Go for the Gold June 9 11, 2008 Starr Pass Resort Tucson, Arizona Hospital Outpatient Measures (HOP) Data Abstraction Scenarios Does the Hospital Outpatient Program have you hopping? The HOP initiative, beginning with April 2008 discharges, was developed by CMS to reflect quality of care in hospital based outpatient settings. This measure is required for hospitals wanting to receive their full Medicare OPPS Annual Payment Update. In this session we will cover the three Focus Studies that comprise HOP: HOP Acute MI, HOP Chest Pain, and HOP SCIP. Data abstraction guidelines will be covered using case studies entered into the MIDAS+ Care Management System for each type of outpatient qualifying for this measure set. Presented by: Dawn Harrison Clinical Resource Analyst, ACS MIDAS+
Post-Symposium Availability Shortly after the conclusion of this year s Symposium, some General Session and all Breakout Session presentations will be available for downloading by licensed MIDAS+ clients from our Clients Only Web site. The presentations will be available online in PDF format. Copies of presentations in native PowerPoint format are not generally available. Copyright 2008 MidasPlus, Inc. All Rights Reserved. Contact us at: ACS Healthcare Solutions MIDAS+ 2500 North Pantano Road, Suite 200 Tucson, Arizona 85715 (520) 296 7398 (800) 737 8835 Visit our Web site at: http://www.midasplus.com/ 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.
Hospital Outpatient Measures (HOP) Data Abstraction Scenarios HOP Data Abstraction Case Study Scenarios Dawn Harrison RN, MSN Clinical Resource Specialist/Analyst ACS MIDAS+ Tucson, AZ Objectives Describe the Hospital Outpatient Department (HOP) National Quality Measures and key data elements Demonstrate abstraction of a HOP case study into the MIDAS+ Focus Encounter Entry 17th Annual MIDAS+ User Symposium Tucson, Arizona June 2008 1
Hospital Outpatient Measures (HOP) Data Abstraction Scenarios HOP AMI/Chest Pain - 2 distinct populations: Acute Myocardial Infarction: OP-1 through OP-5 E/M Code Discharge Status Outpatient Encounter Date earliest documented date patient arrived Birthdate ICD-9-CM Principal Diagnosis Code Chest Pain: OP-4 through OP-5 E/M Code Discharge Status Outpatient Encounter Date earliest documented date patient arrived Birthdate ICD-9-CM Principal Diagnosis Code ICD-9-CM Other Diagnosis Codes AMI HOP Population E/M code: the code used to report evaluation and management services provided in the hospital outpatient department clinic or ED. Must be a valid E/M code from Appendix A, OP Table 1.0 Exclude from HOP Measure Population Not a valid E/M code found on Table 1.0 = Excluded from HOP Measure Population Only qualifying D/C status codes: 02 - D/C or transferred to a short term general hospital for inpatient care 43 D/C or transferred to a Federal health care facility 66 D/C or transferred to a Critical Access Hospital 2 17th Annual MIDAS+ User Symposium Tucson, Arizona June 2008
Hospital Outpatient Measures (HOP) Data Abstraction Scenarios AMI HOP Population Outpatient Encounter Date: The earliest date the patient arrived in the hospital outpatient setting ICD-9 Principal Codes in Appendix A OP Table 1.1: Acute MI Diagnosis Codes Excluded: Patients less than 18 years Excluded from measure Population if Principal DX code is NOT on OP Table 1.1 Chest Pain HOP Population E/M code: the code used to report evaluation and management services provided in the hospital outpatient department clinic or ED. Must be a valid E/M code from Appendix A, OP Table 1.0 Not a valid E/M code found on Table 1.0 = Excluded from HOP Measure Population Exclude from HOP Measure Population Only qualifying D/C status codes: 02 - D/C or transferred to a short term general hospital for inpatient care 43 D/C or transferred to a Federal health care facility 66 D/C or transferred to a Critical Access Hospital 17th Annual MIDAS+ User Symposium Tucson, Arizona June 2008 3
Hospital Outpatient Measures (HOP) Data Abstraction Scenarios Chest Pain HOP Population Outpatient Encounter Date: The earliest date the patient arrived in the hospital outpatient setting ICD-9 Principal Codes in Appendix A OP Table 1.1a: Chest Pain Diagnosis Codes Excluded: Patients less than 18 years Excluded from Outpatient Chest Pain measure Population if Other DX code is NOT on OP Table 1.1a Excluded from Outpatient Chest Pain measure Population if Principal DX code is NOT on OP Table 1.1 *Principal or Other (secondary) ICD-9 Diagnosis Code of Chest Pain qualifies for Chest Pain population HOP Surgical Measures Surgical: OP-6 through OP-7 CPT Code Outpatient Encounter Date earliest documented date patient arrived Birthdate Patients with Lap Cholecystectomy procedure codes LESS THAN 70 years of age are EXCLUDED from the study) 4 17th Annual MIDAS+ User Symposium Tucson, Arizona June 2008
Hospital Outpatient Measures (HOP) Data Abstraction Scenarios Surgical HOP Population Does the Patient have a qualifying CPT-4 code on Table 6.0? Outpatient Encounter Date: The earliest date the patient arrived in the hospital outpatient setting If no qualifying CPT-4 code or less than 18 years of age, patient is not in the HOP OP-6 or OP-7 population Does the Patient have a qualifying CPT-4 code on Table 6.4b? Is the patient 70 years or older?, then they are IN the OP-6 and OP-7 population. Key Points AMI and Chest Pain Measures E/M Code and Discharge Status are key for the case to qualify Largely focused on pre-transfer care of AMI patients Surgery Measures Timely delivery of antibiotic w/in 60 min before incision Use of a guideline recommended antibiotic Looks specifically at Antibiotic Name and Route 17th Annual MIDAS+ User Symposium Tucson, Arizona June 2008 5
MIDAS+ Comparative Performance Measurement System Core Hospital Outpatient Program Acute MI PATIENT NAME FOCUS WORKSHEET ACCOUNT NO. MEDICARE ID # (HIC #) FACILITY NAME OUTPATIENT ENCOUNTER DATE DATE OF BIRTH DISCHARGE DATE UTD Core HOP Acute MI: Focus Questions (Page 1 of 2) 1. E/M Code: 99281 99282 99283 99284 99285 99291 None of the above 2. Discharge Status: 01 Home care or self care (routine discharge) 07 Left against medical advice 09 Medicare outpatient admitted as 61 Medicare approved swing bed 62 Inpatient rehab facility (IRF) 02 Short term general hospital for inpatient to this hospital inpatient care 63 Medicare certified long term care 20 Expired in acute care hospital 03 Medicare certified skilled nursing facility (SNF) 41 Expired in medical facility 64 Nursing facility Medicaid only [Medicare, CHAMPUS only] 65 Psychiatric hospital 04 Intermediate care facility 43 Federal health care facility 66 Discharge to critical access hospital 05 Designated center or children s hospital 50 Hospice home care program 70 Another institution not in this code list 06 Home with home health 51 Hospice certified medical facility providing hospice 3. Discharge Status Confirmed: Yes No 4. Payment Source: 5. Race: 1 Medicare (Title 18) 1 White 5 Native Hawaiian/Pacific Islander 2 Medicaid (Title 19) 2 Black or African 7 UTD 3 Other American 4 No insurance/not documented/utd 5 Medicare Other 3 American Indian/Alaska Native 4 Asian 6. Hispanic or Latino Ethnicity: Yes No/UTD 7. ED Arrival Time: UTD 8. Discharge Time: UTD 9. Probable Cardiac Chest Pain: Yes No 11. Contraindication to Aspirin: 1 Allergy/Sensitivity to aspirin 2 Coumadin/warfarin prescribed pre-arrival 10. Aspirin Received: Yes No 3 Other documented reasons 4 No documented contraindication/utd 12. ECG: Yes No 13. ECG Date: UTD 14. ECG Time: UTD Healthcare Solutions 2500 North Pantao Road Tucson, AZ 85715 midas.core@acs-inc.com April 1, 2008 Discharges
PATIENT NAME CORE HOP ACUTE MI PAGE 2 OF 2 15. Initial ECG Interpretation: 16. Fibrinolytic Administration: Yes No Yes No 17. Fibrinolytic Administration Date: UTD 18. Fibrinolytic Administration Time: UTD 19. Reason for Not Administering Lytics: 1 Documented contraindication/reason 2 Cardiogenic Shock 3 No contraindication/utd 20. Reason for Delay in Lytic Therapy: Yes No 21. Transfer for Acute Coronary Intervention: 1 Pt transferred from this ED to another facility for acute coronary intervention 2 Pt was admitted to observation status prior to transfer 3 Pt transferred from this ED to another facility for other reasons/utd Healthcare Solutions 2500 North Pantao Road Tucson, AZ 85715 midas.core@acs-inc.com April 1, 2008 Discharges
MIDAS+ Comparative Performance Measurement System Core Hospital Outpatient Program Surgery PATIENT NAME FOCUS WORKSHEET ACCOUNT NO. MEDICARE ID # (HIC #) FACILITY NAME OUTPATIENT ENCOUNTER DATE DATE OF BIRTH DISCHARGE DATE Core HOP Surgery: Focus Questions (Page 1 of 2) 1. Earliest Qualifying CPT Procedure: 2. Earliest Qualifying CPT Procedure Date: 3. Payment Source: 4. Race: 1 Medicare (Title 18) 2 Medicaid (Title 19) 3 Other 4 No insurance/not documented/utd 5 Medicare Other 1 White 2 Black or African American 3 American Indian/Alaska Native 4 Asian 5 Native Hawaiian/Pacific Islander 7 UTD 5. Hispanic Ethnicity: Yes No/UTD 6. Clinical Trial: Yes No 7. Infection Prior to Anesthesia: Yes No 8. Antibiotic: Yes No 9. Antibiotic Timing: Yes No 10. Antibiotic Allergy: Yes No 11. Vancomycin: 1 Beta-lactam (penicillin or cephalosporin) allergy 2 MD/APN/PA/RPH documentation of known infection or colonization with MRSA 5 MD/APN/PA/RPH documentation of increased MRSA rate, facilitywide or operation-specific 6 MD/APN/PA/RPH documentation of chronic wound care or dialysis 3 MD/APN/PA/RPH documentation of high risk due to acute inpatient hospitalization within last year 4 MD/APN/PA/RPH documentation of pt being high-risk due to nursing home or extended care facility within last year prior to admission 8 Other MD/APN/PA/RPH documented reason 9 No documented reason / Unable to determine Antibiotics Administered: Name of Antibiotic Antibiotic Administration Route 1 1 PO/NG/PEG tube 2 1 PO/NG/PEG tube 3 1 PO/NG/PEG tube 4 1 PO/NG/PEG tube Healthcare Solutions 2500 North Pantao Road Tucson, AZ 85715 midas.core@acs-inc.com April 1, 2008 Discharges
Patient Name: Core HOP Surgery, Page 2 of 2 5 1 PO/NG/PEG tube 6 1 PO/NG/PEG tube 7 1 PO/NG/PEG tube 8 1 PO/NG/PEG tube 9 1 PO/NG/PEG tube 10 1 PO/NG/PEG tube 11 1 PO/NG/PEG tube 12 1 PO/NG/PEG tube 13 1 PO/NG/PEG tube 14 1 PO/NG/PEG tube 15 1 PO/NG/PEG tube 16 1 PO/NG/PEG tube 17 1 PO/NG/PEG tube 18 1 PO/NG/PEG tube 19 1 PO/NG/PEG tube 20 1 PO/NG/PEG tube Healthcare Solutions 2500 North Pantao Road Tucson, AZ 85715 midas.core@acs-inc.com April 1, 2008 Discharges
MIDAS+ Comparative Performance Measurement System Core Hospital Outpatient Program Chest Pain PATIENT NAME FOCUS WORKSHEET ACCOUNT NO. MEDICARE ID # (HIC #) FACILITY NAME OUTPATIENT ENCOUNTER DATE DATE OF BIRTH DISCHARGE DATE Core HOP Chest Pain: Focus Questions 1. E/M Code: 99281 99283 99282 2. Discharge Status: 01 Home care or self care (routine discharge) 02 Short term general hospital for inpatient care 03 Medicare certified skilled nursing facility (SNF) 04 Intermediate care facility 05 Designated center or children s hospital 06 Home with home health 99284 07 Left against medical advice 09 Medicare outpatient admitted as inpatient to this hospital 20 Expired in acute care 41 Expired in medical facility [Medicare, CHAMPUS only] 43 Federal health care facility 50 Hospice home care program 51 Hospice certified medical facility providing hospice 99285 99291 None of the above 61 Medicare approved swing bed 62 Inpatient rehab facility (IRF) 63 Medicare certified long term care hospital 64 Nursing facility Medicaid only 65 Psychiatric hospital 66 Discharge to critical access hospital 70 Another institution not in this code list 3. Discharge status confirmed: Yes No 4. Payment Source: 5. Race: 1 Medicare (Title 18) 2 Medicaid (Title 19) 1 White 2 Black or 5 Native Hawaiian/Pacific Islander 3 Other 4 No insurance/not documented/utd African 7 UTD American 3 American 5 Medicare Other Indian/Alaska Native 4 Asian 6. Hispanic or Latino Ethnicity: Yes No/UTD 7. ED Arrival Time: UTD 8. Probable Cardiac Chest Pain: Yes No 9. Aspirin Received: Yes No 11. Contraindication to Aspirin: 1 Allergy/sensitivity to Aspirin 3 Other documented reasons 2 Coumadin/warfarin prescribed pre-arrival 4 No documented contraindication/utd 12. ECG: Yes No 13. ECG Date: UTD 14. ECG Time: UTD Healthcare Solutions 2500 North Pantao Road Tucson, AZ 85715 midas.core@acs-inc.com April 1, 2008 Discharges
NOTES 17th Annual MIDAS+ User Symposium Tucson, Arizona June 2008