ. E Codes 19,132 Other E Codes b)Invalid - 3 Princ. E Codes 3 Other E Codes Freestanding ASCs a)Valid - 2,577 Princ. E Codes 2,416 Other E Codes b)Invalid - 21 Princ. E Codes 9 Other E Codes

Jan-Mar 2005 Place of Occurrence - as cause Hospital AS – Principal E Code Position a)E849.0 Home8 b)E849.3 Industrial Places 1 c)E849.4 Recreation Places1 d)E849.7 Residential Institution14 e)E849.9 Unspecified Place16 Freestanding ASCs – Principal E Code Position a)E849.0 Home2 b)E849.3 Industrial Places8 c)E849.4 Recreation Places2 d)E849.6 Public Building1 e)E849.7 Residential Institution1 f)E849.9 Unspecified Place15

Jan-Mar 2005 Place of Occurrence - unspecified Hospital AS – Other E Codes a)E849.0 Home3,942 b)E849.3 Industrial Places 793 c)E849.4 Recreation Places1,472 d)E849.7 Residential Institution1,363 e)E849.8Other Specified Place1,518 f)E849.9 Unspecified Place8,605 Freestanding ASCs – Other E Codes a)E849.0 Home 85 b)E849.3 Industrial Places 938 c)E849.4 Recreation Places 191 d)E849.6 Public Building 184 e)E849.7 Residential Institution 26 f)E849.8Other Specified Place 82 g)E849.9 Unspecified Place 784

Jan-Mar 2005 SSN data quality = very good! Hospital AS Valid - 412,499 Invalid Unknown - 26,558 Blank - 70 Freestanding ASCs Valid - 223,096 Invalid - 41 Unknown - 25,899 Blank - 96

Jan-Mar 2005 Top 3 Dispositions Hospital AS 1.422,760 - Home (code 01) 2. 13,758 - Other (code 00) 3. 1,121 - Medicare-certified SNF (code 03) Freestanding ASCs ,231 - Home (code 01) 2. 7,501 - Other (code 00) Blank/Missing (code - ) Other Findings: Deaths Hospital AS 47 Freestanding ASCs 0

Jan-Mar 2005 Top 4 Payers Hospital AS 1.108,694 - HMO (code HM) 2. 56,242 - Medicare Part A (code MA) 3. 48,435 - PPO (code 12) 4. 43,019 - Medi-Cal (code MC) Freestanding ASCs 1. 60,406 - Medicare Part B (code MB) 2. 36,794 - Blue Cross/Blue Shield (code BL) 3. 32,727 - PPO (code 12) 4. 26,062 - HMO (code HM)

Jan-Mar 2005 Questioned Payers Hospital AS 36,058 - Medicare Part B(code MB) 13,584 - Other (code 00) Freestanding ASCs 11,759 - Medicare Part A (code MA) 8,266 - Other (code 00)

Importance of Ambulatory Surgery Data Legislative staff, health planners, researchers, state agencies, insurers, media, and health facilities Growth and trends of ambulatory surgery Comparisons with hospital care Needs assessments, marketing, outcomes, report cards, access to healthcare, healthcare disparities

Data Availability Immediate Data Distribution Report Summaries on the Internet 15 days after approval Public data sets with sensitive data masked Custom reports from OSHPD

MIRCal Resources Monthly updates to MIRCal Informational Web site “Quick Notes” publication Computer Based Training (CBT), Updated for ED & AS – December 2004 ED & AS Reporting Manual – June 2005

MIRCal Web and MIRCal Web Site (Bookmark it today!!) What’s New, Presentations, FAQ, UAA Forms, CBT, Regulations, Quick Notes, Contact Information, etc. MIRCal

Questions and Answers

Thank you, CASA