1. Data Quality Management Control Program
February 2009

2. Overview Regulatory Guidance Patient Records Accountability
Program Management
Organizational Factors
System Inputs, Processes, and Outputs
CHCS
ADM
MEPRS/EAS
TPOCS
MEWACS
Patient Records Accountability
Coding Audits
Sampling Size and Techniques
Inpatient Records
Outpatient Records
Workload Comparison
System Security
System Design, Development, Operations, and Education and Training

3. Regulatory Guidance DODI 6040
Regulatory Guidance DODI Military Health System Data Quality Management Control Procedures
Department of Defense
INSTRUCTION
DODI dated November 2002.
Established the DQMC Program.
DQ Manager is appointed by MTF Commander.
DQ Manager works with senior-level leaders, including the Commander.
Establishes the Data Quality Assurance Team. Recommendations for team members are:
DQ Manager
Directors of clinical activities
MEPRS/EAS Coordinator
Budgeting/Accounting
Patient Administration
Health Information Manager
CHCS Administrator
Ambulatory Data System Administrator
Information Management
Internal Review offices
6. Monthly DQMCP results will be briefed to the Service Surgeons General and then forwarded to TMA.

4. Regulatory Guidance DODD 6040
Regulatory Guidance DODD Medical Records Retention and Coding at Military Treatment Facilities
Department of Defense
DIRECTIVE
Establishes policy and assigns responsibilities for the administration of medical records retention and encounter coding.
Establish and maintain a medical records control process, 95% availability, while striving for 100%.
Outpatient and Inpatient Coding Compliance Plan at MTF.
Incorporate external auditors as part of compliance plan.
Provide in-house auditors, trainers, and coders and ensure they have appropriate resources.
Provide certified coders with substantial experience to serve as advisors and mentors to coding instructors and auditors.
Established standards for coding percentages

5. Regulatory Guidance DODD 6040
Regulatory Guidance DODD Medical Encounter and Coding at Military Treatment Facilities
Department of Defense
DIRECTIVE
Army Surgeon General responsibilities. A. Arrange for random and targeted external audits. B. Ensure optimal coding program performance through monitoring of metrics. C. Metrics will cover timeliness of record completion, availability of records, quality of documentation, accuracy of coding.
MTF CDRs responsibilities: A. Coding compliance plan is available at the MTF. B. Training for administrative and coding personnel. C. Training for Clinical staff. D. Data user training. E. Outline an audit plan for evaluating coding compliance. F. Evaluate coding accuracy and timeliness of both provider and medical coding staff. G. Incorporating external auditors. H. In-house auditors/trainers and coders should have the following coding references (DOD coding guidelines, ICD-9-CM, CPT 4th edition, The Coding Clinic for the HCPCS, Medical dictionary, book of common medical abbreviations, PDR, The CPT assistant).

6. Regulatory Guidance DODD 6040
Regulatory Guidance DODD Custody and Control of Outpatient Medical Records
Department of Defense
DIRECTIVE
It is DOD policy that all beneficiary medical records are the property of the DOD and their maintenance and availability at MTFs is key to appropriate medical care and legal and administrative proceedings.
MTF responsibilities: The establishment of a medical records control process. Process should include a communications plan that focuses on educating the beneficiaries on the procedures to be utilized by each MTF to store, verify, and locate medical records.
The establishment of a policy that ensures “no hand-carrying” of medical records by beneficiaries. MTF CDRs have the authority to set policy on exceptions to the “no hand-carrying guidance”.
A process to provide a beneficiary with a copy of the medical record upon his/her request in accordance with DoD Directive and DoD Directive , references (c) and (d).
The CHCS Medical Records Tracking Module should be used as a toll to monitor and track the availability and movement of OPRs and to facilitate the development and maintenance of a closed records system.
The commander’s effectiveness in improving and sustaining medical record availability should be considered during his/her annual performance evaluation.
The availability of outpatient medical records shall be monitored and evaluated as an Assessable Unit under the Military Department Management Control Program.

7. Program Management Data Quality Manager Data Quality Assurance Team
Intermediate Command DQ Manager
Service Data Quality Manager
DQMC Review List
Commanders Monthly Data Quality Statement (internet based)

8. System Inputs, Processes, and Outputs
Composite Health Care System (CHCS)
Armed Forces Health Longitudinal Technology Application (AHLTA)
Ambulatory Data Module (ADM)
Medical Expense and Performance Reporting System (MEPRS) / Expense Assignment System (EAS)
MEPRS Early Warning and Control System (MEWACS)
Defense Medical Human Resources System –Internet (DMHRS-i)
Third Party Outpatient Collection System (TPOCS)

9. Data Input MEPRS/EAS, ADM, CHCS, TPOCS
Written Procedures
Current Versions
Upgrades & Updates
Rejected Records
End of Day Processing
Percentage of Clinics
Percentage of Appointments
Timely Coding Completion
Written Procedures – Should have readily available. Located on TMA or PASBA website.
Current Versions of software
Examples of upgrades & updates are: CPT, ICD, DRG tables, Department Service Location File update, MEPRS Code File update
Rejected Records – Were all rejected records corrected and retransmitted? For MEPRS, ADM, CHCS, AHLTA (write-back to ADM), etc.
Was a trouble ticket submitted if the system is rejecting records?
Do you have any open trouble tickets that have not be resolved within 14 calendar days nor have a plan of action in place to resolve it?
End of Day and timely coding will be addressed in subsequent slides.

10. Commander’s Data Quality Statement
Q. 1. In the reporting month:
a) What percentage of clinics have complied with “End of Day” processing requirements, “Every clinic – Every day? (B.5.(a.))
b) What percentage of appointments were closed in meeting your “End of Day” processing requirements, “Every appointment – Every day?” (B.5.(b))
Note on DQMC Program. The monthly reports submitted by the MTFs have a two month lag (i.e. a February DQ Statement is addressing data from December).
All questions on the DQ Statement have a 95% compliance standard, unless otherwise stated. MTFs that do not meet a particular questions compliance standard must provide an explanation for non-compliance. The explanations should include the identified problem, corrective action(s), expected date to reach compliance goal.
Question (1a) Not closing out clinics can cause a loss of workload accountability, overstatement of expenses from the understatement of workload, and it negatively impacts other system processes.
CHCS will not report the clinics workload statistics in the Patient Appointment and Scheduling (PAS) Monthly Statistics Reports (Managed Care Function)
CHCS will generate Delinquent End-of-Month processing report for resolution.
The Worldwide Workload Report (WWR) can be generated, but the heading of the report will indicate that there are still pending appointments.
The CHCS Workload Assignment Module (WAM) will populate the Expense Assignment System (EAS), but only with visits that have “kept” as an appointment status.
Question (1b) is being populated by PASBA for the DQMC Program Commander’s Statement.
For the DQMCP Statement PASBA is doing most of the data pulls after the 10th of the month (this is for the reporting month). The MEPRS/EAS data is usually pulled in the middle of the month (reporting month), usually around the 14th -16th of the month.
Question 1b is calculated by: #Closed Appointments/Total Appointments x days. The number of appointments and compliance percentage is calculated by PASBA (using DOWDR, patient appointment file and completed Standard Ambulatory Data Records (SADR).
For the reporting month only include B*** and FBN* accounts.
End of Day processing is a matter of system discipline.

11. Commander’s Data Quality Statement
Q. 2. In accordance with legal and medical coding practices, have all of the following occurred:
a) What percentage of Outpatient Encounters, other than APVs, have been coded within 3 business days of the encounter? (B.6.(a))
b) What percentage of APVs have been coded within 15 days of the encounter? (B.6.(b))
Questions 2a and 2b are being populated by PASBA on the DQMCP Statement.
PASBA, DQ Section, is producing a report that will identify those outpatient encounters that are incomplete. Incomplete encounters are those that do not show up in corporate databases. Our report indicates the MTF, clinic, provider, and encounters by IEN (Initial Entry Number). PASBA now has a ORT3 metric which is updated on a monthly basis. The DQ Section of PASBA will continue, for the time being, to produce the monthly report on incomplete encounters. This report gives MTFs a quick view of clinics and providers compliance. The challenge for the MTF is determining why the record is in an incomplete status.
Question 2a - 3 business days do not include weekends and national holidays.
Question 2b – Within 15 days of the encounter, weekends and holidays are included in 15 day requirement.

12. Commander’s Data Quality Statement
Q. 2. In accordance with legal and medical coding practices, have all of the following occurred:
c) What percentage of Inpatient records have been coded within 30 days after discharge? (B.6.(c))
1. Currently the PASBA website has an IRT3 metric that shows incomplete Standard Inpatient Data Records (SIDRs).
PASBA does not populate this question, as there is no definitive way to determine the 30 day timeframe.
Weekends and holidays do count towards the 30 compliance standard.

13. Data Output MEPRS/EAS, ADM, CHCS, TPOCS
Financial Reconciliation
Inpatient and Outpatient Workload Reconciliations
MEWACS Review
Timely Data Transmittal
Workload Comparison

14. Commander’s Data Quality Statement
Q. 3. In accordance with TMA policy, “Implementation of EAS/MEPRS Data Validation and Reconciliation,” dated 21 Dec 99 and “MEPRS Early Warning and Control System,” dated 28 May 02, along with the most current Service-Level Guidance: (C.1.)
a) Was monthly MEPRS/EAS financial reconciliation process completed, validated and approved prior to monthly MEPRS transmission?
Validation and approval should be done by the MTF Resource Manager or Budget Officer.
Those MTFs that have deployed DMHRSi (Defense Medical Human Resources System-internet) are having problems complying with the MEPRS/EAS related questions, on the DQMC Program statement.
All Army MTFs are currently using DMHRSi, except for a few overseas sites that are currently transitioning to the new system.
Individuals are responsible for entering their time into DMHRSi. No batch processing by admin personnel within clinics or sections, within an MTF.
When time is not submitted by individuals then the MEPRS community can not complete their reconciliation process and submit reports to the EASIV Repository in a timely manner.
Currently the Army is the least compliant of the three services is submitting MEPRS data.
The primary determinate of MTF compliance with this question is Command support.
The MTF leadership needs to hold accountable those individuals that do not submit their timecard information in a timely manner.

15. Commander’s Data Quality Statement
Q. 3. In accordance with TMA policy, “Implementation of EAS/MEPRS Data Validation and Reconciliation,” dated 21 Dec 99 and “MEPRS Early Warning and Control System,” dated 28 May 02, along with the most current Service-Level Guidance: (C.1.)
b) Were the data load status, outlier/variance, WWR-EAS IV, and allocations tabs in the current MEWACS document reviewed and explanations provided for flagged data anomalies?
“Current MEWACS document reviewed”, means the month being reviewed in MEWACS should be the same data month that is being reporting on the DQ Statement.
Who should be checking MEWACS? For the DQMC Program Report the Review List states either the DQ Manager or the MEPRS staff. MEWACs has some good information. Not really sure how many RMs or MEPRS personnel are presenting any of the MEWACs information to their commands.

16. Commander’s Data Quality Statement
Q. 4. Compliance with TMA or Service-Level guidance for timely submission of data (C.3.).
a) MEPRS/EAS (45 days)
This question is populated by PASBA on the DQMC Program Statement
The actual suspense date for any particular month may vary based on 45 days after the previous submission, usually around the 14th,15th or 16th of the month.
Failure to provide timely data negatively impacts on ability to reflect the clinical intensity and utilization of services.
This question is being impacted by deployment of DMHRSi.
There are still Army sites trying to process FY08 data for MEPRS.

17. Data Output MEPRS/EAS, ADM, CHCS, TPOCS
Duplicate Records
Timely Data Transmittal
Standard Inpatient Data Record (SIDR)
Worldwide Workload Report
Inpatient Records
Accountability
Documentation
Coding
SIDRs completed (in a “D” status)
Workload Comparison

18. Commander’s Data Quality Statement
Q. 4. Compliance with TMA or Service-Level guidance for timely submission of data (C.3.).
- b) SIDR/CHCS (5th and 20th calendar day of the month)
This question is populated by PASBA for the DQMC Program Statement.
The Army is the only service that requires submission twice a month, although the M2 only updates Standard Inpatient Data Record (SIDR) once a month.
The PASBA database is updated on a daily basis with SIDRs.
PASBA has a program that reviews submitted SIDRS and sends incorrect SIDRs back to the sending MTF for correction. These incorrect SIDRS will not be populated in the PASBA database until they are corrected. The M2 does not reject incorrect SIDRs.
PASBA website has a R299 report that shows monthly and year-to-date status of submitted SIDRs.

19. Commander’s Data Quality Statement
Q. 4. Compliance with TMA or Service-Level guidance for timely submission of data (C.3.).
- c) WWR/CHCS (10th calendar day following month)
This question is populated by PASBA for the DQMC Program Statement.
The WWR only reports “count” workload.
Past review has indicated that there are MTFs that will not recalculate and retransmit WWR with changes.

20. Commander’s Data Quality Statement
Q. 4. Compliance with TMA or Service-Level guidance for timely submission of data (C.3).
d) SADR/ADM (daily)
This question is populated by PASBA for the DQMCP Statement.
There should be a daily SADR transmission, this includes weekends and holidays. Even if there are no records to transmit on a given day, a SADR file still needs to be transmitted. This is a systems discipline issue.
If a site is using another service (AF, Navy) as the host service and this is the reason for failed transmission, then PASBA will determine on a case-by-case basis whether or not to decrement the MTF on the DQMC Program Statement.

21. Data Output
A minimum of 30 records/encounters should be pulled randomly from the entire population of MTF inpatient medical records for the audit data month.
A random audit of 30 records per MTF will provide a statistical confidence level of 90%, with a confidence interval/sampling error range of plus or minus 15%.
Army guidance is a minimum of 30 records randomly selected (random selection process with M2 data query is located in the DQMC Program User’s Manual).
MTFs are still encouraged to do focused/targeted audits of providers/clinics. The focused audits may assist each MTF in targeting their coding improvement efforts, while the random audits can be extrapolated to asses the overall coding accuracy for the MTF.
During FY08, TMA audited more records that they have in the past. For FY09 TMA has sent out letters to the Army activities with the specific records/encounters they will audit.
The PASBA has the Code Auditing and Reporting Application (CARA). The CARA will audit approximately 22,000 SADRS on a monthly basis. Records audited are SADRS documented using AHLTA. Encounters audited are from MEPRS Functional Cost Codes (FCC) of “B” and “FBN”.
Currently MTFs have the option of reporting CARA results for the SADR coding questions.
Coding audits help to ensure that medical encounters are accurately documented, coded according to authorized guidelines, and that paper and electronic documentation accurately reflects the patient encounter.
Documentation that does not support codes used may generate fraudulent Third Party Collection claims.

22. Data Output Inpatient Coding
DRG Codes
Related Data Elements (C.5)
All Diagnoses
Any Procedures
Sex
Age
Discharge/Disposition
Percentage of SIDRs Completed (D-Status)

23. Commander’s Data Quality Statement
Q. 5. Outcome of monthly inpatient coding audit: (C.5.c.f.g,h,i,j)
- a) What percentage of inpatient records whose assigned DRG codes were correct?

24. Commander’s Data Quality Statement
Q. 5. Outcome of monthly inpatient coding audit: (C.5.c.f.g,h,i,j)
- b) Inpatient Professional Services Rounds encounters E & M codes audited and deemed correct?
Ideally there should be at least one round note per day per patient.
The Perspective Payment System has been looking at IPSRs and trying to determine what standards to use for funding this activity.
The Army has decided to include IPSR in the Production Based Adjustment Model (PBAM). For Fy09 there will only be plus-ups in funding for IPSRs, but in future years there will probably be funding penalties for not meeting service-specific goals.

25. Commander’s Data Quality Statement
Q. 5. Outcome of monthly inpatient coding audit: (C.5.c.f.g,h,i,j)
- c) Inpatient Professional Services Rounds encounters ICD-9 codes audited and deemed correct?

26. Commander’s Data Quality Statement
Q. 5. Outcome of monthly inpatient coding audit: (C.5.c.f.g,h,i,j)
- d) Inpatient Professional Services Rounds encounters CPT codes audited and deemed correct?

27. Commander’s Data Quality Statement
Q. 5. Outcome of monthly inpatient coding audit: (C.5.c.f.g,h,i,j)
- e) What percentage of completed and current (signed within the past 12 months) DD Form 2569s are available for audit?
-f) What percentage of available, current and complete DD Form 2569s are verified to be correct in the Patient Insurance Information (PII) module in CHCS?
For questions 5e and 5f FY09 is the first year for these questions.
These two questions pertain to non-active duty patients only.
Reference question 5e - For the first data month of the FY09 report (October 2008 data month) the Army’s overall compliance is 85%. The lowest compliance rate was 33%. The Army had 7 MTFs that were not Green on this measure.
Reference question 5f – For the same time period as stated above the Army’s overall compliance is 99%. The Army had 1 MTF that did not meet the 95% compliance standard.

28. Data Output MEPRS/EAS, ADM, CHCS, TPOCS
Timely Data Transmittal
Standard Ambulatory Data Record (SADR)
Error Logs
Workload Comparison

29. Data Output Outpatient Coding
Sample Size
Accountability
Percentage Located or Properly Checked Out
Checked-out Over 30-Days?
DD Form 2569 (Third Party Insurance Information)
1. Random audit methodology that was discussed for inpatient records also applies to outpatient records.

30. Commander’s Data Quality Statement
Q.6. Outpatient Records. (c.6.a,b,c,d,e,f)
a) Is the documentation of the encounter selected to be audited available? Documentation includes documentation in medical record, loose (hard copy) documentation or an electronic record of the encounter in AHLTA?
1. This question is asking “Is the documentation of the encounter available to be audited?” If the documentation is available but the patient’s outpatient medical record is not available, the “record of the encounter” is considered available for audit. This is less of an issue with AHLTA usage, which we will cover in question 9.

31. Data Output Outpatient Coding
E&M Codes
ICD-9 Codes
CPT Codes

32. Commander’s Data Quality Statement
Q. 6. Outpatient Records.
b) What is the percentage of E & M codes deemed correct? (E & M code must comply with current DoD guidance.)
1. If the paper record does not indicate an E&M code was required and the computerized record does not have an E&M, then the record is deemed correct.

33. Commander’s Data Quality Statement
Q. 6. Outpatient Records.
c) What is the percentage of ICD-9 codes deemed correct?

34. Commander’s Data Quality Statement
Q. 6. Outpatient Records.
d) What was the percentage of CPT codes deemed correct? (CPT code must comply with current DoD guidance.)
1. If the paper record does not indicate a CPT code was required and the computerized records does not have a CPT, the record is deemed correct.

35. Commander’s Data Quality Statement
Q. 6. Outpatient Records.
e) What percentage of completed & current (signed within the past 12 months) DD Form 2569s (TPC Insurance Info) are available for audit?
Non-active duty only, although there may be MSAs if the soldier was involved in an auto accident with someone that does have insurance.
MTFs may start collecting DD 2569 information electronically, which several MTFs are currently doing or working towards.
If MTF is still capturing paper DD 2569’s they may be stored in any location, does not have to be located in the patients medical record.
Memo from Army MEDCOM Chief of Staff directing electronic capture of DD 2569.

36. Commander’s Data Quality Statement
Q. 6. Outpatient Records.
- f) What percentage of available, current and completed DD Form 2569s are verified to be correct in the Patient Insurance Information (PII) module in CHCS?
1. For all of the 2569’s that were found during the audit how many were in the PII module?

37. Commander’s Data Quality Statement
Question 7 Ambulatory Procedure Visits (C.7.a,c,d,e,)
Questions 7.a,c,d,e, are the same as Questions 6.a,c,d,e,
Same requirement for random audits.
Same requirement for 2569’s.

38. Commander’s Data Quality Statement
Q. 8. Comparison of reported workload data (C.9).
a) # SADR Encounters (count + non-count) / # WWR visits
b) # SIDR Dispositions / # WWR Dispositions
c) # EAS Visits / # WWR Visits
d) # EAS Dispositions / # WWR Dispositions
e) # IPSR SADR encounters (FCC=A***)/# Sum WWR (Total Bed Days + Total Dispositions)
Note: Question e, FY09 Goal is 80%.
All of the question in #8 are PASBA populated on the DQMC Program Statement.
Some general guidance on criteria for # 8 questions.
ADM encounters, omit appointment status of “No-show”, “Canceled” and Disposition Code “Left without being seen”, but include appointment status of “Tel-con”.
For WWR visits and MEPRS visits use outpatient visits that include APVs.
Only SADRs in “B***” and FBN* clinics that are marked complete “C” will be included, or SIDRs with a disposition status of “D” will be included.
Since WWR now collects visit information on B codes and FBN, ADM and MEPRS should also include FBN and B MEPRS codes for encounters/visits.
SIDRs to exclude Carded for Record Only (COR) and absent sick records (primarily Army issue).
For Inpatient Professional Services Rounds SADR completion insure WWR calculation includes live births (section 01) and Bassinet Days (section 00).
Note: If b-d, are greater than 100% (i.e. 103%) then the recorded percentage will be 97%.
Note If e, is greater than 105% then the MTF needs to provide an explanation on why. (MTFs only get credit on this measure for one round note per day per patient, unless the patient has a change in service providing care., i.e. the patient is transferred from Orthopedic service to Cardiology service. In this example the gaining service of Cardiology should write a round note).
Question 8e has a compliance standard of 80%, for FY09.

39. Data Output Workload Comparison
Q.8a SADR Encounters / WWR Visits
Should Have More Encounters Than Visits
Encounters – Omit Appt. Status of “No-Shows,” “Canceled,” and Disposition Code “Left Without Being Seen”
Encounters – Include Appt. Status “TelCon”
Only SADR Records Marked with an Appt. Status of “C” (complete) Are To Be Included
1. PASBA populates this question on the DQMC Program Statement.
2. The number of SADR encounters will need to be broken out to indicate “Out of the total number of SADRs, how many were count and non-count encounters?”;
The number of count encounters should equal the number of WWR visits.
This metric measure will exceed 100%.

40. Data Output Workload Comparison
Q.8bSIDR Dispositions / WWR Dispositions
Must Match
Only SIDRs With a Disposition of Status of “D” Are To Be Included
SIDRs – Exclude Carded for Record Only (CRO) and Absent Sick Records
PASBA populates this question on the DQMC Program Statement.

41. Data Output Workload Comparison
Q. 8cEAS Visits / WWR Visits
Must Match
Include MEPRS Functional Cost Code B** (Outpatient) and FBN (Hearing Conservation)
Include APVs
1. PASBA populates this question on the DQMC Program Statement.
2. Deployment of DMHRS-i has negatively impacted this measure. For the December 08 reporting month the Army’s overall compliance average was 28%.

42. Data Output Workload Comparison
Q. 8dEAS Dispositions / WWR Dispositions
Must Match
Only SIDRs with a Disposition Status of “D” are to be included
1. PASBA populates this question on the DQMC Program Statement.
2. Deployment of DMHRS-i has negatively impacted this measure. For the December 08 reporting month the Army’s overall compliance average was 23%.

43. Data Output Workload Comparison
IPSR encounters (FCC=A***)/# Sum WWR (Total Bed Days + Total Dispositions)
Note: FY09 Goal is 80%
Insure WWR calculation includes live births (section 01) and Bassinet Days (section 00).
1. IPSR’s will become part of Production Based Adjustment Model (PBAM). For FY09 MTFs will not be decremented any funds for not meeting compliance goals, but they may receive a plus-up in funding based on compliance above goals.

44. Commander’s Data Quality Statement
Q System Design, Development, Operations and Education/Training (E.4.c).
- # AHLTA SADR encounters/# of Total SADR encounters
Note: FY09 compliance goal is 80%..
(* It is understood that not all clinical modules are deployed in the current version of AHLTA.)
No departments excluded from this measure. Does include Observation patients (for FY09 there is no longer a MEPRS Functional Cost Code for Observations).
Intent of this measure is to show command to what extend AHLTA is utilized within the AMEDD. All activities must be captured electronically to truly have an electronic record.
There are long range future plans for the VA system and the MHS to share the same platform for electronic medical record. (Currently the VA uses system call VISTA. Built on older platform than AHLTA).

45. Commander’s Data Quality Statement
Q.10.- CHCS software used during the reporting month to identify duplicate patient registration records. (C.2a)
- What was the number of potential duplicate records in the reporting month?
This question addresses the reporting month, the other questions on the DQ Statement ask for the data month.
Duplicate patients created in CHCS should be fixed at MTF level. A trouble ticket to MHS should not be required.
Duplicate patients in the system present issues involving patient care.
Per TMA only Host Sites were to answer this question.

46. Commander’s Data Quality Statement
Q.11.- Provide the number of incomplete and non-transmitted SIDRs for the month. (F.1)
Note: This question on the DQ Statement is only a requirement for Army sites.
There are numerous reason for including this question.
To insure the MTF Commander is aware of incomplete and non-transmitted SIDRs.
The Army will be using Production Based Adjustment Model (PBAM) to decrement or plus-up funding based on compliance.
Above efforts are being undertaken to address missing workload.
Missing workload has the potential to misrepresent cost (MEPRS).

47. Commander’s Data Quality Statement
Q.12.- Provide the number of loose forms/documents/papers that are currently waiting to be filed, either electronically or in the hard-copy medical record. (F.2)
Note: This question on the DQ Statement is only a requirement for Army sites.
Army sites only.
Need to determine the amount of loose documentation waiting to be filed.
Define the scope of the problem, and assist in determining a process to improve on current processes.
Area to address is whether or not use of AHLTA has any impact on this measure. One would surmise that there greater the number of encounters documented using AHLTA the less paperwork there would be to file.
There is no compliance goal established.

48. Commander’s Data Quality Statement
Q. 13. – I am aware of data quality issues identified by the completed Commander’s Statement and Review List and when needed, have incorporated monitoring mechanisms and have taken corrective actions to improve the data from my facility.

49. Security
Are there internal controls and procedures in place to approve and manage assignment of security key privileges?
Have all security key holders been identified and their need for security key privileges validated by the CIO or designee?
1. Security key privileges determine an individuals level of access to CHCS/ADM.

50. System Design, Operations, and Education/Training
System Administrator Appointed In Writing for Each System
Training and Education Procedures and Documentation
System Change Request Process
System Incident Report
Routine Maintenance
Points of Contact for Equipment Failure Issues
Contingency Plans
Trouble tickets
System Administrator for EAS, CHCS, ADM, TPOCS, AHLTA, CCE, CMHRSi
Training and Education – Are procedures and documentation in place to ensure that all assigned personnel responsible for data entry receive training and education on CHCS, MEPRS/EASi TPOCS, ADM, etc?
Number of new users trained in quarter?
Did the systems office provide additional computer classes this quarter? What training was provided? How many individual attended training?
SCRs – Was a process in place that allows users to submit suggestions concerning new or enhanced requirements to MHS centrally funded systems (CHCS, ADM, TPOCS, EASi, etc.)
How many SCRs submitted this quarter?
Was a copy sent to your Service Data Quality Manager for review?
Was a process in place, such as System Incident Report (SIR), where users can identify issues affecting system functioning and operations?
How many SIRs submitted this quarter?
When is the fix scheduled to be deployed?

51. Data Quality Section, PASBA
Chief DQ Section PASBA
Tim Bacon,
North Atlantic Regional Medical Command
Ms. Tama Oringderff,
Southeast Regional Medical Command,
European Regional Medical Command,
Western Regional Medical Command
Mr. Joe Alley,
Great Plains Regional Medical Command,
Pacific Regional Medical Command
Mr. Dwayne Mentis,

52. BACKUP SLIDES

53. METRIC MANIA OTSG Why should you care? What can you do to help?
Department of Army
Strategic Readiness System
(SRS)
Review
&
Analysis
TMA metrics
OTSG
Command Management System
(CMS)
BALANCED
SCORECARD
Why should you care? What can you do to help?

54. MEDCOM STRATEGY MAP Improve overall health & wellness of
GOALS:
Improve overall health & wellness of
enrolled beneficiaries.
Improve patient access and satisfaction.
Improve effectiveness of peacetime direct care system.

55. KEYS TO SUCCESS Improve Data Quality Efforts Cultural Change
Improve Access to Care
Tie Financing to Performance
PBAM – Performance Based Adjustment Model

56. Army Health System Army Health System 65+ AD Ret/RetFM (<65) ADFM
WT Population ~ 12,000
MEDCOM Capacity (Human Capital)
65+
Total MEDCOM
DHP Human Resources AD
Medical
Green-Suit
Military
Ret/RetFM (<65)
The Military Health System is composed of 2 main components:
The Direct Care Side – managed by the Surgeon General and the AMEDD
And the Purchased Care side – managed by TRICARE Management Activity (TMA) and the managed care support contractors.
ADFM
MEDCOM direct care capacity cannot meet the Healthcare demand of the around 3 million eligible beneficiaries (MEDCOM cares for million enrolled & 300K users)
Reasons include:
-Population dispersion (especially among Retirees & their Families)
-Efficiency demands (numerous small population centers)
-Military structure supports Readiness – not peacetime healthcare
Population Requiring Healthcare (Demand) 56

57. Overall Satisfaction With Health Plans
This independent survey, with same results 5 years running, measures customer satisfaction with Tricare. This survey does not depend upon queries to patients who have seen provider (need to be clear on this, that this is true!)
Understand that Army Senior Leaders are bombarded at community meetings by small vocal minority of unsatisfied. The goal remains to satisfy everyone with reasonable issues. It should not be to distort distribution of available resources away from primary mission (Win the War) and second mission (care for WTUs).
“And the Winner is…” Managed Care Magazine, September 2008 pp 41-46
Data -Wilson Health Information LLC Annual Survey Jan-Feb 2008

58. Increased emphasis on MTF submissions Improved reporting timeliness
DATA QUALITY
Increased emphasis on MTF submissions
Improved reporting timeliness
Improved accuracy
SIDRs
SADRs
MEPRS

59. Data Quality SIDRs Nov 2007 = 20 Million in lost revenues
Nov 2008 = Only 2 million in lost revenues
TOOLS
Operational – DSC/SRA Lost Revenue (CMS)
Tactical - PASBA IRT3 – PASBA website

60. Data Quality SADRs Nov 2007 > 35 Million = 70 Million
Differing methodologies, but ACSRM, DSC, PASBA
& SRA arrived at similar amounts
TOOLS:
Operational: DSC/SRA Lost Revenue (CMS)
Tactical: – PASBA ORT 3 (PASBA Website)

61. DQ - MEPRS DMHRSi vs ARTS Analysis Methodology:
Oct 07 thru most recent reported month of DMHRSi or UCAPERS (Most MTFs between Mar-May 08)
Compared monthly DMHRSi data at the SSN level to those having ARTS activity in the same month. (Limited Subset of DMHRSi data reported)
ARTS Deployed days calculated to include weekends (slight error in hours when fewer days in the month)
Compared those having ARTS activity (Monthly) with how they reported their DMHRSi time (Monthly)
Focused on gross reporting errors:
Deployed for the month, with no F or G time (Special Programs or Readiness)
Deployed, and reporting more than 176 hrs in F or G
Deployed, and reporting more than 210 hrs in All accounts (A thru G)
Deployed, and reporting more than 176 hrs in clinic (B Account)
*DMHRSi- Defense Medical Human Resource System- Internet
ARTS- AMEDD Resource Tasking System

63. Lean Six Sigma Project Increasing Access (Sep-Oct 2008)
3 Providers with 2 Exam Rooms (Sub-specialty Clinic)
Adjusted schedule from 5 X 8 hr days to 4 X 10 hr days
Did not make any facility or space changes
Preliminary Results:
Available time to clinic (B account) increased 25%
(206 hrs to 259 hrs)
Total admin time (E account) decreased by 21%
(102 hrs to 80 hrs)
Encounters: 42.8% increase (15.6 per day to 22.3 per day)

64. HEDIS Summary Reports

65. Enrollment Capacity Forecast Model (ECFM)
Combines Multiple Data Systems
Current Enrollment (ECM)- Assumes Historical Space-A work
Potential Enrollment (MTF Business Plans)
EBSM- Forecast population changes
Ops- UNCLASSIFIED Deployments and Redeployments by location by month
ARTS- Deployed personnel from MTF
Provides Adjusted Enrollment for those Active duty deployed, and redeploying
Adjusts MTF enrollment capacity based on deployed PCMs (1000/Per deployed PCM)
Future Development to include:
Adjustments for Backfilling PCMs from another MTF
Forecast ARTS deployments- (Pending Deployments)
Deployment to CMS

66. MTF = Nuclear Fire Storm
USE OF THE DATA
TMA = Gospel
“Garbage In, Garbage Out”
OTSG = Disaster
MTF = Nuclear Fire Storm

67. Priorities The data matter Cultural shift Use the CMS Ask: What are we
asking our staff to do?

68. Medical Treatment Facilities
Standardize Core R&A for
Medical Treatment Facilities
No standard R&A approach in MEDCOM
MTF Cdrs create their own “TOC”
MTF’s spend a lot of time designing/developing
the “TOC”
Cdrs and staffs learn together at the expense of
Organizational Performance
R&A provides the Azimuth….critical to direction
and success

69. Core Measures for MTFs Enrollment Productivity Access
Patient Satisfaction
Coding Accuracy
Prevention/HEDIS

70. Questions ?