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DATA QUALITY MANAGEMENT CONTROL (DQMC) PROGRAM

DATA QUALITY MANAGEMENT CONTROL (DQMC) PROGRAM. TRICARE Data Quality Training Course February 10, 2009. DQMC Program Briefing Purpose. Provide an overview of the Data Quality Management Control (DQMC) Program in the Military Health System (MHS): Data quality concepts;

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DATA QUALITY MANAGEMENT CONTROL (DQMC) PROGRAM

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  1. DATA QUALITY MANAGEMENT CONTROL (DQMC) PROGRAM TRICARE Data Quality Training Course February 10, 2009

  2. DQMC ProgramBriefing Purpose • Provide an overview of the Data Quality Management Control (DQMC) Program in the Military Health System (MHS): • Data quality concepts; • Background of DQMC Program; • Components of the DQMC Program; • TMA Summary of Commander’s Data Quality Statement metrics; • Inspections and External Audit statistics; • Highlight current topics and ongoing issues; and • Conclusion.

  3. DQMC ProgramData Quality Concepts Attributes …

  4. GAO Audit Agencies Congress DQMC ProgramData Quality Concepts Why Worry about Data Quality? One reason is external scrutiny... DoD IG

  5. DQMC ProgramData Quality Concepts Problems with Information Technology (IT) • Typically, Data Quality is formulated as an IT problem ... • Some of our problems with data quality can be attributed to problems with Information Technology (IT); • Examples: • Errors in transmission of data; • Errors in processing data; • Unsynchronized databases; • But … • The most difficult problems we face with data quality are not directly attributable to IT, nor readily fixed by IT solutions.

  6. DQMC ProgramData Quality Concepts A few examples of non-Information Technology problems causing problems with data quality: • Lack of standardized business rules and policies; • Inconsistent choices of codes, weights and algorithms; • Lack of adequate training and education; • Lack of adequate local data quality assurance; and • Failure to set and enforce tough performance expectations about data quality.

  7. DQMC ProgramData Quality Concepts Our people have to understand both the business and the technology… • Training & Education: Quality data requires more than training data-entry personnel; • Data Quality Training Course - aimed at DQ Managers (offered 3 times a year); • MEPRS Application & Data Improvement (MADI); • Working Information Systems to Determine Optimal Management (WISDOM); and • Providers – Documentation and Coding.

  8. DQMC ProgramData Quality Concepts Solutions to effectively fix data problems: • Reasonable feedback for Commanders and Users, such as: • Metrics - Fast feedback to Commanders about the quality of their data; • Rapid availability of data for use; • Best Practices – literature, forums, conferences; and • Core competency.

  9. DQMC ProgramBackground TMA DQMC Program Implemented 01 Dec 2000 (FY 2001) • DoD IG identified material management control weakness for MHS - Directed development of data quality assurance and management control program; • 2 Specific Reports: • DoD IG report concerning the FY98 Retirement Liability Estimate; • GAO Medicare Subvention Demonstration report; • ASD (HA) concurred with DoD IG materialmanagement control weakness findings; and • ASD (HA) designated TMA Resource Management Steering Committee to oversee the development of an MHS DQ Management Control Program.

  10. DQMC Program Background TMA Data Quality Management Control Program • Development of DQMC involved multiple workinggroups to include major system representatives; • DoD comptroller, DoD IG and GAO provided oversight in its development; • Program has been staffed through the Services with substantial input from field (former Region 11 MTFs); and • Policy Memorandum signed on 29 Nov 00 forimplementation on 01 Dec 00. Subsequently updated by policy memorandums dated 09 May 01, 17 Oct 01, 05 Sep 02 and DoDI 6040.40 dated 26 Nov 02.

  11. DQMC Program Background • 2 Enclosures: • DQMC Review List • Commander’s DataQuality Statement Regulatory GuidanceDODI 6040.40Military Health System Data Quality Management Control Procedures

  12. DQMC Program Background • Commander’s Data Quality Statement for FY 2009 • Look at your handout • New questions – for 5e and 5f 5e: Percent of completed and current DD Form 2569s 5f: Percent of current DD Form 2569s verified to be correct in Patient Insurance Information module in CHCS? • New question 10 Number of potential duplicate patient registration records from running CHCS standard report. Only for CHCS host site. • Old question 10 has become question 11

  13. DQMC Program Components of Program TMA DQMC Program improves data quality and ensures that the MTF receives credit for properly recording the workload. • Data Quality Manager & Data Quality Assurance Team; • DQMC Review List- Internal tool to assists MTFs monthly in identifying and correcting financial and clinical workload data problems. This list is prepared by the Data Quality Manager and Data Quality Assurance Team [Enclosure 1 of DODI 6040.40];and • Monthly Commander’s Data Quality Statement– Specific information from the DQMC Review List that the Commander approves for forwarding to Service DQ Managers and the TMA Management Control Program Manager[Enclosure 2 of DODI 6040.40].

  14. DQMC Program Components of Program Active Leadership Involvement Data Quality Managers Rapid Feedback Critical Success Factors Use of Data/Metrics by the MTFs File/Table Build Data Base Management Timely Coding/End-Of-Day Processing Data Reconciliation and Audits

  15. DQMC Program DQ Metrics • TMA DQ Website • http://www.tricare.mil/ocfo/mcfs/dqmcp.cfm; • Metrics and Report; and • Important reference materials. • TMA DQ metrics • Commander’s DQ Statements: • Received by TMA from Services on the 10th of the month for the preceding month’s report. (Applies to the prior month’s data.) Used to create the TMA Service Trends spreadsheets; • TMA Summary: • Constructed from the Service Trends and briefed to both the Resource Management Steering Committee and TMA Senior Leadership and Service DSGs twice a year; • Posted on the DQMC website; • Monthly DQMC Program Workgroup meetings: • Service DQMC POCs and TMA meet at TMA-MC&FS; and • Service and TMA wide issues discussed and documented.

  16. DQMC Program DQ Metrics • TMA DQ Webpage • http://www.tricare.mil/ocfo/mcfs/dqmcp.cfm

  17. DQMC Program DQ Metrics • The following “DQMC Commander’s Statement TMA Summary Sheet” summarizes results of the Commander’s Data Quality Statements submitted by each Service for Data Month Jan 08; • Metric Standards (colors) are as follows: • Green- 95-100 (Except 8e – 80 and above green) • Yellow -80-94 • Red -0-79 • Color coding generally moves from red to green as the fiscal year progresses and issues are ironed out.

  18. DQMC Program DQ Metrics See TMA Summary Sheet handout - below is an example for FY 2008

  19. DQMC Program Inspections/External Audits DoD IG inspected -- results (Apr 01-Oct 01) were published in a report signed 29 Aug 02. General Comments: • Overall indifference toward the program; • Lack of communication and timely feedback to identify shortfalls in performance; • Inadequate preparation and training of the DQ Team for completion of the Control Review List; and • Lack of monitoring to ensure proper implementation of the program.

  20. DQMC ProgramInspections/External Audits DoD IG MTF Specific Comments: • Responses to the Commander’s Statement andControl Review Lists are unreliable. Need audit / validation of responses in the Commander’sStatement / Review List; • Lack of audit trail - no supporting documentation; • Lack of accountability; • Lack of training; and • Inadequate dedication of resources to data quality.

  21. DQMC ProgramInspections/External Audits The DOD IG Inspection raised concerns: • Prevents Defense Health Program (DHP) and Office of Secretary of Defense (OSD) from receiving a “Clean Audit Opinion;” • Puts future DHP funding in jeopardy; • Puts Prospective Payment in jeopardy; • Third Party Collections (TPC) placed in jeopardy; and • Jeopardizes MTF Accrual Financing Reimbursement.

  22. DQMC Program Inspections/External Audits External Audit – 2002 Iowa Foundation • The audit consisted of 50 sites, 11,254 cases; • Unavailability of records (47%); • Specific encounter not found in 9% of the records; • Coded incorrectly, 27%; 70% over coded, 30% under coded; and • Coded correctly, 17%. AdvanceMed ended up with similar results • National Capitol Region (NCR) availability of records (9%).

  23. DQMC Program Inspections/External Audits External MHS Coding Audit

  24. DQMC ProgramInspections/External Audits External MHS Targeted Coding Audit

  25. N=30 N=30 N=30 N=30 N=30 N=30 N=30 N=30 N=30 N=30 N=30 N=29 N=30 N=30 N=23 N=24 N=30 N=26 DQMC Program Inspections/External Audits External Coding Audit Results 2007 – Targeted 6 Hospitals New Study Rules Source: Data is Post-Feedback % Records Correct from Final Report Coding Audit, Military Health System, 27 July 2007 by STI. Note: IP = DRG accuracy; OP and APV = E&M, CPT, and ICD-9 accuracy.

  26. DQMC ProgramInspections/External Audits External Coding Audit Results 2007 (Data Records FY 2005) These tables are excerpts from Final Report Coding Audit, Military Health System, 27 July 2007 by STI.

  27. DQMC ProgramInspections/External Audits External Coding Audit Results 2008 (Data Records FY 2006)

  28. DQMC Program Current Topics Some of the items currently being pursued: • Training: • DQ Course; • Presented DQMC brief at Navy Patient Admin Course and UBO/UBU Conferences; • Using M2 Data Quality Reports to Improve MTF Data Quality; • Annual Commander’s Data Quality Statement Update: • FY09 – Clarification of Coding Audit formulas; • FY09 – Addition of Duplicate Records reporting from Review List; and • Internal Compliance, External Evaluation: • MHS External Coding Audit fpr FY09 (FY07 data records).

  29. DQMC ProgramOngoing Issues Issues being pursued: • Medical Expense Performance and Reporting System (MEPRS) Timely Reporting • Difficulty with DMHRSi • MHS Trouble-Ticket Management (Tier 2 & 3): • AHLTA Implementation Issues; • Central System Table Synchronization (e.g., CPT Table): • AHLTA, CCE, CHCS; • Coding Accuracy: • TMA External Coding Audits.

  30. DQMC Program Conclusion • There are many benefits to Data Quality: • Records (with accurate documentation / coding): • Provide evidence of treatment and supports budget, reimbursement and billing; • Support training and education; • Facilitate quality assurance processes; • Provide the legal defense for patients, providers and the MHS; • Availability of records provides the communications link between providers and continuity of care; and • Credit for MTF quality work.

  31. DQMC Program Conclusion How Can You Help? • Brief medical staff on command data • Executive Steering Committee • Department & Division Heads • Develop Dashboards • Provide feedback to staff and use the data • Be well-read/knowledgeable in data quality • Reporting • Analysis • Network and share information

  32. DQMC Program Conclusion • Service DQ POCs • Army • Navy • Air Force

  33. Questions?

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