Enhancing Occupational Health Surveillance Through Addition of New Codes - Benefits and Process Discussion

1. Addition of New Codes into Administrative Data A Discussion of the Process and Benefits for Occupational Health Surveillance

2. Presenter Disclosures Jennifer A. Taylor, PhD, MPH No relationships to disclose (1) The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months:

3. The Crew • Jennifer Taylor, PhD, MPH, Department of Environmental & Occupational Health, Drexel University School of Public Health, Philadelphia, PA • Amy Costello, MPH, NH Institute for Health Policy and Practice, University of New Hampshire, Durham, NH • Robert Davis, Consultant, National Association of Health Data Organizations, Albany, NY • Leah Roman, MPH, CHES, Department of Environmental & Occupational Health, Drexel University School of Public Health, Philadelphia, PA • Josephine Porter, MPH, NH Institute for Health Policy and Practice, University of New Hampshire, Durham, NH

4. Introduction http://publichealth.drexel.edu/first

5. Firefighter Injury • LODD=OK • Estimates range from 90 - 80,100 nonfatal injuries per year

6. Source: U.S. Fire Department Profile Through 2007, by Michael J. Karter, Jr. www.nfpa.org

7. Public Health Surveillance • Surveillance systems (Thacker & Berkelman, 1992): • enable the detection of new health problems and epidemics • provide quantitative estimates of the magnitude of morbidity and mortality • identify potential factors involved in injury occurrence • facilitate epidemiological research • target resources for program intervention • assess the effectiveness of prevention activities

8. Source: National Hospital Discharge Survey. Age-adjusted rates are plotted on a log scale.

9. Add Codes to Existing Data • Specifically, add occupation and industry codes to the uniform bill (UB04) used by the Centers for Medicare and Medicaid Services (CMS) and private insurers.

10. Repurposing billing data • The uniform bill serve two crucial functions: • submitting claims for reimbursement, and • reporting important data to State government • State reporting, enables the use of hospitals’ administrative data for the public good: • minimizes the need for additional resources by avoiding data duplication • enabling public health surveillance goals

11. Standard Setting Organizations • American National Standards Institute (ANSI ) • Accredited Standards Committee (ASC) X12 • http://www.x12.org • NUBC • The uniform bill • http://www.nubc.org

12. NUBC Mission “The National Uniform Billing Committee (NUBC) was brought together by the American Hospital Association (AHA) in 1975 and it includes the participation of all the major national provider and payer organizations. The NUBC was formed to develop a single billing form and standard data set that could be used nationwide by institutional providers and payers for handling health care claims.” Source: http://www.nubc.org/history.html

13. DSMO • Data Standards Maintenance Organization (DSMO) • The final HIPAA rule titled "Standards for Electronic Transactions”(2000) • The HHS Secretary may designate as DSMOs those organizations that agree to maintain the standards adopted by the Secretary. • X12 and NUBC = DSMOs

14. Role of the NUBC “Over the years, the NUBC has realized that the UB data set has become more than a billing instrument. It is also used by many others, including public health and health researchers, as a tool to gauge the delivery of health care services to patients. Therefore, the data set has broad policy implications for shaping the future of our health delivery system. Recently, the NUBC increased it membership to include the public health sectoras well as the electronic standards development organizations.” Source: http://www.nubc.org/history.html

15. Petitioning X12 and NUBC

16. Add: NAICS • The North American Industrial Classification System (NAICS) • NAICS was developed to accommodate new developments in the global economy and new approaches to classifying economic activity. • http://www.census.gov/eos/www/naics/

17. Add: SOC • The Standard Occupational Classification (SOC) was first published in 1980, and revised in 1998 to create comparable data among all government agencies and private industries. • http://www.bls.gov/soc/

18. Codes • NAICS • 92 Public Administration • 922 Justice, Public Order, and Safety Activities • 9221 Justice, Public Order, and Safety Activities • 922160Fire Protection • SOC • 33-0000 Protective Service Occupations • 33-2000 Fire Fighting and Prevention Workers • 33-2011 Firefighters

19. NIOSH Industry and Occupation Computerized Coding System NAICS + SOC = NIOCCS • Available in 2012 • http://www.cdc.gov/niosh/soic/SOIC_About.html

20. Benefits • Capitalizes on a system that already collects most of the information needed • Extends benefit of data analysis to everyone who works • Captures both injuries AND illnesses • Incorporation of NAICS and SOC enables the uniform bill to be an ongoing, systematic, standardized source of occupational injury data • Trend analysis • Hypothesis development

21. Supporters • Occupational Safety and Health and Health Association - Director, David Michaels, MD • National Institute for Occupation Safety and Health - Director, John Howard, M.D. • Injury Control and Emergency Health Services, American Public Health Association - Chair, T. Bella Dinh-Zarr, PhD, MPH • Council of State and Territorial Epidemiologists - President, Thomas Safranek, MD • Division of Occupational and Environmental Medicine, Michigan State University - Chief, Kenneth D. Rosenman, M.D. • Occupational Health Surveillance Program, New Hampshire Bureau of Public Health Statistics & Informatics - Principal Investigator, Karla Armenti, ScD • Occupational Health Surveillance Program, Florida Department of Health - Principal Investigator, Sharon M. Watkins, PhD • Occupational Health Surveillance Program, New Jersey Department of Health and Senior Services - Supervisor, Margaret E. Lumia, PhD, MPH

22. Petitioning X12 and NUBC

24. What’s at Stake? • Public Health Source: http://www.itvs.org/films/struggles-in-steel/reviews-and-awards

25. Next Steps • Send your letters of support • Contact Leah Roman at FIRST • http://publichealth.drexel.edu/first/ • Work with FEMA, HHS, OSHA, NIOSH and others

26. Contact Jennifer A. Taylor, PhD, MPH Assistant Professor Department of Environmental & Occupational Health Drexel University School of Public Health 1505 Race Street, MS 1034 Philadelphia, PA 19102 215.762.2590 215.762.8846 fax Jat65@drexel.edu http://publichealth.drexel.edu/first