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Acknowledgments and thanks to?. Qualis Health ED Project colleagues:Sen Dimas, BS; Karen Benson-Huck, ARNP, PhD; Fred Drennan, MD, MHACMS Central Office:Mary Beth Ribar (GTL), Steven Blackwell, Aaron Goldfarb, Judy Goldfarb, John Hebb, Jackie Kennedy SullivanTEP members, consultants. . ED Co
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1. Uncharted Territory:Exploring the content andcharacteristics of Medicare ED claims Neal Traven, PhD
AHQA Technical Conference
New Orleans LA March 12, 2004
2. Acknowledgments and thanks to… Qualis Health ED Project colleagues:
Sen Dimas, BS; Karen Benson-Huck, ARNP, PhD; Fred Drennan, MD, MHA
CMS Central Office:
Mary Beth Ribar (GTL), Steven Blackwell, Aaron Goldfarb, Judy Goldfarb, John Hebb, Jackie Kennedy Sullivan
TEP members, consultants
3. ED Continuity of Care Project Contract awarded October 2002
Purpose: “to assess use(s) of emergency department (ED) administrative data and to develop ED quality indicators”
Technical Expert Panel for clinical guidance
To assess the utility of ED claims, we must learn what is in ED claims
4. What are ED claims? Part A
Rolled into Inpatient if admitted within 72 hours
Outpatient claim if beneficiary not admitted
Part B
Physician services, procedures
Either/both Part A and Part B (?)
Labs, imaging, etc.
May depend on hospital corporate structure
5. Data request decision-making What information can be obtained from ED administrative data?
What are potential sources of variation in ED claims datasets?
Should we look for ED visits rolled into Inpatient admissions?
How many requests can we make?
How large are the analytic datasets?
6. Ad hoc data request Institutional outpatient records, CY 2001
Six states -- AK, CO, MS, NH, WA, WI
Beneficiary 5% sample (last two digits of HIC = 05, 20, 45, 70, 95)
Select on specified Revenue Center codes
045X (emergency room services)
0981 (professional services in ED)
Return all Revenue Center records of selected encounters
7. Records returned 38770 Base records
1 record per encounter
Service dates, bene demographics, UPINs, ICD codes (diagnosis, procedure), FI, total charge and payment
285475 Revenue Center records
Multiple records per encounter
One record for each Revenue Center within encounter
Revenue Center code, HCPCS, APC
Linkage to Base record via uniqueid
8. Encounters and beneficiariesby state
9. Encounters per beneficiaryby state and age
10. Proportion of beneficiaries withED-only visits, by state and age
11. Commonly-reported“principal” diagnosis groups Symptoms/signs/ill-defined (780 - 799) 25.7%
Injury and poisoning (800 - 999) 22.2%
Musculoskeletal/connective tissue (710 - 739) 9.5%
Respiratory system (460 - 519) 8.8%
Circulatory system (390 - 459) 7.7%
Digestive system (520 - 579) 5.8%
Genitourinary system (580 - 629) 4.3%
Nervous system/sense organs (320 - 389) 3.4%
Mental disorders (290 - 319) 3.3%
(all other groups) 9.3%
12. Revenue Center code characteristics Code ‘0001’ = “Total charges” appears once in every encounter
Multiple Revenue Center codes / encounter
Range = 2 - 45
Median = 5
Mean = 7.36
State-specific means range from 6.50 (MS) to 7.74 (NH)
13. Important or commonRevenue Center Groups Encounters
Revenue Center Group Percent Times
Laboratory (030X) 51.6% 5.06
Ambulance services (054X) 1.6% 2.44
Observation (076X) 3.9% 1.28
Radiology diagnosis (032X) 44.8% 1.27
Pharmacy (025X) 41.4% 1.23
Medical-surgical supplies (027X) 35.3% 1.23
Computed tomography (035X) 9.3% 1.23
ED services (045X) 99.9% 1.22
Electrocardiogram (073X) 26.7% 1.15
15. Phase Two ED Quality Performance Measures Project
Identify preliminary QPMs reflecting ER care
intrinsic clinical validity
evidence-based, when possible
cost-effective to measure
aligned with other CMS/JCAHO priorities
National call for measures
Engage stakeholders and TEP
Abstraction of ED records