Care Management Toolkits

Transcription

1 Care Management Toolkits Cindy Gebremariam, RN Product Manager, Care Management Dan Parker, PMP Product Manager, Midas+ Live TJ McGreevy Product Management Specialist Muffie Gallardo, CPCS, CPMSM Product Management Specialist

2 Care Management Toolkits AHRQ PSO Event Reporting NHSN SSI Toolkit NHSN CLABSI/CAUTI Toolkit PA Referral Toolkits EHR and Accretive EHR Integrated RAC Appeals AHA RACTrac - 2 -

3 Acronyms AHRQ Agency for Healthcare Research and Quality PSO Patient Safety Organization HERF Healthcare Event Reporting Form PIF Patient Information Form SIR Summary of Initial Report NHSN National Healthcare Safety Network SSI Surgical Site Infection CLABSI Central Line Associated Blood Stream Infection CAUTI Catheter Associated Urinary Tract Infection MDRO Multi-drug Resistant Organism CDI Clostridium difficile Infection PA Physician Advisor EHR Executive Health Resources CMS Centers for Medicare and Medicaid Services ALJ Administrative Law Judge AHA American Hospital Association RAC Recovery Audit Contractor - 3 -

4 Why a Toolkit? Standardized data collection and submission model Report data to third-parties in prescribed format Available for CM versions 8.0 and newer Toolkit revisions and/or updates are provided as indicated - 4 -

5 AHRQ PSO Event Reporting Concept A custom set of Focus Studies, Dictionaries, and Standard Reports Enables the hospital to electronically submit Patient Safety Event reports to their PSO Meets specifications created by AHRQ for Common Formats for Patient Safety Event Reporting - 5 -

6 AHRQ PSO Event Reporting Components Focus Studies for reporting Safety Events to a PSO using AHRQ Common Formats Virtual Worklist Target for SmarTrack, to auto-create a PSO Focus Episode and auto-populate selected fields from a qualifying Risk Event Special Mapper Focus for translating data from Risk into specified PSO Focus fields PSO File Extraction utility launched by Standard Report Distributed Dictionaries for PSO data collection - 6 -

7 AHRQ PSO Event Reporting Process Users enter data in Risk (module or RDE) Qualifying Events generate Worklist entries and Focus episode is auto-created with mapped and copied data from Risk Users update and complete Focus Study Designated Events are flagged to send to PSO Standard Report generates extraction files Files are stored in application root (midshare) Files are uploaded to PSO - 7 -

8 AHRQ PSO Event Reporting - 8 -

9 AHRQ PSO Event Reporting Risk RDE can be used to report safety events remotely

10 AHRQ PSO Event Reporting Risk Event function is populated via Remote Data Entry

11 AHRQ PSO Event Reporting Then, the qualified Risk Event notifications appear on a Worklist

12 AHRQ PSO Event Reporting and the PSO Event Focus is automatically created with Risk Event data automatically populating applicable fields

13 AHRQ PSO Event Reporting Some additional data is delivered to fields on other tabs

14 AHRQ PSO Event Reporting Event-specific data is entered by PSO Toolkit users

15 AHRQ PSO Event Reporting Data not delivered automatically will be entered by a user

16 AHRQ PSO Event Reporting The PSO Mapper is used to translate data in Risk to AHRQ Common Formats terminology

17 AHRQ PSO Event Reporting Extraction File is created for selected Facilities and PSOs

18 AHRQ PSO Event Reporting Extraction File is stored in the application directory

19 AHRQ PSO Event Reporting CDA-format files meet AHRQ Common Formats 1.1 & 1.2 specifications

20 AHRQ PSO Event Reporting Reports are to be transmitted as prescribed by your PSO

21 AHRQ PSO Event Reporting Future Directions AHRQ Common Formats updates v1.2 ready for distribution v2.0 in development Distributed Indicators, Profiles, and ReporTrack reports Enhanced mapping Streamlined data submission

22 NHSN SSI Reporting Concept Starting in January of 2012 CMS implemented a mandatory reporting requirement for surgical procedures and SSI through the NHSN. To assist clients in reporting Midas+ created the SSI toolkit to leverage the surgery and infection control modules within Care Management. The toolkit allows for the collection of surgical procedure data from the surgery module and infection information from the infection control module. The goal of the toolkit is to allow the collection of all procedure data through the surgery interface, without the interaction of a user. Infection information requires Infection Preventionist review and approval for submission

23 NHSN SSI Reporting Components User fields within the Surgery module collect procedure information. These fields are updated through the surgery interface. User fields within the Infection Control module collect infection information. These infections are linked through standard functionality to the attributable surgical procedure in the surgery module. This linkage is communicated through the toolkit to NHSN. A standard report that creates the files necessary for upload to NHSN. These files contain both the procedures and infections. A process focus study called the Mapper that allows for the declaration of which surgical procedure groups will be reported and allows for mapping your terms to NHSN terms when they are received through the interface. Distributed Dictionaries for NHSN data collection

24 NHSN SSI Reporting Surgery User Fields Procedures

25 NHSN SSI Reporting Infection Control User Fields Infections

26 NHSN SSI Reporting Infection Control User Fields Infections

27 NHSN SSI Reporting Infection Control User Fields Infections

28 NHSN SSI Reporting Process Focus Study Mapper

29 NHSN SSI Reporting Future Directions Midas+ values client feedback on the toolkit and uses that feedback to make improvements As NHSN improves their reporting process the toolkit will be updated as well

30 NHSN CLABSI/CAUTI Toolkit Concept Beginning in January 2011, CMS implemented a mandatory reporting requirement for central line-associated bloodstream infections (CLABSI) through the National Healthcare Safety Network (NHSN). On January 1, 2012, CMS implemented a mandatory reporting requirement for catheter-associated urinary tract infections (CAUTI) through NHSN. The toolkit supports Care Management users in the collection and extraction of CLABSI and CAUTI data to meet these mandatory requirements with electronic data submission

31 NHSN CLABSI/CAUTI Toolkit Components An encounter-level Focus Study that gathers the CLABSI and CAUTI event data. A process-level Focus Study that gathers in a single form, denominator information for all reporting locations. A process-level Focus Study for mapping facility locations to those defined by NHSN. A set of dictionaries that supply the terms and associated codes that match those terms to those from NHSN. A standard report that generates a data extraction file suitable for upload to NHSN

32 NHSN CLABSI/CAUTI Toolkit

33 NHSN CLABSI/CAUTI Toolkit

34 NHSN CLABSI/CAUTI Toolkit

35 NHSN CLABSI/CAUTI Toolkit

36 NHSN CLABSI/CAUTI Toolkit

37 NHSN CLABSI/CAUTI Toolkit

38 NHSN CLABSI/CAUTI Toolkit Future Directions Midas+ is currently working on adding MDRO/CDI and LabID reporting abilities to the CLABSI/CAUTI Toolkit. Midas+ will continue to monitor NHSN reporting requirements and evaluate the feasibility of further expansion of this toolkit

39 PA Referral Toolkits Two separate toolkits: Executive Health Resources Accretive PAS

40 PA Referral Toolkits Concept A real-time, electronic interface between Midas+ and third-party vendors to manage the External Physician Advisor referral process Provides status updates Enables the electronic receipt and attachment of the Determination letter to the Hospital Case Management Concurrent Review (HCM-CR) in Midas

41 PA Referral Toolkits Components A set of distributed User Fields Unique to contracted vendor Positioned on a separate sub-tab under the Episode User Field tab in HCM-CR 3 Dictionaries Referral Reason Status Update Disposition

42 PA Referral Toolkits Process The referral is initiated in HCM-CR 40+ data elements are sent to the vendor via the interface The external PA reviews the case Vendor may have been given access to medical record by facility Status updates, final disposition, and letter are sent via the interface The letter is attached to the HCM-CR episode

43 PA Referral Toolkits Executive Health Resources

44 PA Referral Toolkits Accretive PAS

45 PA Referral Toolkits Initiating a Referral Referral is sent to external PA when you click SAVE

46 PA Referral Toolkits Outbound Transaction Transmission Date and Time Unique Identifier Midas+ Facility Code Patient Name Patient s MRN/Universal ID Patient DOB Patient Sex Facility ID (Vendor specific code) Encounter Type:Type Principal Payer Type Principal Payer Name Insurance ID# Account Number Start Date End Date Attending Physician s Contact Info Current Location/Room Number HCM Diagnoses HCM Procedures Comments Review Date/Time Care Date Reviewer s Contact Info Level of Care PA Referral Date/Time Referral Reason Reviewer s Contact Information Original Referral Initiated Manually flag (if applicable) Faxing Additional Information (yes or no)

47 PA Referral Toolkits Comments

48 PA Referral Toolkits Inbound Transaction Status Updates Status Dates/Times Disposition Disposition Dates/Times Vendor Comments Final letter

49 PA Referral Toolkits Status Updates and Disposition

50 PA Referral Toolkits Future Directions Dependent on feedback from clients and vendors

51 EHR-Integrated RAC Appeals Concept A bi-directional interface developed by Midas+ and EHR to assist clients who contract with EHR to manage their RAC appeals process Enables the automatic daily exchange of appeals information and status updates between the client and EHR

52 EHR-Integrated RAC Appeals Components Encounter level Focus study Midas+ EHR Appeal Hospital tab EHR tab Distributed dictionary with terms relevant to the RAC appeals process Automated daily transmission of data between Midas+ and EHR

53 EHR-Integrated RAC Appeals Process The client initiates the process by completing the Hospital tab Data is automatically transmitted to EHR from Midas+ on a nightly basis Updates are automatically transmitted to Midas+ from EHR on a nightly basis The Midas+ system s logic runs once nightly in a batch process to send data to and receive status updates from EHR Updates received from EHR populate fields on the EHR tab in the MIDAS+ EHR APPEAL Focus Study Clients may choose to create a SmarTrack Worklist to monitor this activity

54 EHR-Integrated RAC Appeals Hospital Tab

55 EHR-Integrated RAC Appeals EHR Tab

56 EHR-Integrated RAC Appeals Future Directions Will include the ability to send Documents to EHR in the outbound transaction Attain Platinum level certification with EHR Dependent on feedback from clients and EHR

57 AHA RACTrac Reporting Concept In response to the CMS RAC Program, the AHA has created RACTrac. This web-based survey tool allows the AHA to aggregate RAC data that can later be used to educate CMS and Congress on the impact of RACs on hospitals across the United States. To assist clients Midas+ created the AHA RACTrac toolkit. The toolkit allows for the collection of RAC denial information that can be electronically reported to the AHA RACTrac web application

58 AHA RACTrac Reporting Components An Encounter Focus Study that is used to enter information on all denial types. The MIDAS+ AHA RACTRAC focus study collects the information that is needed by AHA. A Process Focus Study, called MIDAS+ AHA RACTRAC INCEPTION, that is used to collect denial information from the inception of your RACTrac reporting program. A standard report that creates the file necessary for upload to the RACTrac online application. Distributed Dictionaries for AHA RACTRac data collection

59 AHA RACTrac Reporting Encounter Focus Study MIDAS+ AHA RACTRAC

60 AHA RACTrac Reporting Process Focus Study MIDAS+ AHA RACTRAC INCEPTION

61 AHA RACTRac Reporting Future Directions Midas+ values client feedback on the toolkit and uses that feedback to make improvements As AHA modifies their reporting process the toolkit will be updated as well

62 Toolkit Documentation

63 Thank you for attending. Questions? Cindy Gebremariam Product Manager, Care Management Dan Parker Product Manager, Midas+ Live TJ McGreevy Product Management Specialist Muffie Gallardo Product Management Specialist