Using Administrative Data to Assist in Completing The Leapfrog Hospital Survey

1. Using Administrative Data to Assist in Completing The Leapfrog Hospital Survey Survey Townhall CallsApril 29, 2009

2. Town Hall Call Overview • Introduction • Why are we doing this town hall call? • What is administrative data? (See Disclosure’s Summary) • Where to find the data? • Should I use administrative data? • What does administrative data include? • Survey Submission Logistics/Timeline/Web Resources • Survey Sections Where Administrative Data Can Reduce Burden • Common Acute Conditions (CACs) • Evidence-based Hospital Referral (EBHR) • Resource Utilization • Q & A • Slides for this presentation can be found at: www.leapfroggroup.org –see the right hand column and look for announcement of town hall calls. Click through and select link for slides

3. Why are we doing this call? • Increasing use of standardized measures—considerable number of NQF-endorsed measures make use of administrative data • Burden reduction—use administrative data for measures of volume, observed death; for first cut of cases (reducing chart review time) in normal deliveries; for risk factor counts for risk adjustment in the LOS • Some problems in submission last year for resource utilization risk factors and readmission • Ongoing monitoring of cases for internal quality improvement activities found in Safe Practices

4. What is Administrative Data? • Claims data is considered administrative data • Hospital Discharge Abstract*--an abstract from the claims data Each of these contain standardized information on hospitalizations and/or test results—stored under an individual patient’s ID (usually medical record number, sometimes SSN) *It is based on a summary for each discharge—many states/hospital associations/vendors collect this information on a quarterly basis from hospitals. It is frequently used by states and others for comparative performance reporting.

5. Where do I find the data? • If not in the quality department—it can be found in billing or claims processing • If not available there—48 states collect this information—acquire from state health data agency or hospital association • Use information from submitted claims (if using paid claims be sure it includes those claims where no payment has been received) • May need to request assistance in data access and analysis (don’t wait until the last minute) • Can have specific subsets of data dumped into excel spreadsheets for analysis (request separate files for specific measures using ICD codes)

6. Should I Use Administrative Data? • Does your hospital store hospital discharge abstracts? For how long? • Do you have access to this information? Could you have access? • Do you routinely analyze this type of data? If not, is there someone in your facility that does? Does your hospital have a vendor analyze this data? • What format is the data available in? Database? Excel? • Do you have the coding requirements for the survey questions? (If no code for a component of the measure—will need to augment with clinical chart data)

7. What Does Administrative Data Include? • Demographics (age, gender, address) • Patient Identifier (Med Rec #, SSN, name) • Dates of admission and discharge • Diagnosis Codes (ICD-9-CM Diagnosis Codes) • Present on Admission (POA) • Procedure Codes (ICD-9-CM Procedure Codes) includes day of procedure • Admission status (from home, ED, nursing home) • Discharge Status (Deceased, Home, Nursing Home, etc.) • Health plan, hospital and physician identifiers • Revenue codes—can be used to identify ICU stay

8. What Can It Be Used For? • Can use to measure outcomes of care (death, complications, hospital readmission) • Can use to measure processes of care (e.g., CABG done using IMA) • Can use to measure volume of a procedure • Can use to measure resource utilization (LOS, ICU care) • Can use to examine disparities in care based on gender, or payer status • Can use to examine market share for certain diagnoses, procedures • Cannot be used when clinical details are needed—for example parity (first born)

9. Survey Submission Logistics, Timeline, Website Resources

10. 2009 Timeline • April 2, 2009 -- Leapfrog launched 2009 Survey • June 30, 2009 -- RRO-targeted hospitals report or be listed on Leapfrog’s website as Did Not Respond • July 21, 2009 -- Leapfrog website lists new results • Top Hospitals List/Highest Value Hospitals –Must have submitted survey prior to August 31, 2009

11. Website Resources for EBHR • Medical Coding for High-Risk Procedures and ConditionsProcedure code, diagnosis codes and other specifications for counting high-risk surgery volumes • Process Measures -- SpecificationsDetailed specifications for Leapfrog’s procedure-specific process measures of quality -- for CABG, PCI, AAA Repair, and high-risk deliveries. • Resource Utilization Measures – Specifications Detailed specifications for Leapfrog’s CABG and PCI including: • Coding for counting eligible cases • Coding and other criteria for identifying cases with risk factors • Reporting geometric mean length of stay • Criteria for identifying cases followed by readmission • Excel Tool for Computing Geometric Mean Length of Stay

12. Website Resources for Common Acute Conditions (CAC) • Volume Standard Coding: Medical Coding for Common Acute Conditions Procedure/diagnosis codes and other specifications for counting AMI and Pneumonia volume • Process Measures - SpecificationsSpecifications for Leapfrog’s nationally-endorsed condition-specific process measures of quality -- for AMI, Pneumonia, and Normal Deliveries. • Resource Utilization Measures – Specifications Detailed specifications for Leapfrog’s Common Acute Conditions (AMI and Pneumonia) – including: • Coding for counting eligible cases • Coding and other criteria for identifying cases with risk factors • Specifications for reporting geometric mean length of stay • Criteria for identifying cases followed by readmission • Excel Tool for Computing Geometric Mean Length of Stay • Outcome Measures for Normal Deliveries • Coding for counting eligible cases (denominator) • Criteria for determining numerator

13. 2009: Time to Use Existing Resources

14. Common Acute Conditions • Acute Myocardial Infarction (AMI) • Can submit responses based on submission to CMS (use all cases) instead of chart pull OR • Find number of patients in administrative data discharged with principal diagnosis code within range defined in survey documentation and not indicated as an exclusion (answer Q1) (If total <30 cases over 24 months no further data reported) • Pull charts for identified cases, use process measure specifications to submit cases measured and cases adhering to process (answers for (b) and (c) • Pneumonia (PNE) • Can submit responses based on submission to CMS (use all cases) instead of chart pull OR • Find number of patients discharged with a diagnosis code of pneumonia or septicemia or respiratory failure using administrative data (denominator) and not indicated as an exclusion (If total < 30 cases (24 months) no further data reported) • Pull charts for identified cases, use process measure specifications to submit number of cases where process took place (numerator)

15. Resource Utilization for AMI and PNE • Use administrative data to report total number of inpatient cases meeting AMI criteria (specific inclusions/exclusions for resource utilization measures) • Use administrative data to find re-admissions from those reported inpatient cases to your hospital for any cause. Look for “readmission”—use patient ID or Medical Record Number to search for additional admissions within 14 days of discharge. • Determine in each administrative record the LOS for the specific hospitalization. Record on Geometric Mean worksheet. • Risk factors were designed to be supportable by claims data Dx/PX. When identifying risk factors, make sure to count the case only once for each risk factor. Then, tabulate the number of cases with the risk factor present. Refer to specifications document for ICD-9-CM codes.

16. Common Acute Conditions: Normal Deliveries • New condition added to the 2008 survey • Four new measures (two outcome; two process) • Elective Deliveries between 37 completed weeks and 39 completed weeks • Elective, low-risk C-Sections • DVT prophylaxis for Cesarean Sections • Bilirubin Screening

17. Normal Deliveries-1: Elective Delivery Prior to 39 Completed Weeks Gestation • To find cases—use either birth registry or administrative data. For administrative data-- • Find all cases where gestational age at delivery = at or after 37 completed weeks (ICD-9-CM code 765.29) and births that were a singleton birth (exclude cases with multiple gestation ICD-9 code 651) Report in Q2 • Exclude cases from total above using ICD-9 codes listed in Normal Deliveries: Leapfrog Specifications. Report new total in Q3 • Determine number of elective deliveries at or before 39 completed weeks gestation using: • ICD-9 Procedure code 73.4--for medical induction • ICD-9 Procedure code 654.2--for previous cesarean delivery complicating pregnancy, childbirth, or the puerperium. Report in Q4

18. Normal Deliveries-2: Cesarean Rate Denominator: • Use administrative data to identify total number of Live Births using listed ICD-9-CM codes (see specification document for codes) • Be sure to drop case exclusions listed in Leapfrog specifications—this will considerably pare down number of cases • Then pull charts/birth record and keep and record those cases that meet all of the following requirements: • Parity = 0 • Presentation = Vertex or cephalic • Gestational age at delivery = at or after 37 completed weeks gestation code (765.29) • Plurality = 1 (i.e., singleton) Numerator: • Using DRG codes count number of cases (meeting criteria above) where c-section occurred (765 or 766) • Report counts on survey by age group (number in age group and number with c-section)

19. Normal Deliveries-3: Newborn Bilirubin Screening Prior to Discharge • Count number of newborns born at or beyond 35 completed weeks gestation using ICD-9 codes 765.28 and 765.29. Exclude cases where discharge status was death prior to discharge, admitted to NICU, or parental refusal (will need to go to charts for two of the exclusions). Report number of Measured Cases. • Count number of eligible cases who have a serum or transcutaneous bilirubin screen prior to discharge to identify risk of hyperbilirubuinemia. Report in Cases Adhered.

20. Normal Deliveries-4: Appropriate DVT Prophylaxis in Women Undergoing Cesarean Delivery • Include cases with following MS-DRG: • 765 Cesarean section w CC • 766 Cesarean section w/o CC • No exclusions –Put this number in Measured Cases • Determine from chart whether mother received fractionated or unfractionated heparin or pneumatic compression devices prior to surgery. Record in Cases Adhere.

21. Evidence-based Hospital Referral • All procedures require a volume count and a count of observed deaths—both available within discharge data • Some procedures also require process measures, some can also be determined from electronic data (eg. CABG using IMA); others will require chart review if not submitted to an external reporting entity, such as STS, ACC, VON, CMS. (Note: specifications may differ from volume count)

22. EBHR Survival Predictor • Use administrative data to count number of procedures performed (meeting specific ICD-9- CM procedure codes or CPT codes in EBHR specifications document) • Count number of deaths that occurred during or following procedure (inpatient death only). Use discharge status to ascertain death. Report number of deaths • White paper available on LF website http://www.leapfroggroup.org/media/file/SurvivalPredictorWhitepaper.pdf

23. EBHR Resource Utilization Measures • CABG and PCI both require completion of the resource utilization section—see specific codes for resource utilization—when the hospital performs elective procedures. • Complete in same manner as AMI and PNE

24. Dates of Town Hall Calls • 2009 Leapfrog Hospital Survey Overview Call #3 • Date/Time: Friday, May 1st at 2 pm ET/1 pm CT/12 noon MT/11 am PT Call-in number: (866) 802-4364 • CPOE Evaluation Tool • Date/Time: Wednesday, May 6th at 2 pm ET/1 pm CT/12 noon MT/11 am PTCall-in number:  (866) 802-4321

25. Questions?