Medical Executive Data Overview

Dr. Raymond “Tres” CrawfordAssistant Professor, Health Services AdministrationUniformed Services University of the Health Sciencesrcrawford@usuhs.mil

Objectives

• Introduce common measures of workload used in the Military Healthcare System (MHS)

• To identify MHS systems where data is available to allow for data driven decisions

• Introduce MHS productivity and production related terms and measures

Workload Measures

Raw Workload Measures

Weighted Workload Measures

Simple Raw Workload Measures

• Admission – acceptance of a patient by a facility as an inpatient for treatment

• Disposition – the removal of a patient from a hospital's census by reason of discharge, transfer, death, or other termination of inpatient care

• Encounter – serves as a focal point linking clinical, administrative and financial information. Encounters occur in many different settings – ambulatory care, inpatient care, emergency-care, home health care, field and virtual (telemedicine)

Calculated Raw Workload Measures

• Occupied Bed Day – a day in which a patient occupies a bed at the census-taking hour (usually midnight). Under certain circumstances, an OBD is also credited when a patient is admitted and discharged on the same day– e.g. same day surgery

• Average Daily Patient Load – the average number of inpatients over a defined period of time

• Length of Stay – refers to the number of days that comprise an inpatient's hospital stay

Case Mix Measures

• Case Mix Complexity – with respect to workload measurement, the resource intensity of treating a particular group of patients• Major Diagnostic Category (MDC) – a broad classification of

diagnoses and procedures typically grouped by body systemor etiology

• Diagnosis Related Groups (DRG) – an inpatient classification system that relates demographic, diagnostic and therapeutic characteristics of patients to LOS and amount of resources consumed

• Case Mix Index – the average relative weighted product (RWP) per disposition

Weighted Workload Measures

• Relative Weighted Product (RWP)• a measure of workload credit derived from biometrics

dispositions weighted by DRG weights• the number of RWPs is a measure of the relative resource

consumption of a patient’s hospitalization as compared to that of other patients

• RWP calculation example

• Relative Value Units (RVU)• a weight assigned to an encounter based on CPT coding

Direct Care Outpatient Workload Documentation

Standard Ambulatory Data RecordStandard Ambulatory Data Record

Documentation of an encounterDetailed information on direct care outpatient workloadCoding needing to show workload

SADR

RVU

Relative Value UnitRelative Value Unit

Similar to CMS RVUs—some differences do exist thoughBased on CPT codes from SADR encountersUsed in MHS performance metricsUsed in Prospective Payments System

Direct Care Inpatient Workload Documentation

Standard Inpatient Data RecordStandard Inpatient Data Record

Documentation of an inpatient episode of careDetailed information on direct care inpatient workloadCoding needing to show workload

SIDR

RWP

Relative Weighted ProductRelative Weighted Product

Based on DRG rates from SIDR Used in MHS performance metrics (including PMPM calculations)Used in Prospective Payments System

Where Can You Get Data?

Balanced ScorecardDHP or Service Metrics

Provided

TOCPEPR

Tri-Service Business Planning ToolPopulation Health Portal

Web-based

M2EAS

Processed DataAnalyst Needed

Data Driven Decisions

MDRRaw Data

Difficult to Access

MDR

MDR

What

MHS Data Repository

Location of MHS Data Files

Other data sets are often a reflection of the MDR

Legal and financial mechanisms track to the MDR

Extremely limited direct access

Why

Data Flow to the M2

““MDR”MDR”

SourceSourceBig Big

MDR MDR FileFile

M2 M2 FileFile

M2

M2

What

MHS Mart

A snapshot/subset of the MDR

One-stop shop for many used/needed data elements

Allows MTFs to look beyond the “four walls”

Learn about your MTF, other MTFs, and network

M2 analyst required

Why

M2

MHS Mart:

A very powerful ad-hoc business objects based query tool for

trained analysts.

PurchasedPurchasedCareCare

EligibilityEligibility

EnrollmentEnrollment

OutpatientOutpatient

InpatientInpatient

PharmacyPharmacy

ETC

Non-InstitutionalNon-Institutional

Enrollee Network CareEnrollee Network Care

MCFASMCFAS

ETCETC

Direct CareDirect CareDataData U = M2M2

EASEAS

WWRWWR

InstitutionalInstitutional

MCSC PharmacyMCSC Pharmacy

TMOPTMOP

EAS

EAS

What

Expense Assignment System

MEPRS data

FTE data (including skill types)

EAS data is also in the M2

Why

Other Tools

TOC

If you do not have an M2 analyst

Web-based

Population Health

Tri-Service Business Planning Tool

Sample Metrics

• RVUs per provider FTE per day

• Total number of RVUs

• Total number of RWPs

• Enrollee medical cost per member per month