Briefing: DQ Statement Roundtable

1. Briefing:DQ Statement Roundtable Date: 25 March 2010 Time:1010–1200

2. Objectives • Purpose of the DQMC Review List and DQ Statement Roundtable • Increase community awareness • Background and history • TMA Data Quality Management Control (DQMC) Program • Introduce Service initiatives • Discuss issues

3. DQMC Background & History GAO Audit Agencies Why Worry about Data Quality? One reason is external scrutiny... DoD IG Congress

4. DQMC Background & History TMA DQMC Program improves data quality and ensures that the MTF receives credit for properly recorded workload.

5. DQMC Background & History • Typically Data Quality is formulated as an IT problem • Errors in transmission • Errors in processing • Unsynchronized databases • But our most difficult problems with data quality are often not directly attributable to IT, nor readily fixed by IT solutions • Standardization of business rules and policies across Services, between agencies • Inconsistency of choices for codes, weights, and algorithms • Expectations of low data quality

6. DQMC Background & History • Data Quality Management Control (DQMC) Program was created to alleviate DoD IG’s identification of material management control weaknesses within MHS • DoD IG report concerning the FY 1998 Retirement Liability Estimate • GAO Medicare Subvention Demonstration report • Elements of the DQMC Program • TMA DQMC Program, collaboration between • TMA POC • 3 Service POCs • Policy Memorandum (29 Nov 2000) • DoDI 6040.40 (26 Nov 2002) updated annually • DQMC Review List • Data Quality Statement

7. DQMC Background & History • Start with the DQMC Review List • Enclosure 1 of DODI 6040.40 • Monthly Data Quality Statement • Subset of DQMC Review List sent to Service DQ managers and the TMA DQMC Program Manager [Enclosure 2 of DODI 6040.40] • Commander approval • Used to create TMA Summary • Tri-Service view of data • Briefed to both the Resource Management Steering Committee (RMSC) and TMA Senior Leadership and Service DSGs (CFOIC), twice a year

8. DQMC Background & History • How are these metrics used? • Timely feedback to the Commanders about the quality of their data • Discussed monthly at DQMC Workgroup meetings • Service DQ POCs and TMA meet at TMA-MC&FS • Service and TMA wide issues discussed and documented • Posted on the TMA – OCFO, MC&FS – Web site, DQMC Web page • http://www.tricare.mil/ocfo/mcfs/dqmcp.cfm • Metrics & Reports • Important reference material

9. TMA Comments Example of the TMA Summary Sheet

10. TMA Comments • Metric Standards (colors) are as follows: • Green – 95-100 • Yellow – 80-94 • Red – 0-79 • Except for 8e and 9, which is Green for 80 and above • 3c, 3d, and 10a do not yet have a standard – no color • Metric colors • Generally move from red status to green status over the fiscal year, indicates data quality matures over the year • Sometimes “RED” is good, revealing a system-wide problem • Sometimes there is no coloring to indicate a new question or one for which a goal is not yet established

11. Example of TMA Summary –FY10 Metric Questions 11

12. Example of TMA Summary –FY10 Metric Questions 12

13. TMA Comments • TMA Initiatives this year • Added DMHRSi questions (DQ Statement 3d and 3e) • Clarified existing questions to strive for tri-Service uniformity in answers • Removed one question • DQ Statement question 1a – close every clinic • Replaced with what was 1b – close every record

14. Army Comments • Data Quality Management Control (DQMC) Program Review • Defense Medical Human Resources System-internet (DMHRS-i) • MTFs submitting MEPRS data without 100% of personnel timecards. • DMHRS-i allows for Medical Command level review of what MTFs are submitting for timecards. • Army MTFs will be penalized under Performance Based Adjustment Measures for not meeting monthly MEPRS submission date. Penalty is $10.00 per available FTE per reporting month.

15. Army Comments • Other Health Insurance (OHI), DD Form 2569 • Currently no Army wide solution for development of an electronic DD Form 2569. • Army sites using a contracted vendor to identify beneficiaries with OHI have reported increase in beneficiaries identified with OHI . • Army sites using outside vendor reporting increased revenue collections. • Army Medical Command considering several different models for Third Party Collections.

16. Army Comments Coding Army using Code Auditing and Reporting Application (CARA). Coding audits conducted under Patient Administration Systems and Biostatistics Activity (PASBA) oversight. CARA coding results will be incorporated into Army Production Based Adjustment Model. CARA results will be used by all Army MTFs to populate DQMC Program DQ Statement. DQMC Program Changes for Army New Web-based application, to include Web-based Review List. Added three Army-only questions to DQ Statement. 16

17. Navy Comments • References • Navy FY10 DQMC Guidance • 10% Improvement Required in DDFM 2569 Collection for Outpatient Encounters • Inpatient and APV Records DDFM 2569 Required on Admission, MANMED Chapter: ???? • Coding Timeliness, Coding Accuracy • Audit policy is in concert with Patient Administration Standard Audit Guidelines 17

18. Navy Comments • Data Quality Assurance Teams at all levels • BUMED • Program Manager, Provide Policy • Regions: NCA, NMW, NME • Monitor Execution, Training/Assist Visits • MTF • Program Execution and Reporting • NMSC • NAVMISSA/EDQ Web site and IT Support

19. Navy Comments • Although improving, Red is Red • Drilling down to some MTFs shows the opposite

20. Navy Comments What Can You Do to Improve Stop doing the MINIMUM Requirement Enhance your local program Use technology to help Report Accurately Use the comments section to report. Don’t just explain the issue It’s up to you to fix or request help Don’t be afraid to be Red It simply means “we have an issue” Sometimes you have to lose a battle to win the war

21. Air Force Comments – HAF • AF Organizational Structure • HAF (policy) • AFMOA (execution) • Data Quality Manager’s User Guide (MUG) • Primary AF guidance to support AF DQ Manager’s • Clarification of all DQ Statement Questions

22. Air Force Comments – AFMOA DQ Umbrella DQ Foundation 22 • AFMOA-MTF Engagement • Vector Check…telecons…one-on-one….SAVs • Reduce variance…standardize..improve performance • Current DQ Statement Issues • “Review List” Focus…raising the bar…culture change • eDQ – Electronic Data Quality Statement • Automate…Vector Check…optimize • CHCS Provider File Data Quality Effort • MTF Report Cards…details…way ahead • Other Data Quality Efforts MTF • AF Patient File Data Quality Initiative • Automatic Duplicate Merge – DHIMS

23. Roundtable Topics Are you providing the DQ Manager at your MTF the information needed? DQMC Review List applicable to UBO A.6, B.4, C.5, C.6, C.7, E DQMC Review List applicable to UBU A.5, B.4, B.6, C.2, C.5, C.6, C.7, E What are the pitfalls to collecting updated DD-2569s (Other Heath Information (OHI)) Civilian clinics won’t treat without full insurance information, including OHI 23

24. Roundtable Topics DQ Statement Metrics – FY 2009 data

25. Roundtable Topics DQ Statement Metrics – FY 2009 data

26. Roundtable Topics Late tables. Are you coding when you shouldn’t be? Are you attempting to bill? FY10 ICD-9 code table updates were delayed Must wait for the table update before completing SIDRs and grouping 26

27. Roundtable Topics DQ Statement Metrics – FY 2009 data

28. Roundtable Topics What are your success stories?