2010 ubo/ubu conference 1 title: using m2 to manage mtf data quality speaker: dr. rich holmes and...

2010 UBO/UBU Conference

1

Title: Using M2 to Manage MTF Data Quality

Speaker: Dr. Rich Holmes and Wendy Funk

Session: R-6-1000

Objectives

After completing this session, the attendee can: Characterize the following DQ Issues Affected by Recent

Changes to PPS:– Treatment of Units of Service in RVU Calculations– Substituting the Ceiling on Maximum Units of Service– Usage of “J” Codes in B-Clinic SADRs and. . .

Characterize the following ongoing DQ Issues:– . . . Usage of other HCPCS Codes in B-Clinic SADRs– Usage of New E&M code for Established Patients– Coding Creep– Admitting Same Day Surgeries– Inpatient Procedures Coded in Ambulatory Clinics– Usage of Individual CPT Codes for Group Therapy

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After completing this session, the attendee can: Characterize the following DQ Issues Affecting

Readiness or Continuity of Care:– Case Management Workload and FTEs– MDC 23 Explosion in Utilization

Leverage the MHS Data Mart (M2)– Describe the M2.– Describe the process of retrieving and using a corporate

document.– Describe how M2 can be used to write ad-hoc reports about

data quality.

Objectives

DQ Issues Affected by Recent Changes to PPS

4

Implementation of Unit of Service Limits in RVU

Calculations

5

Units of Service Limits

6

There are three components associated with CPT coding:– The code itself– The code modifier – intended to add additional

information about a procedure code– Units of service: Indicates the number of times a

procedure code is performed on a data record. Proper RVU assignment takes all of these into account,

as well as:– Setting– Type and Number of Providers

There are three types of RVUs.– Work RVUs: represents provider costliness and effort– Practice Expense RVUs:

Represents a provider’s overhead costs, such as supplies, nurses, admin staff, etc..

Two types: “In Office” and “Out of Office”– Malpractice RVUs: intended to assist in covering

malpractice premiums. Initially, HA/TMA used only the work RVU for PPS, with

no other adjustments for units of service, modifiers, etc. (Simple RVU)

Eventually, PPS implemented units of service, so that multiple instances of one CPT code could be credited. (Enhanced Simple RVU)


PPS also incorporated practice expense RVUs. This was very important

– Without units of service, the Services were underfunded; especially for physical therapy and mental health.

– The work RVU usually is reflective of only about half of the cost of ambulatory care – was not the best resource allocation method.

Implementing “total RVUs” (work + PE) and units of service was a significant improvement in the PPS.


The initial implementation of the new RVU data elements that included units of service (UOS) was done without respect to the quality of the reporting of UOS.

Many of the records received, however, contained units of service that simply could not be true.

Limits were developed for each CPT code by TMA/BEA. These limits can be obtained from M2, in the

CPT/HCPCS table. All SADR data were reprocessed to incorporate the

limits.– When this was done, users were not notified– Many questions have arisen from MTFs whose RVUs dropped

as a result. These MTFs typically had data quality problems.


Service-Wide Impact of UOS Changes in FY10

Service Simple RVU

Enhanced Simple (ES)

RVU

Enhanced Simple RVU w/

Limits

Simple vs. Enhanced

Simple

Enhanced Simple vs. Limited ES

Simple vs. Limited ES

A

16,759,382

17,576,133

17,292,735 5% -2% 3%

F

8,072,882

8,378,461

8,291,245 4% -1% 3%

N

9,408,982

9,967,646

9,867,874 6% -1% 5%

Total

34,241,247

35,922,241

35,451,855 5% -1% 4%

Excludes nurse workload, which will no longer be credited in PPS

MEPRS Code Impacts of Unit of Service Limits

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For most MEPRS Codes; impacts of changes in RVU methodologies were minimal

However, a few had major changes

Code A F N Total

BA: Medicine 6% 5% 6% 6%

BF: Mental Health 5% 2% 15% 6%

BL: PT/OT 18% 28% 37% 25%

All MEPRS Codes 3% 3% 5% 4%

Both PT/OT and Mental Health utilize several codes that indicate a time increment.

The impact in medicine is mostly from the Nutrition Clinic.

CPT Impacts of Unit of Service Limits

Some selected extreme examples from SADRs Each SADR represents care provided to one patient on one day. The first three SADRs indicate that there were 80 patients were

given more than 900 vaccinations at one visit! The last SADR shows 159 encounters where the patients had up to

52 days of psych counseling in one day!

CPT Description UOS Raw Limit # SADRs

90471Administration of a Single Vaccine 906 1 48

90471Administration of a Single Vaccine 907 1 15

90473Administration of a Single Vaccine - Oral 906 1 17

90801 Psychiatric Eval (covers up to 24 hours) 52 2 159

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Quantity Limits in Clinic Records

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TMA BEA sets “ceilings” on the maximum reasonable number of times a procedure could occur in an encounter.

If an MHS provider reports more than that number, the data are overwritten using the TMA BEA ceiling.

PPS calculates earnings based on the overwritten new number, and third-party billing when centralized would also see only the new number.

Here are some examples!

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MTF Military Department

CPT Code, Meaning

Quantity Ceiling PPS change if ceiling was 1

All S0810, PRK vision fix

123, 55* 2-$913

Army 96118, hour of psychiatric test

31 20-$2,369

AF Ext RS (same encounter)

12032 (suture up to 7” scalp)11404, excise 4” circle lesion

81

77

1

18

-$2,900

Navy (same encounter)

17311, 17312 (Moh’s Surgery to 5 tissue blocks)

4

3

1

3-$726

*Meant modifier “55” (follow up)

These are single encounters in MTFs in FY10

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Impact on Replacing Impossible Quantities with “1”:

Army $3,260,417Navy $1,448,307Air Force $ 812,071

MHS $5,520,795

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Clinician-Administered Drugs

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Represent $38 million dollars in the FY10 records. PPS funded in FY2010, but will not in FY2011. Can be billed for third-party collections. In FY2010, $5.2 million was coded in clinician

administered medications (J HCPCs) to patients who had other health insurance (OHI).

Not included in this are some outrageous quantities, although PPS did use them for reimbursement!

Clinician-Administered Drugs (HCPCS “J”)

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HCPCs Qty PE RVUMil Dep Record ID Maximum Bill Drug Involved

J9201 850 4.02 F 37107292 $ 127,898.31 Gemcitabine HCL (200 mg chemotherapy)

J1573 999 1.39 N 50642862 $ 51,975.67 Hepatitis B Immune Globulin (0.5 ml injection)

J9310 69 15.62 N 31208321 $ 40,341.31 Rituximab (100 mg chemotherapy)

J9310 69 15.62 N 31208340 $ 40,341.31 Rituximab (100 mg chemotherapy)

J1745 500 1.63 N 2415306343 $ 30,505.45 Infliximab (10 mg injection)

J1335 500 0.73 N 31413113 $ 13,661.95 Ertapenem sodium (500 mg. injection)

Clinician-Administered Drugs (HCPCS “J”)

Ongoing DQ Issues

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BUT “J” IS NOT THE ONLY HCPCS THAT MATTERS!)

HCPCS group SADRs Procedure Groups PPS Earnings

A Transporting Pts 58,368

83,364 $ 2,040,869

B Enteral feeding 14

15 $ 2,038

C Outpt PPS -

- $ -

D Dental 10,234

11,008 $ 460,434

E DME 42,570

51,107 $ 2,656,458

G Temp Prof Svcs 58,799

63,930 $ 4,379,494

H Alc-Substance Abuse 267,270

406,744 $ 22,428,509

J Drugs 591,998

713,616 $ 37,513,974

K DME (Temp) 146

158 $ 22,614


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HCPCS group SADRsProcedure

Groups PPS Earnings

L Orthotics

167,267 187,411 $ 22,064,312

M Other Med Svcs

101

101 $ 4,297

P Pathology

496

520 $ 179,299

Q Temp Codes

420,336 453,564 $ 16,849,055

R Radiology

13

13 $ 360

S Temp Non-Medicare 88,837

90,867 $ 29,802,579

T Medicaid

3,571

3,751 $ 375,752

V Vision 14,056

16,834 $ 1,516,502

Total

1,724,076

2,083,003 $ 140,296,545

BUT “J” IS NOT THE ONLY HCPCS THAT MATTERS!)


Use of New Patient E&M Codes

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New Patient E&M Codes

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Evaluation and Management Codes describe the nature of a provider to patient interface

An important feature of some E&M codes is the distinction between a new patient and an established patient.– New patients require more work that established patients– And therefore, providers receive higher reimbursement and

RVUs for new patients

Code Description Weight

99201 - 99205 New Patients Lowest intensity work RVU = 0.96Highest intensity work RVU = 6.34

99211 – 99215 Established Patients Lowest intensity work RVU = 0.36Highest intensity work RVU = 4.22


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What is a new patient?– Defined based on CPT Coding Rules– A new patient is one who has not received any professional

services from the physician, or another physician of the same specialty who belongs to the same group practice, within the past three years.

The definition of a new patient doesn’t only mean “new to the provider”, it can mean “new to the practice” also.

To determine the extent to which new patient E&M codes are properly used:– Developed a history file– Person ID, MTF, date of service, specialty and MEPRS code– Compared with coding on each new/established SADR– Compared 2007 to 2010


YearMTF

ServiceProperly Coded

New Patient

Improperly Coded New

PatientTotal New

Patient

% That Appear to be Coded

IncorrectlyPPS Impact of

Improper Coding

2007 Army 682,121 107,655 789,776 14% $ 3,075,185

2007 Air Force 288,431 45,164 333,595 14% $ 1,347,508

2007 Navy 390,754 75,699 757,820 10% $ 2,234,421

2010 Army 601,677 66,009 667,686 10% $ 2,003,614

2010 Air Force 250,547 29,209 279,756 10% $ 889,554

2010 Navy 154,583 32,005 186,588 17% $ 996,275


Coding of new patient E&Ms has improved for 2 of the three Services from 2007 to 2010.

Service 2007 2010

Army 14% 10%

Air Force 14% 10%

Navy 10% 17%

% of records that seem to be improperly coded


At MTF-level, some MTFs have shown improvement in new patient E&M coding, while others have not.

Year MTF Properly Coded

New Patient


PatientTotal New

Patient

% That Appear to be Coded Incorrectly

2007 Lemoore 5,668 2,999 8,667 35%

2007 Dover 2,002 1,180 3,182 37%

2007 Scott 6,840 1,518 8,358 18%

2007 Fort Riley 20,547 4,849 25,396 19%

2010 Lemoore 4,378 161 4,539 4%

2010 Dover 1,424 337 1,761 19%

2010 Scott 3,799 279 4,078 7%

2010 Fort Riley 10,739 1,245 11,984 10%


At MTF-level, some MTFs have shown improvement in new patient E&M coding, while others have not.

Year MTF Properly Coded

New Patient


PatientTotal New

Patient

% That Appear to be Coded Incorrectly

2007 0043 2,753 118 2,871 4%

2007 0019 1,100 89 1,189 7%

2007 0030 5,333 691 6,024 11%

2007 0029 6,472 9,725 74,453 13%

2010 0043 1,294 634 1,928 33%

2010 0019 263 82 345 24%

2010 0030 1,123 257 1,380 19%

2010 0029 17,226 4,139 21,365 19%

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Coding Creep. . .

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Coding Creep. . .

2.60

2.65

2.70

2.75

2.80

2.85

2.90

2.95

3.00

3.05

3.10

Average E&M Intensity

MHS Worldwide Average (non ERs), October 2005 through January 2011

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Coding Creep. . .

2.70

2.75

2.80

2.85

2.90

2.95

3.00

3.05

3.10

3.15

A

F

N

Total

MHS Worldwide Average (non ERs), October 2005 through January 2011

Average E&M Code Intensity

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1.00

1.50

2.00

2.50

3.00

3.50

4.00

4.50

5.00

Coding Creep. . .

One Medical Examination Clinic. . .

October 2005 through January 2011

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Coding Creep. . .

MHS Worldwide Average (ERs), FY2006 through FY2010

2.40

2.50

2.60

2.70

2.80

2.90

3.00

A

F

N

Total

Average E&M Code Intensity in Emergency Rooms

Admitting Routine Same Day Surgeries

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Admitting Same Day Surgeries

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Over the past several decades, the settings for many procedures has changed from inpatient to ambulatory

Using an ambulatory setting when appropriate is beneficial to both the patient and the health system.

Many health plans require pre-authorization for hospitalizations for care that is routinely provided in ambulatory settings.– This is because some patients have complications or co-

morbidities that may require the admission. No such pre-authorizations are required for MTF care. Reimbursements are far greater for inpatient settings than for

ambulatory

AHRQ published a list of procedures where 90% or more of cases are done in an ambulatory setting; based on data from their Health Care Utilization Project (HCUP)– Russo, C.A., Elixhauser, A., Steiner, C., and Wier, L. Hospital-

Based Ambulatory Surgery, 2007. HCUP Statistical Brief #86. February 2010. Agency for Healthcare Research and Quality, Rockville, MD.

– http://www.hcup-us.ahrq.gov/reports/statbriefs/sb86.pdf

For this analysis, we selected tonsillectomies (with adenoid removal)


https://server2.kennellinc.com/exchweb/bin/redir.asp?URL=http://www.hcup-us.ahrq.gov/reports/statbriefs/sb86.pdf

MTF SIDR records were classified using the AHRQ Clinical Classification Software (CCS) for Procedures– AHRQ CCS groups either ICD-9 procedures or CPT procedures

into categories– http://www.hcup-us.ahrq.gov/toolssoftware/ccs/ccs.jsp#download

Provides a handy crosswalk. All procedure codes on each SIDR were grouped and

records that contained only the 4 selected procedures were retained.

Admissions from same day surgery and ER were excluded, as were cases with complications and co-morbidities.


http://www.hcup-us.ahrq.gov/toolssoftware/ccs/ccs.jsp#download

PPS Earnings for these ambulatory-type services were then calculated from the SIDRs

And using SADRs, for these same MTFs, PPS earnings were calculated for the same procedures (based on AHRQ CCS groupings), but when done in an ambulatory setting.

7,474 uncomplicated tonsillectomies/adenoiodectomies were performed at MTFs in FY10.

For most MTFs, only 3% were performed in an inpatient setting


MTFs and Tonsillectomies

MTF # Inp% of All MTFs # Amb Total % Inp PPS IP $

Would be PPS OP $

Tripler 161 30% 425 586 27% 1,879,379 344,843

Walter Reed 44 8% 138 182 24% 546,945 94,243

Landstuhl 41 8% 145 186 22% 311,124 87,817

BAMC 36 7% 187 223 16% 351,642 77,108

Seoul 26 5% 66 92 28% 207,763 55,689

Wilford Hall 25 5% 180 205 12% 261,280 53,547

Lejeune 18 3% 108 126 14% 272,857 38,554

All Others 194 36% 5,680 5,874 3% 1,588,609 415,525

Total 545 100% 6,929 7,474 7% 5,419,599 1,167,325

Tonsils:– About half of all uncomplicated tonsillectomies done

as inpatients were done at 3 MTFs.– These three MTFs earned almost 3 million dollars for

these surgeries– If these had been done on an outpatient basis, there

three sites would have earned only about a half a million dollars!


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Inpatient Procedures Coded in B Clinics

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PPS includes in its RWP (inpatient) earnings a “price per RWP” that includes both the hospital and all clinicians’ work for the inpatients.

UBU and CHCS create SADRs in B-Clinics, sometimes labeled as inpatients and sometimes not, but for patients who are clearly inpatients. If a B-clinic SADR is created, PPS pays RVU earnings in addition to the inpatient RWP earnings.

There are enormous differences on the extent to which B-Clinic SADRs are reported for inpatients, both between services, and between MTFs.

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Mil Dep

Total PPS Earnings

Nurse PPS Earnings

Non-Nurse PPS Earnings Encounters Admissions

A $ 55,140,020 $ 381,346 $ 54,758,673 306,560

86,347

N $ 25,678,645 $ 235,100 $ 25,443,545 157,173

50,680

F $ 11,805,190 $ 105,312 $ 11,699,878 43,000

23,193

Total $ 92,623,855 $ 721,758 $ 91,902,097 506,733

160,220

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A single patient admitted for a broken hip, reduced at one MTF but then transferred to a Medical Center for wound debridement, had as an inpatient:– 417 B-clinic SADRs– Which earned $50,089 for the medical center– In ADDITION to the PPS earnings for the 5 month stay.

Coding of Group Sessions

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Group Service Records

Group encounters require coding with special CPT or HCPCS to reflect that group counseling or other therapies are less effort per patient than individual care.

Appointment times (MDR only) show when groups are treated instead of individuals.

Conclusions are only as valid as the appointment times – “cattle call” sessions would appear to be groups.

Oddly, a handful of CPT codes give MORE weight for a group than for an individual, like H0004 and H0005 (alcohol and drug counseling). Perhaps it was intended that billing for such groups would not be individually identified?

On the next slide, the FY10 data are corrected into groups.

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Number of SADRs

Difference in RVUs

Difference in Earnings

Army

45,195

-13,303 -$ 497,913

Navy

38,691

-19,746 -$ 739,091

Air Force

4,791

-258 -$ 9,672

MHS

88,677

-33,307 -$ 1,246,677

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ClinicAppt Date Time

Pat Uniq CPT UOS RVU

Grp CPT

Grp RVU

Orig Earnings

Correct Earnings

Diff in Earnings

BFEA 9/16 5:12xx297

4 96151 127.44 96153 1.44 $ 278.48 $ 53.90 -$ 224.58

BFEA 9/16 5:12xx070

2 96151 84.96 96153 0.96 $ 185.65 $ 35.93 -$ 149.72

BFEA 9/16 5:12xx808

4 96151 63.72 96153 0.72 $ 139.24 $ 26.95 -$ 112.29

BFEA 9/16 5:12xx770

8 96151 127.44 96153 1.44 $ 278.48 $ 53.90 -$ 224.58

$ 881.85 $ 170.68 -$ 711.17

Same doctor, same day and clinic, same appointment time

Data Quality

Affecting Readiness or Continuity of Care

Case Management SADRs

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Case Management

MTFs have special requirements for coding of case management– Significant Congressional Interest– Congress is requiring reporting of # of case managers

and their case loads. New coding guidelines utilize SADRs to capture

information And MEPRS to capture full-time equivalent case

managers Contained in UBU Coding Guidelines, Appendix E

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Case Management Coding

MEPRS codes:– Tri-Service consensus was not reached with regard to the use of

MEPRS codes for case management.– The following codes are to be used exclusively for case

management:

Service WTU Funded Non-WTU Funded

Army MTF FAZ2 ELAN

Navy MTF ELA2 ELAN

Air Force MTF ELAN ELAN

Characteristics of Case Management Records

Case Managers are required by HA to submit at least one SADR per month that represents an acuity assessment– Not necessarily a provision of healthcare services,

like most SADRs. CM SADRs contain the same data elements as regular

SADRs. Provider ID represents the case manager. Two new provider specialty codes were created:

– Nurse Case Manager (613)– Social Worker Case Manager (714)

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Dx Code & Extender Description

V4989 2 Initiation of Case Management Services

V4989 3 Case Management Maintenance

V4989 4 End of Case Management Services

Tri-Service case management work group decided that case managers would not make diagnoses.

Rather, case managers would use the following diagnosis codes on CM SADRs:


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Code Acuity Interventions Contact Psychosocial

G9002 1 0-2/month 1+/month Minimal

G9005 2 1-4/month 3-4/month Minimal

G9009 3 1-4/month 1-2/week Moderate

G9010 4 1-6/month 3/week Moderate to Complex

G9011 5 1-6+/month 3+/week Complex


Procedure Code is used to represent the case manager’s assessment of the patient’s acuity.

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Example Case Management SADRs

Person Svc Date Diagnosis Proc1 Prov Spec MEPRS Code

A 3/2/2009 V49892 – Initiation G9009 – Acuity 3 613 FAZ2

A 4/1/2009V49893 –

Maintenance G9005 – Acuity 2 613 FAZ2

A 5/1/2009V49893 –

Maintenance G9005 – Acuity 2 613 FAZ2

A 5/17/2009 V49894 - End G9005 – Acuity 2 613 FAZ2

Coding of Case Management

The M2 SADR table can be used to review CM SADRs. (Corporate document or ad-hoc) Some issues have been identified with reporting

Use of MEPRS codes (FY10 data)

MEPRS Code Encounters Total RVUs

All Others 9,884 30,742

B Codes 18,461 43,357

ELA2 11,359 42,509ELAN 80,669 253,078FAZ2 55,104 369,685

Total 175,477 739,371

Red Font indicates that these RVUs would have earned PPS $ in 2010


Completeness of Data– There is no perfect method to identify how many case managed

patients there should be.– The following chart shows selected MTFs that treat patients

enrolled in Warrior in Transition Units (WTUs).

Selected MTFs and % of Patients Treated in WTU MEPRS codes who have a case manager

# reported in WTU # with CM % with CM

0052: Tripler 178 14 8%

0075: Fort Leonard Wood 233 23 10%

0057: Fort Riley 542 64 12%

0110: Fort Hood 1,070 147 14%

0037: Walter Reed 784 111 14%

0049: Fort Stewart 394 237 60%

0047: Fort Gordon 781 494 63%

0029: San Diego 83 54 65%

0089: Fort Bragg 801 553 69%0091: Camp Lejeune 47 39 83%


Completeness of Data– Requirement includes coding of CM data for active duty and non

active duty. First priority was to implement coding for AD

DMISID # AD # NAD Total

0089: Fort Bragg 1,549 897 2,446

0014: Travis AFB 70 511 581

0039: Pensacola 93 354 447

0038: Jacksonville 138 340 478 0032: Fort Carson 857 291 1,148

0049: Fort Stewart 236 9 245

0109: Brooke AMC 337 9 346

0110: Fort Hood 99 6 105 0064: Fort Polk 137 4 141

0061: Fort Knox 59 59


Effect on MEPRS costs– One purpose of MEPRS is to allocate overhead costs to the areas

that benefit (stepdown).– Costs recorded in MEPRS codes that begin with D and E are

allocated. – Army uses FAZ2 for WTUs, and thus costs are not allocated.

MEPRS Code Receiving CM $ Army Air Force Navy Total

A 4,870,902 381,558 2,938,887 8,191,347

B 18,696,480 3,849,112 1,575,886 34,121,478

C 5,966 998,027 758,382 1,762,376

D 1,579,828 3,913,894 5,493,721

F 911,574 1,941,994 2,109,471 4,963,039

Total 24,484,922 8,750,519 21,296,521 54,531,961

Increases in Encounters for MDC 23 (Other Factors Influencing Health)

MDC 23 Trend by Service: MEPRS B Codes and FBI/FBN

Service 2008 2009 2010 % Chg

A 7,984,220 8,707,937 9,420,864 18%

F 3,497,455 3,867,486 4,037,588 15%

N 4,366,609 4,765,890 5,195,587 19%

MDC 23 as a % of total ambulatory encounters; by bencat and Service (FY2010; MEPRS B Codes; FBI and FBN)

Service AD ADFM RET Others Total

Army 5,617,135 2,072,584 609,680 1,121,465 9,420,864

Air Force 1,883,854 1,067,196 428,836 657,702 4,037,588

Navy 2,885,591 1,206,229 399,892 703,875 5,195,587

Total MDC 23 10,386,580 4,346,009 1,438,408 2,483,042 18,654,039

Total Encounters 20,786,325 10,182,108 3,760,641 5,858,721 40,587,795

% MDC 23 50% 43% 38% 42% 46%

Types of Care Being Recorded in MDC 23

MDC 23 by Type of Care for FY2010

14%

61%

11%

6%8%

IMMUNIZATION

OTHER

PHYSICAL

PRE/POST DEP

PT

Top Diagnoses in “Other”• Encounters for Unspecified Administrative Services (16% of other)• Periodic Preventive Exam (6%)• Issue of Repeat Prescription (4%)

Encounters for Unspecified Administrative Purposes

Bencat 2007 2008 2009 2010 % Chg

AD 447,120 511,458 591,865 695,235 55%

ADFM 385,752 451,052 593,019 699,788 81%

RET 121,232 151,931 212,916 251,360 107%

OTH 209,924 257,495 348,095 396,165 89%

Total 1,164,028 1,371,936 1,745,895 2,042,548 75%

Unrealistic MDC 23 Workload

One provider did more than 65,000 encounters in 212 work days.– Averages more than 300 encounters per day.– Averages more than 580 Total RVUs per day.– In FY10, these RVUs would have earned PPS $.

RVUs per Day # Days

0-100 40

100-500 47

500-1000 88

1000-5000 37

Total Days Worked 212

Total RVUs Earned 124,527

The MHS MART (M2)

Introduction of M2

What is M2?– MHS Mart– Data Mart containing a subset of the MHS Data Repository.– 1700 users of M2, across the MHS.– Includes DEERS, Direct Care and Purchased Care.– Easy to query; no programming knowledge required.– Analytical Tools, such as “Slice and Dice”.– Can upload and download data.– Significant advantage with multiple data sources all contained in

one system.– Data Dictionary:

http://www.tricare.mil/ocfo/bea/functional_specs.cfm

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Live M2 Screen with Menu of Data Files

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M2 Query Panel

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• Folders are called “Classes”

• Directories which contain the data files people query from

• Behaves like directory structures in Windows

Live M2 Screen with Menu of Data Files

MTF Data in M2

M2 contains several data files sent from MTFs Detailed event-level records:

– Standard Inpatient Data Record– Standard Ambulatory Data Record (to be renamed

“CAPER”)– MTF Laboratory, Radiology and Pharmacy

Summary records:– Medical Expense and Performance Reporting System– Worldwide Workload Report

M2 also contains several files that don’t originate at MTFs– For example, claims or DEERS records

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MTF Data Files

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SIDRSADR Lab/RadPharmacyMEPRSWWR

Using M2

Users can write ad-hoc reports or can use already written “Corporate Documents”

Corporate Document Handbook is available– Describes the purpose, content and how to use each

report– Financial Reports, Clinical Reports and Data Quality

Reports Corporate Reports are very easy to use

– Users simply need to know their MTF DMISID– Tools within M2 (slice and dice) allow for analysis of

data within the reports

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Data Quality Corporate Documents

Some examples of Data Quality Corporate Documents Completeness of Data:

– Inpatient Completeness (WWR vs. SIDR vs. MEPRS)– Ambulatory Completeness (WWR vs. SADR

Count/No-Count vs. MEPRS) Accuracy:

– Ungroupable MS-DRGs on SIDRs– Unlisted Provider Specialty on SADR– Record Level Uncoded SADR Report– PDTS Most Expensive Drug Report– Invalid Provider ID

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Steps for retrieving a corporate document:1. File2. Retrieve From3. Corporate Documents

The following box will appear…

Select the document you wish to retrieve and then select “Retrieve”. If the “Open on Retrieval” box is selected, the document will open automatically.

Ad-Hoc Use of M2

The possibilities for analysis of data quality issues using ad-hoc M2 are limitless.

M2 records can be retrieved at detailed level, enabling easy visibility of the coding at each MTF.

To write an ad-hoc query, users:– Select the data file to use.– Select the data elements needed.– Create “filters” to limit the data to answer a specific

question. Recommend that users who write ad-hoc queries obtain

training on the use and interpretation of MHS data.