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Future of OSHPD Data

Future of OSHPD Data. Presenters : Starla Ledbetter Ginger Cox. Future Enhancements. Present on Admission Principal Language Spoken MS-DRGs Clinical Measurements Patient Address External Cause of Injury Payer Typology Facility Summary Report ICD-10 Code Sets.

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Future of OSHPD Data

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  1. Future of OSHPD Data Presenters: Starla Ledbetter Ginger Cox

  2. Future Enhancements • Present on Admission • Principal Language Spoken • MS-DRGs • Clinical Measurements • Patient Address • External Cause of Injury • Payer Typology • Facility Summary Report • ICD-10 Code Sets

  3. Condition Present At Admission • Collection: January 1, 1996 • THREE Values • Y = Yes • N = No • U = Uncertain • Reported on principal and secondary diagnoses for all inpatient records

  4. Present On Admission (POA) • National Standard: October 1, 2007 • OSHPD Collection: July 1, 2008 • FIVE Values • Y = Yes • N = No • U = No Information in the Record • W = Clinically Undetermined • Blank = Exempt from POA Reporting • Reported on all diagnoses and external cause of injury codes (E-codes)

  5. Interim Present On Admission • Oct 1, 2007 through Jun 30, 2008 • Allowed the reporting of two additional values for POA, with no validation • W = Reported as Clinically Undetermined • 1 = Reported as Exempt

  6. POA Frequencies 2007 Data will show the interim W and 1 values as reported

  7. Medicare Severity Diagnosis Related Groups Transition from DRG Grouper: 500+ DRGs Jan- Dec 2007 Implement MS-DRG Grouper: 900+ DRGs Jan – June 2008 MS-DRGs

  8. Principal Language Spoken • Collection: IP, ED, AS data • Collection begins: January 1, 2009 • Available to you with 2009 data!

  9. Principal Language Spoken • ENG – English • ARA – Arabic • ARM – Armenian • CHI – Chinese • FRE – French • CPF – French Creole • GER – German • GRE – Greek • GUJ – Gujarathi • HEB – Hebrew • HIN – Hindi • HUN – Hungarian • ITA – Italian • JPN – Japanese • KOR – Korean • LAO – Laotian • HMN – Miao, Hmong • KHM – Mon-Khmer, Cambodian • NAV – Navajo • PER – Persian • POL – Polish • POR – Portuguese • RUS – Russian • SCR – Serbo-Croatian • SPA – Spanish • TGL – Tagalog • THA – Thai • URD – Urdu • VIE – Vietnamese • YID – Yiddish • 999 – Unknown 24 spaces for write-in language

  10. Clinical Measurements • Albumin, serum • AST • BUN • Creatinine • Hemoglobin • INR • Oxygen Saturation • pH • Platelet count • Potassium • Sodium • White blood cell count

  11. Patient Address • Business Case • Technical Solution • Three data types • Inpatient • Emergency Department • Ambulatory Surgery HOME

  12. External Cause of Injury • Codes E870-E876 for misadventures • Codes E878-E879 for abnormal reactions • Proposed date: January 1, 2010

  13. Payer Typology • Need for comprehensive, mutually exclusive categories and definitions • Developed and maintained by the Public Health Data Standards Consortium • Updated annually each October • http://www.phdsc.org/standards/payer-typology-source.asp

  14. 01 Medicare 02 Medical 03 Private Coverage 04 Workers Comp 05 County Indigent 06 Other Govt. 07 Other Indigent 08 Self Pay 09 Other Payer 1 Managed Care* (Knox Keene/MCOHS) 2 Managed Care Other 3 Traditional Coverage *Name of Plan OSHPD IP Payer Codes

  15. 09 Self-pay 11 Other Non-Federal Programs 12 Preferred Provider Organization (PPO) 13 Point of Service (POS) 14 Exclusive Provider Organization (EPO) 16 Health Maintenance Organization (HMO) Medicare Risk AM Automobile Medical BL Blue Cross/Blue Shield CH Champus CI Commercial Insurance Company DS Disability HM Health Maintenance Organization MA Medicare Part A MB Medicare Part B MC Medicaid OF Other Federal Program TV Title V VA Veteran Affairs Plan WC Workers’ Compensation 00 Other OSHPD ED and AS Payer Codes

  16. Payer Typology: 1st Level

  17. Payer Typology: Expanded

  18. Payer Typology: Expanded

  19. Facility Summary Reports • Data Distribution Report • Immediate feedback to the reporting facility • Facility Profile Report • Within 15 days of approval • Revised Facility Summary Report • Within 15 days of approval

  20. http://www.oshpd.ca.gov/MIRCal/Default.aspx Choose Date Type : ED or AS or IP

  21. Select which facility

  22. Select which report period

  23. Click on “List Report”

  24. ICD-10-CM and ICD-10-PCS Code Sets • ICD-10-CM • Diagnosis • External cause of injury, poisoning, adverse effect • ICD-10-PCS • Inpatient procedure • Effective date: October 1, 2013

  25. ICD-10-CM Format

  26. ICD-9-CM vs ICD-10-CM Diagnosis • ICD-9-CM365.83aqueous misdirection (malignant glaucoma) • ICD-10-CMH40.839 aqueous misdirection (malignant glaucoma) • H40.831Aqueous misdirection, right eye • H40.832Aqueous misdirection, left eye • H40.833 Aqueous misdirection, bilateral eyes • H40.839Aqueous misdirection, unspecified eye

  27. ICD-10-PCS Format 2 3 4 5 7 1 6 Root Operation Approach Extension Section Body Part Body System Device

  28. ICD-9-CM vs ICD-10-PCS Procedure • ICD-9-CM42.41 Partial esophagectomy • No further breakdown for what part of esophagus was resected • ICD-10-PCSODT10ZZ Open resection of upper esophagectomy • 4th digit = body part = upper esophagus

  29. Next Steps • Effective Date: October 1, 2013 • Impact Analysis • Budget Planning • System upgrades • Limit to basic edits • Regulation proposal • Education • Test • Go Live • Continue updates as usual

  30. Any Questions ??

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