1. ED and AS Data Reporting OSHPD Healthcare Information Division Patient Data Section May 23, 2005

2. Agenda  Announcements  Frequently Asked Questions  Preliminary Data Findings

3. Hospital IP Data Hospital ED Data Hospital AS Data Freestanding ASC Data Patient Data Reporting to OSHPD

4. FAQ # 1 What is the first ED and AS Reporting Period? a) Jan – Jun 2005 b) Jan – Mar 2005 c) Apr – Jun 2005 d) Nov – Dec 2004

5. FAQ # 2 What is the due date for the first ED and AS Reporting Period? a) February 14, 2005 b) February 15, 2005 c) May 15, 2005 d) September 30, 2005

6. FAQ # 3 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

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

8. FAQ # 4 What type of hospitals are required to report ED records? a) Hospitals with EDs b) Hospitals and Urgent Care (not EDs) c) Freestanding Urgent Care Centers d) All of the above

9. Emergency Departments

10. FAQ # 5 What are all locations that are required for reporting AS procedures? a) OR, Radiology, Cardiac Cath Lab, ASC b) OR, Day Surgery, Cardiac Cath Lab, ASC c) OR, Ambulatory Surgery Rooms, ED, ASC d) OR, AS Rooms, Endoscopy Units, Cardiac Cath Lab, or Freestanding ASC

11. AS Patient Data Reporting to OSHPD Ambulatory Surgery Room Cardiac Cath Lab Endoscopy Unit General Operating Room Freestanding ASC

12. FAQ # 6 Do hospitals report invasive AS procedures done in locations other than general OR, ambulatory surgery room, endoscopy units, or cardiac cath lab? a) Yes b) No c) Sometimes (if part of ED record)

13. FAQ # 7 What ED records must be reported? a) Only ED encounters with procedures b) Only ED encounters without procedures c) All ED encounters, including LWBS d) All ED encounters, including discontinued care

14. FAQ # 8 Is the ED and AS format the same as IP format? a) Yes b) No

15. FAQ # 9 What service date do we report if ED patient came in on May 23 rd and stayed overnight? a) May 23 b) May 24

16. FAQ # 10 What service date do we report if AS patient came in on May 23 and sent home on May 24? a) May 24 b) May 23

17. FAQ # 11 What admit date do we report if an AS patient came in on May 23 and was admitted to the same hospital on May 24? a) May 24 b) May 23

18. FAQ # 12 Our hospital has to combine observation records with ED records. What do we report? a) The combined record b) ED record c) Observation record

19. FAQ # 13 Our hospital has to separate observation records from ED records. What do we report? a) The combined record b) ED record c) Observation record

20. FAQ # 14 When ED or AS patient is moved to observation, the record is replaced as an observation record. How do we report? a) If treated in ED, report as ED record. b) If treated in AS, report as AS record. c) Do not report. d) Either a or b.

21. FAQ # 15 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

22. FAQ # 16 If the patient comes from ED of acute hospital A and admitted to another hospital B, who reports the E codes? a) ED of acute hospital A b) Hospital B

23. FAQ # 17 If a patient fell from a hospital bed in a psych facility A, the attending physician first diagnosed and ordered the patient to be transferred to hospital B, who reports the E code? a) Psych facility A b) Hospital B

24. FAQ # 18 If a patient has a drug reaction that was first diagnosed or treated during the encounter or stay, who reports the E code? a) Psych facility b) Rehab facility c) ED encounter d) AS encounter e) Any of the above, whichever occurs first

25. FAQ # 19 If an injured patient was first diagnosed in a doctor office and sent to Endoscopy Unit, who reports the E code? a) Doctor’s office b) Endoscopy Unit c) Not applicable

26. FAQ # 20 What procedure codes will OSHPD collect? a) CPT Codes 10000-69999 b) CPT Codes 10000-69999, HCPCS G Codes c) CPT Codes 00100-99999 d) CPT Codes 00100-99999, 0001T-9999T

27. FAQ # 21 Can OSHPD crosswalk the HCPCS Level II G codes to HCPCS Level I CPT codes? a) Yes b) No

28. FAQ # 22 Can we report modifiers with CPT codes? a) Yes b) No

29. FAQ # 23 Do we report cancelled procedures? a) Yes, if the procedure was begun b) No c) Report all procedures whether it began or not.

30. FAQ # 24 What types of crosswalk of data elements should we be looking at? a) Your crosswalk b) Our crosswalk Your crosswalk of in-house codes to OSHPD. Our crosswalk of IP codes to ED & AS codes.

31. FAQ # 25 Will OSHPD change the IP data elements to the national standards? a) Yes b) No c) Later

32. FAQ # 26 What is the number of extension days allowed for 2005? a) 45 days b) 28 days c) 14 days d) 7 days

33. FAQ # 27 There is a hospital 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

34. FAQ # 28 www.oshpd.ca.gov/hid/MIRCal/index.htm Where can I find the Quick Notes, Due Dates, Regulations, System Requirements, FAQs, Data Elements, and Reporting Manual? a) MIRCal Stars for IP or ED or AS b) Resources c) Laws and Regulations d) All of the above

35. FAQ # 29 Where can I find licensing information? a) www.oshpd.ca.gov/ALIRTS/index.htm b) www.oshpd.ca.gov/hid/MIRCal/index/htm

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

37. Voluntary Data Submissions (Thank you!) Timeframe: February 16 through March 29 Number of voluntary submissions of Oct-Dec 2004 data  94 ED  94 Hospital-based AS  34 Freestanding ASCs Win-Win for all!  Facilities tested format structures & mapping w/o pressures  Facilities received personal training from PD analysts  Freestanding ASCs learned the MIRCal process better  We were able to further our testing with ‘live’ data – thank you!

38. Preliminary Data Submissions January – March 2005 MIRCal Opened April 11 th Gathered preliminary data findings from those facilities who were approved or below error tolerance level (ETL) between April 11 th through May 16 th. Remember, this preliminary data does not have all facilities’ data that are still being submitted or corrected.

39. Preliminary Data Submissions As of May 16 th Emergency Departments (ED) a) 235 approved data b) 109 remaining for submission or approval Hospital-based Ambulatory Surgery a) 256 approved data b) 133 remaining for submission or approval Freestanding Ambulatory Surgery Centers a) 329 approved data b) 120 remaining for submission or approval

40. Preliminary Data Submissions (Based on approved data or below ETL) Number of Patient Records a) ED1,520,340 b) Hospital AS 387,754 c) Freestanding ASCs 282,182 Average Number of Extension Days Used a) ED 7 days b) AS 7 days

41. Preliminary Data Findings – 1 st Qtr ‘05 (gathered from April 11 – May 16) Number of Outpatients by Gender a) ED o 807,431 Females o 696,477 Males o 16,395 Unknown o 37 Invalid and Blank b) AS o 300,510 Females o 235,293 Males o 3,500 Unknown o 8 Invalid and Blank

42. Preliminary Data Findings – 1 st Qtr ‘05 (gathered from April 11 – May 16) Race a) ED o Highest: 947,290 White (R5) o Lowest: 12,991 Hawaiian/Pac.Islander (R4) b) AS o Highest: 350,416 White (R5) o Lowest: 3,180 Amer.Indian/Alaskan (R1)

43. Preliminary Data Findings – 1 st Qtr ‘05 (gathered from April 11 – May 16) ED Diagnosis a) Valid -1,518,884 Princ. Diagnoses 1,310,676 Other Diagnoses b) Blank - 1,400 Princ. Diagnoses c) Invalid - 57 Princ. Diagnoses 47 Other Diagnoses AS Diagnosis a) Valid - 538,933 Princ. Diagnoses 727,355 Other Diagnoses b) Blank - 231 Princ. Diagnoses c) Invalid - 148 Princ. Diagnoses 98 Other Diagnoses  Top three diagnoses – Unknown at this time

44. Preliminary Data Findings – 1 st Qtr ‘05 (gathered from April 11 – May 16) ED Procedures a) Valid - 648,694 Princ. Procedures 1,341,023 Other Procedures b) Invalid - 491 Princ. Procedures 531 Other Procedures AS Procedures a) Valid - 538,485 Princ. Procedures 428,011 Other Procedures b) Invalid - 230 Princ. Procedures 428 Other Procedures c) Blank - 598 Princ. Procedures  Top three procedures – Unknown at this time

45. Preliminary Data Findings – 1 st Qtr ‘05 (gathered from April 11 – May 16) ED Cause of Injuries a) Valid - 356,486 Princ. E Codes 351,780 Other E Codes b) Invalid - 7 Princ. E Codes 6 Other E Codes AS Cause of Injuries a) Valid - 17,562 Princ. E Codes 17,186 Other E Codes b) Invalid - 15 Princ. E Codes 3 Other E Codes  Top three causes – Unknown at this time

46. Preliminary Data Findings – 1 st Qtr ‘05 (gathered from April 11 – May 16) Social Security Numbers a) ED o Valid - 1,215,040 o Invalid - 1,491 o Unknown - 303,443 o Blank - 366 b) AS o Valid - 500,970 o Invalid - 250 o Unknown - 37,960 o Blank - 133

47. Preliminary Data Findings – 1 st Qtr ‘05 (gathered from April 11 – May 16) Top Three ED Dispositions 1. 1,391,404 - Home (code 01) 2. 48,026 - Other (code 00) 3. 39,688 - AMA or Discontinued Care (code 07) Top Three AS Dispositions 1. 516,372 - Home (code 01) 2. 19,278 - Other (code 00) 3. 1,087 - Medicare-certified SNF (code 03) Deaths (as of May 16 th ) ED 3,500 AS 39

48. Preliminary Data Findings – 1 st Qtr ‘05 (gathered from April 11 – May 16) Top Four ED Payers 1. 398,633 - Medi-Cal (code MC) 2. 255,339 - Self-Pay (code 09) 3. 233,838 - HMO (code HM) 4. 106,900 - PPO (code 12) Top Four AS Payers 1. 105,352 - HMO (code HM) 2. 75,826 - Medicare Part B (code MB) 3. 65,303 - PPO (code 12) 4. 55,702 - Blue Cross/Blue Shield (BL)

49. Possible Data Needs Possible Ideas a) Public Data Sets b) Top Five Reasons to EDs c) Top Five Procedures in AS Facilities d) Volume load in EDs or AS Facilities e) Clusters of Cardiac Cath Procs in Certain Counties f) Clusters of Auto Accidents in Certain Counties g) Quick Notes – Preliminary Data Snapshots

50. Your Data Needs? How do you want the data to work for you? Dissemination Plans – Facility Profile Report – Aggregate Reports of Frequency of Diagnosis and Procedure codes Timeline: After 2 nd Quarter report period (April-June) Your feedback and suggestions needed HIRC@oshpd.ca.gov