Productivity Tracking with MIDAS+

Transcription

1 Productivity Tracking with MIDAS+ Presented by: Andrea Aber MIDAS+ System Manager Magee Womens Hospital, Pittsburgh, PA Cyndi Gaefke Director of Health Management Magee Womens Hospital, Pittsburgh, PA John Playford Regional Consultant ACS MIDAS+

2 Track Session Description Post-Symposium Availability This session outlines how to use MIDAS+ in an internal case management setting to meet institutional goals and market demands. This includes understanding department goals, instituting processes to reach the goals, and documenting that the goals have been met. One objective of meeting these goals is to determine the necessary staffing to complete the processes in a timely, efficient, and cost-effective manner. This session includes a discussion about how data is collected in the day-to-day use of general fields in MIDAS+ as well as Focus Studies, and how MIDAS+ SmarTrack Indicators are used to pull the data for analysis. Shortly after the conclusion of the Symposium, most General Session and Track Session presentations will be available for viewing and downloading by licensed MIDAS+ clients from our Web site: The presentations are available both in PDF and native Microsoft PowerPoint format. This document contains confidential information which is proprietary to MidasPlus, Inc. Possession and use of this document or any part thereof, in any form, is limited to licensed MIDAS+ clients only and is regulated by specific license agreement provisions. Any other use or unauthorized disclosure is strictly prohibited. MIDAS+, the MIDAS+ logo, DataVision, ReporTrack, Seeker, and SmarTrack are trademarks of MidasPlus, Inc. The ACS logo is a registered trademark of ACS, Inc. Third party trademarks, trade names, product names and logos may be the trademarks or registered trademarks of their respective owners. Contact us at: ACS MIDAS+, 2500 North Pantano Road, Suite 200, Tucson, AZ (800) Visit our Web site at:

3 14th Annual MIDAS+ User Symposium Measuring Productivity Using MIDAS+ Andrea Aber System Manager Cyndi Gaefke, RN Director of Health Management Magee Womens Hospital Pittsburgh, Pennsylvania John Playford Regional Consultant ACS-MIDAS+ Productivity Multifaceted measure which fluctuates with institutional goals, market demands and advancing technology Includes Understanding goals of the department Instituting processes to reach the goals as well as documentation that goals have been met Productivity (cont.) Determine staffing needed to complete the processes in a timely, efficient and cost effective manner 14th Annual MIDAS+ Symposium June

4 Our Mission: To enhance the healthcare and well-being of women, infants and their families espousing the Womancare Philosophy Woman Care Philosophy A woman is primarily responsible for her own health and our role is to empower every woman to take a active role in her healthcare Multidisciplinary Team Concept Cost Effective Quality Respect Education Advocacy Magee Health Management Department 2 June th Annual MIDAS+ Symposium

5 Magee Health Management Program Primary Focus Appropriate admissions (InterQual) Monitor LOS Discharge planning process Payor requirements Concurrent denial process Patient satisfaction Quality indicators Our Staff Role of a Care Manager Financial and Quality Initiatives to Achieve Goals Interviews patient and family for a Health Management introduction and Risk Level Assessment Sets expectations for length of stay and discharge disposition, conveys this information to the multidisciplinary team, works with physician staff to communicate information to payors to prevent denials 14th Annual MIDAS+ Symposium June

6 Role of a Care Manager (cont.) Financial and Quality Initiatives to Achieve Goals Performs chart reviews to obtain information to support medical necessity and correct patient status Interprets insurance benefits, coverage parameters and payor requirements Intervenes in the patient care plan to assure care coordination and the timeliness of testing and treatment when necessary Role of a Care Manager (cont.) Financial and Quality Initiatives to Achieve Goals Coordinates discharge planning and assures that appropriate post-acute options have been reviewed, freedom of choice has been offered and payor has approved of the post acute discharge plan Role of a Care Manager (cont.) Financial and Quality Initiatives to Achieve Goals Ultimately ensures appropriate and timely discharge Has overall responsibility for patient care coordination pre-admission through postdischarge 4 June th Annual MIDAS+ Symposium

7 Care Manager Daily Process Get Started procedures Print Smart Track, gather Rounding Sheets, laptops, etc.. Care Manager Daily Process (cont.) Initial Review Interview patient and/or family to determine risk for discharge planning needs, complete FEE for assessing high risk criteria, beings URDP module Low risk followed by nursing, care manager places sticker on chart Care Manager Daily Process (cont.) Initial Review (cont.) Checks chart to determine correct patient status, enters initial review into URE module, completes Interqual criteria on non-ob patients, marked start and stop time of OVS patients, enters OVS hours into ADT system, determines anticipated length of stay, communicates with Payor Specialist via worklist rule if auth is needed for the stay 14th Annual MIDAS+ Symposium June

8 Care Manager Daily Process (cont.) Initial Review (cont.) OB patients enters OBE and NNE data, anticipates length of stay based on delivery type Care Manager Daily Process (cont.) Continued stay review Review time is payor driven May require daily review but must be done every 48 hours to check for change in discharge status Care Manager Daily Process (cont.) Discharge Planning Complete arrangements for post acute services if needed, print home care referral form and autofax to agency Review Freedom of Choice 6 June th Annual MIDAS+ Symposium

9 Care Manager Daily Process (cont.) Discharge Planning (cont.) Monitor for appropriate and timely discharge Place discharge form on chart Print URSE and autofax if needed FEE for Risk Assessment Time of assessment should be completed within 24 hours of admission Assessment type Initial or Reassessment Primary contact Contact relationship FEE for Risk Assessment (cont.) Contact phone number alternate emergency number NOT pt home phone Pt lives with and living arrangements Does pt care for anyone Who cares for patient 14th Annual MIDAS+ Symposium June

10 FEE for Risk Assessment (cont.) How does pt communicate verbal, sign, language barrier Any transportation issues Patient mental status Current physical status ambulatory, bedrest FEE for Risk Assessment (cont.) Patient financial situation, payor concerns Has patient had previous post acute care services If infant, any infant discharge issues, adoption, CYS FEE for Risk Assessment (cont.) Any OB discharge issues Education discussed Who were issues discussed with 8 June th Annual MIDAS+ Symposium

11 Discharge Planning URDP and URSE Discharge Planning by Case Managers Initiated on admission for high risk patients Discharge Planning URDP and URSE (cont.) Discharge Planning by Case Managers (cont.) User fields address consults set up by the Care Manager as well as documenting members of any team conferences that may occur Discharge Planning URDP and URSE (cont.) Discharge Planning by Case Managers (cont.) Report printed by Care Manager and placed on chart 14th Annual MIDAS+ Symposium June

12 Discharge Planning URDP and URSE (cont.) Support Entry Contains information concerning post acute care services Completed by the Case manager for all services such as home care, transfers, DME s Discharge Planning URDP and URSE (cont.) Support Entry User fields added for Freedom of Choice questions, alternate address, special instructions for home care agency Report printed and autofaxed to agency from Agency dictionary Custom Reports High Risk Criteria Documents reasons for identifying patient as a high risk for discharge planning Discharge Planning Documents, consults, patient living arrangements, Freedom of Choice documentation, community support agencies used if applicable 10 June th Annual MIDAS+ Symposium

13 Custom Reports Home Care Referral Documents, address, physician, agency and orders needed for home care or DME referral What to Measure OB and Med Surg Risk Assessment: Interview, data entry, charting Initial Review entry in Midas: Pt status, Interqual Continued Stay Reviews: medical necessity, re-evaluation of discharge needs, medical history for payor needs Entering OVS hours Discharge Planning (Post Acute Services) What to Measure NICU Complex discharges to home or another facility Payor and agency phone calls 14th Annual MIDAS+ Symposium June

14 Time Studies Involves shadowing Care Managers during their daily work Must follow more than one Care Manager, preferably a very experienced Care Manager as well as a neophyte Time Studies Involves shadowing Care Managers during their daily work (cont.) Must follow Care Managers from all subdivisions of the department Beneficial to do numerous times and take an average time Times will vary according to disciplines 12 June th Annual MIDAS+ Symposium

15 Times by Discipline Adding Up the Numbers MIDAS+ Indicators 14th Annual MIDAS+ Symposium June

16 Risk Assessments Initial Reviews Total Reviews 14 June th Annual MIDAS+ Symposium

17 OVS Patients Supports Phone Calls 14th Annual MIDAS+ Symposium June

18 Complex Transfers MIDAS+ Indicator Profile 16 June th Annual MIDAS+ Symposium

19 Excel Spreadsheet Department Productivity Total Department Productivity Begin Home Cares 120% 100% % Productivity 80% 60% 40% 20% 0% Jul-03 Aug-03 Sep-03 Oct-03 Nov-03 Dec-03 Jan-04 Feb-04 Mar-04 Apr-04 May-04 Jun-04 Series1 96% 95% 110% 92% 87% 90% 81% 83% 79% 74% 103% 99% Month 14th Annual MIDAS+ Symposium June

20 Apr-03 May-03 Jun-03 Jul-03 Aug-03 Sep-03 Oct -03 Nov-03 Dec-03 Jan-04 Feb-04 Mar-04 Apr-04 May-04 Jun-04 Productivity Tracking with MIDAS+ Productivity by Specialty 180.0% Productivity by Specialty HM begins Home Care Ref errals 160.0% 140.0% 120.0% % Productivity 100.0% 80.0% 60.0% 40.0% 20.0% 0.0% OB 111.4% 114.1% 116.2% 105.3% 122.9% 164.1% 129.0% 115.1% 94.5% 82.7% 82.4% 89.9% 93.8% 122.0% 125.5% Med Surg 98.7% 99.7% 111.9% 114.3% 119.6% 104.0% 103.0% 99.3% 120.4% 95.5% 99.9% 95.6% 77.9% 125.6% 101.5% NICU 39.7% 60.8% 57.1% 68.5% 41.0% 61.3% 45.8% 46.9% 57.0% 65.2% 66.9% 51.9% 46.7% 61.8% 70.9% Daily Productivity March Productivity - Med Surg 200.0% 180.0% 160.0% 140.0% 120.0% 100.0% 80.0% 60.0% 40.0% 20.0% 0.0% W W W W 3/1 3/2 3/3 3/4 3/5 3/6 3/7 3/8 3/9 3/10 3/11 3/12 3/13 3/14 3/15 3/16 3/17 3/18 3/19 Med Surg 46.4% % % % % 0.2% 0.0% 0.0% 0.0% 0.0% Institutional Monitoring Monitors that address the success of our productivity Length of Stay Average LOS at Magee 3.59 including NICU days Denial Management denial rate < 0.1% Patient Satisfaction measured by patient satisfaction surveys and rate of repeat consumers Staffing effectiveness 18 June th Annual MIDAS+ Symposium

21 In Summary Need to know goals, processes and times of processes Data elements can be counted by Midas Indicators Can be monitored by institutional outcomes In Summary (cont.) Requires staff buy-in Model can be used for any group Always evolving, must be revisited with staffing changes, change in department processes 14th Annual MIDAS+ Symposium June

22 4/27/2005 MIDAS HOSPITAL & MEDICAL CENTER PAGE 1 10:25 Focus Criteria Definition List Criteria Response Mand Age Sex Subcriteria Name: HIGH RISK CRITERIA - MAWH Type: FOCUS HIGH RISK CRITERIA OBSERVED SELECT MULTIPLE N OLDER THAN 70 YRS AND FRAIL OLDER THAN 70 YRS WITH MULTI RISKS TRANSFERRED FROM A NURSING HOME LESS THAN 17 YRS POTENTIAL TO BE ABANDONED POTENTIAL FOR POST ACUTE CARE/DME NEEDS SPECIAL SERVICES LIVES ALONE MENTALLY OR PHYSICALLY HANDICAPPED HI-RISK ANTEPARTUM AND POSTPARTUM STA BABY FOR ADOPTION KNOWN HISTORY OF SIDS MOTHERS WITH INFANTS WITH FEEDING PROBLEMS PRE-TERM DELIVERY PSYCHOSOCIAL ISSUES INTRACTABLE PAIN CONFUSED AN/OR DISORIENTED PATIENTS WITH SUICIDAL THREATS OR ATTEMPTS PT/FAMILY REQUIRING TRANSLATOR OR SIG SERVICES UNIT TO FOLLOW LO-RISK CARE AND DC SELECT SINGLE N ICU 5300 COMPLICATED INSURANCE ISSUES INSUFFICIENT PREP FOR INFANT EARLY DISCHARGE PREMATURITY WITH POOR WT GAIN NONE IDENTIFIED ANOREXIA/BULEMIA END STAGE ILLNESS UNPLANNED READMISSION WITHIN 30 DAYS TIME OF FOCUS TIME N ASSESSMENT TYPE SELECT SINGLE N INITIAL RISK ASSESSMENT RE-EVALUATION PRIMARY CONTACT TEXT N CONTACT RELATIONSHIP SELECT SINGLE N ADULT CHILDREN ADULT GUARDIAN FAMILY FRIEND PARENT/GUARDIAN SPOUSE/SIGNIFICANT OTHER SIBLING GRANDPARENT CONTACT PHONE NUMBER TEXT N COUNTY TEXT N PT LIVES WITH? SELECT SINGLE N ADULT GUARDIAN ADULT CHILDREN ALONE ALONE WITH PETS FAMILY FOSTER CARE FRIEND INCARCERATED MINOR CHILDREN MULTIPLE RESIDENTS PARENT PERSONAL CARE HOME SPOUSE Continued 20 June th Annual MIDAS+ Symposium

23 4/27/2005 MIDAS HOSPITAL & MEDICAL CENTER PAGE 2 10:25 Focus Criteria Definition List Criteria Response Mand Age Sex Subcriteria HIGH RISK CRITERIA - MAWH - Continued LIVING ARRANGEMENT SELECT SINGLE N ADOPTIVE APARTMENT ASSISTED LIVING CORRECTIONAL FACILITY CHILDRENS HOME FOSTER CARE NURSING HOME OWN HOME RELATIVES HOME HOMELESS MH INSTITUTION RETIREMENT CENTER SHELTER WHO DOES PT CARE FOR? SELECT SINGLE N ADULT RELATIVE DEPENDENT ADULT CHILDREN NEIGHBORS NONE IDENTIFIED PARENT PETS SPOUSE FAMILY WHO CARES FOR PT? SELECT SINGLE N ADULT RELATIVE DEPENDENT ADULT CHILDREN NEIGHBORS NONE IDENTIFIED PARENT SPOUSE COMMUNITY AGENCY SELF OTHER FACILITY FRIEND HOW DOES PT COMMUNICATE? SELECT SINGLE N ADEQUATE VERBAL NON-VERBAL, SIGN NON-ENGLISH INTERPRETER NEEDED NON-VERBAL, COMMUNICATION BOARD NON-VERBAL HAS ABILITY, ON VENT EXHIBITS CONFUSION WHAT INTERPRETER? TEXT N TRANSPORTATION ISSUES SELECT SINGLE N DRIVES SELF FAMILY FRIEND PUBLIC TRANSPORTATION ACCESS AMBULANCE MATP MENTAL STATUS SELECT SINGLE N ALERT OREINTED DISORIENTED TIME, PLACE, PERSON COMATOSE AGITATED LETHARGY VENT SUPPORT CURRENT PHYSICAL STATUS SELECT SINGLE N INDEPENDENT AMBULATION AMBULATION WITH ASSISTANCE BLADDER INCONTINENCE ADJ PAIN CONTROL ADJ CALORIC INTAKE ADJ FLUID INTAKE CATHETER/OSTOMY WHEELCHAIR BEDREST PT FINANCIAL SITUATION SELECT SINGLE N EMPLOYED RETIRED NO INCOME/LIMITED INCOME HI COST MEDS HI COST TREATMENT Continued 14th Annual MIDAS+ Symposium June

24 4/27/2005 MIDAS HOSPITAL & MEDICAL CENTER PAGE 3 10:25 Focus Criteria Definition List Criteria Response Mand Age Sex Subcriteria HIGH RISK CRITERIA - MAWH - Continued PT FINANCIAL SITUATION - Continued SELECT SINGLE SELF PAY NO INSURANCE UNEMPLOYED DISABILITY SSD WORKER'S COMP NO ISSUES PRINCIPAL PAYOR CONFIRMED YES/NO/NA N IF NOT, WHO IS PRIN PAYOR TEXT N PT HAD PREV POSTACUTE SRVCS YES/NO/NA N IF YES, WHERE TEXT N PSYCHOSOCIAL ISSUES SELECT MULTIPLE N FAMILY ANOREXIA/BULEMIA BEHAVIORAL ISSUES DOMESTIC VIOLENCE SUBSTANCE ABUSE SUICIDAL ATTEMPTS END STAGE ILLNESS BABY FOR ADOPTION FETAL DEATH NONE IDENTIFIED TERMINATION OF PREGNANCY HOMELESS INSUFFICIENT PARENTING SKILLS CYF INTERVENTION INSUFFICIENT PREP FOR INFANT IF PATIENT INFANT SELECT MULTIPLE N 0-1 BABY FOR ADOPTION POOR FEEDING PREMATURITY ALL NICU ADMISSIONS > 24 HRS INSUFFICIENT PREP FOR INFANT ANY HIGH RISK OB ISSUES? SELECT MULTIPLE N ANTEPARTUM ADMIT PREVIOUS SIDS BABY FEEDING PROBLEMS EARLY DISCHARGE PREMATURE RUPTURE OF MEMBRANES PRE-ECLAMPSIA POST PARTUM COMPLICATIONS NOT APPLICABLE NONE IDENTIFIED INFANT STATUS SELECT SINGLE N NO HM INTERVENTION, NURSING TO FOLLOW HM INTERVENTION PT HAS ADVANCED DIRECTIVES YES/NO/NA N ADV DIR ON CHART YES/NO/NA N IF NO, WHERE ARE ADV DIR TEXT N EDUCATION/INFO PROVIDED SELECT MULTIPLE N WIG PACKET PROSTHETIC INFORMATION URO/GYNE PAMPHLETS WTC ANTEPARTUM EDUCATION MODULES MEDICATION SHEETS VENDOR INFO ONCOLOGY TEACHING MATERIALS VERBAL EDUCATION COMMUNITY SERVICE ISSUES DISCUSSED SELECT MULTIPLE N SSI EQUIPMENT TRAINING MEDICAL STATUS INSURANCE ISSUES TRANSFER TO FACILITY CODE STATUS MEDICATION EDUCATION DME NEEDED HOME SERVICE TYPE NICU INTRO Continued 22 June th Annual MIDAS+ Symposium

25 4/27/2005 MIDAS HOSPITAL & MEDICAL CENTER PAGE 4 10:25 Focus Criteria Definition List Criteria Response Mand Age Sex Subcriteria HIGH RISK CRITERIA - MAWH - Continued ISSUES DISCUSSED - Continued SELECT MULTIPLE ALLIANCE FOR INFANTS PARENTS HELPING PARENTS LACTATION ISSUES FOLLOWUP APPOINTMENTS WIC DC TRANSPORTATION UTILITIES MEDICATION PROCUREMENT MEDICATION PAYMENT MEDICATION STORAGE DME PROCUREMENT/PAYMENT INADEQUATE BATHROOM FACILITIES PRESENCE OF STAIRS FOLLOWUP TRANSPORTATION FOLLOWUP APPOINTMENTS TRANSPORTATION AVAILABLE INSUFFICIENT INFANT SUPPLIES DOMESTIC VIOLENCE ROLE OF CASE MANAGER ROLE OF HOME CARE NURSE PHOTOTHERAPY DISCHARGE NEEDS DRUG TREATMENT CENTERS LIFESTYLE ADAPTATION ISSUES DISCUSSED WITH SELECT MULTIPLE N PATIENT FAMILY GUARDIAN SPOUSE FAMILY CONFERENCE LEVEL OF UNDERSTANDING SELECT SINGLE N VERBALIZES DEMONSTRATED NEEDS FURTHER VERBAL NEEDS FURTHER WRITTEN CUSTOMER SATISFACTION INTERVENTIONS SELECT SINGLE N EMOTIONAL SUPPORT COMPLAINT FOLLOWUP SECURE ACTIVITIES ADDRESS PT SPECIAL REQUEST SPECIAL EQUIPMENT FOR DISABILITIES SPECIAL TRANSPORTATION ARRANGEMENTS CLERGY INVOLVEMENT CALL SCRIPTS OVERNIGHT ROOM REFER TO PT REPRESENTATIVE "BECAUSE WE CARE" CM FOLLOWING HI RISK SELECT SINGLE N ACOSTA,JAMES ARMSTRONG,MIGUEL BEERS,GEORGE BRASHER,MARTHA LENARDON,CARLA YOUNG,SHARON SPIVACK,KAREN 14th Annual MIDAS+ Symposium June

26 4/27/2005 MIDAS HOSPITAL & MEDICAL CENTER PAGE 1 10:26 Focus Criteria Definition List Criteria Response Mand Age Sex Subcriteria Name: MAWH NICU PHONE TIMES Type: FOCUS TOTAL MINUTES NUMERIC N NUMBER PATIENTS INVOLVED NUMERIC N 24 June th Annual MIDAS+ Symposium

27 4/27/2005 Profile of SmarTrack Rules PAGE 10:27 MIDAS HOSPITAL & MEDICAL CENTER 1 Profile: MAWH MIDAS PRODUCTIVITY Code Description (** indicates inactive) Other Information 146 MAWH-OB ADMISSIONS Type of Rule: INDICATOR COUNT Identify As: OB ADMISSIONS If: ENCOUNTER:Location Is: or: or: Date: ENCOUNTER:Start Date Prov: ENCOUNTER:Attending Physician Xtab: ENCOUNTER:DRG 147 MAWH OB ADMISSIONS FOR HI RISK EVAL Type of Rule: INDICATOR COUNT Identify As: OB ADMISSIONS FOR HI RISK If: ENCOUNTER:Location Is: or: or: If: ENCOUNTER:Start Time (is entered) If: ENCOUNTER:Encounter Type:Type Is: =I Date: ENCOUNTER:Start Date Prov: ENCOUNTER:Attending Physician Xtab: ENCOUNTER:DRG 148 MAWH OB TOTAL ASSESSMENTS DONE Type of Rule: INDICATOR COUNT Identify As: OB TOTAL ASSESSMENTS If: ENCOUNTER:Location Is: or: or: or: LD LABOR AND DELIVERY Date: ENCOUNTER:Start Date Xtab: ENCOUNTER:Location If: FOCUS HIGH RISK CRITERIA - MAWH:HIGH RISK CRITERIA OBSERVED (is entered) 149 MAWH OB HIGH RISK ASSESSMENTS Type of Rule: INDICATOR COUNT Identify As: OB HIGH RISK ASSESSMENTS Date: ENCOUNTER:Start Date Xtab: ENCOUNTER:Location If: FOCUS HIGH RISK CRITERIA - MAWH:HIGH RISK CRITERIA OBSERVEDIs Not: 1000 NONE IDENTIFIED If: ENCOUNTER:Location Is: or: or: or: LD LABOR AND DELIVERY 150 MAWH OB OVS Type of Rule: INDICATOR COUNT Identify As: OB OVS If: ENCOUNTER:Location Is: or: or: or: LD LABOR AND DELIVERY Date: ENCOUNTER:Start Date Xtab: ENCOUNTER:DRG If: UTILIZATION REVIEW EXTENDED:TIME OVS START (is entered) 151 MAWH OB REVIEWS Type of Rule: INDICATOR COUNT Identify As: OB REVIEWS Count: UR CONCURRENT REVIEWS If: ENCOUNTER:Location Is: or: or: Date: UR CONCURRENT:Review Date Xtab: ENCOUNTER:Location 152 MAWH OB ADMISSION REVIEWS Type of Rule: INDICATOR COUNT Identify As: OB ADMISSION REVIEWS Count: UR CONCURRENT REVIEWS If: ENCOUNTER:Location Is: or: or: If: UR CONCURRENT:Level Of Care Is: 8 ADMISSION Date: UR CONCURRENT:Review Date Xtab: ENCOUNTER:Location 14th Annual MIDAS+ Symposium June

28 4/27/2005 Profile of SmarTrack Rules (continued) PAGE 10:27 MIDAS HOSPITAL & MEDICAL CENTER 2 Profile: MAWH MIDAS PRODUCTIVITY Code Description (** indicates inactive) Other Information 153 MAWH OB DISCHARGES Type of Rule: INDICATOR COUNT Identify As: OB DISCHARGES If: ENCOUNTER:Location Is: or: or: Date: ENCOUNTER:End Date Prov: ENCOUNTER:Attending Physician Xtab: ENCOUNTER:DRG 154 MAWH OB SUPPORTS Type of Rule: INDICATOR COUNT Identify As: OB SUPPORTS If: UR SUPPORT:Type (is entered) If: ENCOUNTER:Location Is: or: or: or: NSY NURSERY or: LD LABOR AND DELIVERY Date: UR SUPPORT:Date Entered Xtab: UR CERTIFICATION:Principal Payor 155 MAWAH MEDSURG ADMISSIONS Type of Rule: INDICATOR COUNT Identify As: MEDSURG ADMISSIONS If: ENCOUNTER:Location Is: or: Date: ENCOUNTER:Start Date Prov: ENCOUNTER:Attending Physician Xtab: ENCOUNTER:DRG If: ENCOUNTER:Start Time (is entered) 156 MAWH MED SURG ADMISSIONS FOR HI RISK EVAL Type of Rule: INDICATOR COUNT Identify As: MEDSURG ADMISSIONS FOR HI RISK If: ENCOUNTER:Location Is: or: If: ENCOUNTER:Start Time (is entered) If: ENCOUNTER:Encounter Type:Type Is: =I Date: ENCOUNTER:Start Date Prov: ENCOUNTER:Attending Physician Xtab: ENCOUNTER:DRG 157 MAWH MEDSURG TOTAL RISK ASSESSMENTS Type of Rule: INDICATOR COUNT Identify As: MEDSURG TOTAL ASSESSMENTS If: FOCUS HIGH RISK CRITERIA - MAWH:HIGH RISK CRITERIA OBSERVED (is entered) If: ENCOUNTER:Location Is: or: Date: FOCUS HIGH RISK CRITERIA - MAWH:DATE OF FOCUS Xtab: ENCOUNTER:Location 158 MAWH MEDSURG HI RISK ASSESSMENTS Type of Rule: INDICATOR COUNT Identify As: MEDSURG HI RISK ASSESSMENTS If: FOCUS HIGH RISK CRITERIA - MAWH:HIGH RISK CRITERIA OBSERVED Is: 1000 NONE IDENTIFIED If: ENCOUNTER:Location Is: or: Date: FOCUS HIGH RISK CRITERIA - MAWH:DATE OF FOCUS Xtab: ENCOUNTER:Location 159 MAWH MEDSURG REVIEWS Type of Rule: INDICATOR COUNT Identify As: MEDSURG REVIEWS Count: UR CONCURRENT REVIEWS If: ENCOUNTER:Location Is: or: Date: UR CONCURRENT:Review Date Xtab: ENCOUNTER:Location 26 June th Annual MIDAS+ Symposium

29 4/27/2005 Profile of SmarTrack Rules (continued) PAGE 10:27 MIDAS HOSPITAL & MEDICAL CENTER 3 Profile: MAWH MIDAS PRODUCTIVITY Code Description (** indicates inactive) Other Information 160 MAWH MEDSURG ADMISSION REVIEWS Type of Rule: INDICATOR COUNT Identify As: MEDSURG ADMISSION REVIEWS Count: UR CONCURRENT REVIEWS If: ENCOUNTER:Location Is: or: If: UR CONCURRENT:Level Of Care Is: 8 ADMISSION Date: UR CONCURRENT:Review Date Xtab: ENCOUNTER:Location 161 MAWH MEDSURG DISCHARGES Type of Rule: INDICATOR COUNT Identify As: MEDSURG DISCHARGES If: ENCOUNTER:Location Is: or: Date: ENCOUNTER:End Date Prov: ENCOUNTER:Attending Physician Xtab: ENCOUNTER:DRG 162 MAWH MEDSURG SUPPORTS Type of Rule: INDICATOR COUNT Identify As: MEDSURG SUPPORTS If: UR SUPPORT:Type (is entered) If: ENCOUNTER:Location History Location Is: or: Date: UR SUPPORT:Date Entered Xtab: UR CERTIFICATION:Principal Payor 163 MAWH NICU ADMISSIONS Type of Rule: INDICATOR COUNT Identify As: NICU ADMISSIONS If: ENCOUNTER:Location Date: ENCOUNTER:Start Date Prov: ENCOUNTER:Attending Physician Xtab: ENCOUNTER:DRG Is: UMC NICU - UMC or: TMC NICU - TMC If: ENCOUNTER:Start Time (is entered) 164 MAWH NICU HIGH RISK ASSESSMENTS Type of Rule: INDICATOR COUNT Identify As: NICU ASSESSMENTS Date: FOCUS HIGH RISK CRITERIA - MAWH:DATE OF FOCUS If: FOCUS HIGH RISK CRITERIA - MAWH:HIGH RISK CRITERIA OBSERVED (is entered) If: ENCOUNTER:Location Is: TMC NICU - TMC or: UMC NICU - UMC 165 MAWH NICU REVIEWS Type of Rule: INDICATOR COUNT Identify As: NICU REVIEWS Count: UR CONCURRENT REVIEWS Date: UR CONCURRENT:Review Date If: ENCOUNTER:Location Is: TMC NICU - TMC or: UMC NICU - UMC Xtab: ENCOUNTER:Location 166 MAWH NICU ADMISSION REVIEWS Type of Rule: INDICATOR COUNT Identify As: NICU ADMISSION REVIEWS Date: UR CONCURRENT:Review Date If: ENCOUNTER:Location Is: TMC NICU - TMC or: UMC NICU - UMC If: UR CONCURRENT:Level Of Care Is: 8 ADMISSION Xtab: ENCOUNTER:Location 14th Annual MIDAS+ Symposium June

30 4/27/2005 Profile of SmarTrack Rules (continued) PAGE 10:27 MIDAS HOSPITAL & MEDICAL CENTER 4 Profile: MAWH MIDAS PRODUCTIVITY Code Description (** indicates inactive) Other Information 167 MAWH NICU DISCHARGES Type of Rule: INDICATOR COUNT Identify As: NICU DISCHARGES If: ENCOUNTER:End Time If: ENCOUNTER:Location (is entered) If: ENCOUNTER:Encounter Type:Type Is: =I Is: TMC NICU - TMC or: UMC NICU - UMC Date: ENCOUNTER:End Date Prov: ENCOUNTER:Attending Physician Xtab: UR CERTIFICATION:Principal Payor If: ENCOUNTER:Adm Serv Is: NEO NEONATAL If: UR DISCH PLANNING:Discharge Screen Is: 85 COMPLEX TX TO ACUTE CARE FAC or: 86 COMPLEX TX TO HOME 168 MAWH NICU COMPLEX DC Type of Rule: INDICATOR COUNT Identify As: NICU COMPLEX DISCHARGES Date: ENCOUNTER:End Date Xtab: UR CERTIFICATION:Principal Payor If: UR DISCH PLANNING:Discharge Screen Is: 85 COMPLEX TX TO ACUTE CARE FAC or: 86 COMPLEX TX TO HOME 169 MAWH NICU SUPPORTS Type of Rule: INDICATOR COUNT Identify As: NICU SUPPORTS If: UR SUPPORT:Type If: ENCOUNTER:Location (is entered) Is: TMC NICU - TMC or: UMC NICU - UMC Date: UR SUPPORT:Date Entered Xtab: UR CERTIFICATION:Principal Payor 170 MAWH NICU PHONE CALLS Type of Rule: INDICATOR SUM Identify As: NICU PHONE CALLS Monitor: FOCUS MAWH NICU PHONE TIMES Sum: FOCUS MAWH NICU PHONE TIMES:TOTAL MINUTES Date: FOCUS MAWH NICU PHONE TIMES:DATE OF FOCUS 28 June th Annual MIDAS+ Symposium

31 4/27/2005 Profile of SmarTrack Rules -- Rates (continued) PAGE 10:27 MIDAS HOSPITAL & MEDICAL CENTER 5 Profile: MAWH MIDAS PRODUCTIVITY Code Description (** indicates inactive) Numerator/Denominator 171 MAWH OB ASSESSMENT RATE Type of Rule: INDICATOR RATE Identify As: OB ASSESSMENT RATE 148 MAWH OB TOTAL ASSESSMENTS DONE 147 MAWH OB ADMISSIONS FOR HI RISK EVAL 172 MAWH OB RATE HIGH RISK Type of Rule: INDICATOR RATE Identify As: OB RATE HIGH RISK 149 MAWH OB HIGH RISK ASSESSMENTS 146 MAWH-OB ADMISSIONS 173 MAWH MEDSURG ASSESSMENT RATE Type of Rule: INDICATOR RATE Identify As: MEDSURG ASSESSMENT RATE 157 MAWH MEDSURG TOTAL RISK ASSESSMENTS 155 MAWAH MEDSURG ADMISSIONS 174 MAWH MEDSURG RATE HIGH RISK Type of Rule: INDICATOR RATE Identify As: MED SURG RATE HIGH RISK 158 MAWH MEDSURG HI RISK ASSESSMENTS 155 MAWAH MEDSURG ADMISSIONS 14th Annual MIDAS+ Symposium June

32 30 June th Annual MIDAS+ Symposium