SPARCS : AFOOFA

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SPARCS AFOOFA

• June 8, 2009
• NYHIMA Annual Conference
• Buffalo, NY

Laura K. Dellehunt
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Acronyms

• SPARCS Statewide Planning and Research
  Cooperative System
• Nationally recognized data set of health care
  information
• AFOOFA All for One, One for All
• Should be SPARCS motto Solidarity and Unity
• HCS Health Commerce System
• Your secure website for data exchange

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SPARCS Update - Agenda

• Focus on importance of SPARCS
• What is new Health Commerce System
• Changes for 2010
• What is coming Expanded Collection of Outpatient
  Clinic Data

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AFOOFA - Facilities
NYS DOH
Clinics
Ambulatory Surgery Centers
Hospitals
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SPARCS Successes

• Working relationship with health care facilities
• SPARCS celebrating its 30th Anniversary
• Adoption of national standards for billing
  information
• User created dependence on the data

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AFOOFA - SPARCS
Paul Albertson
Kathy Kosek
John McDevitt
John Skerritt
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AFOOFA

• Why you are sending the data to SPARCS?
• What is it used for?
• Who uses the data?

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AFOOFA State Agencies

• NYS Council on Children and Families
• Vision All children, youth and families will be
  healthy and have the knowledge, skills and
  resources to succeed in a dynamic society
• Produce Touchstones NYS Kids Count Data Book
• Charting the futureworking together
• Hospitalization Tables
• Unintentional Injuries
• Asthma
• Resulting from Assault
• Where is it http.nyskwic.org

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AFOOFA Medical School

• Mount Sinai School of Medicine, Depts. of
  Community and Preventive Medicine and Pediatrics
  - Dr. Perry Sheffield
• Future Ground Level Ozone and Pediatric Asthma
  Events in NY City Metropolitan Area
• More children will end up hospitalized over the
  next decade because of respiratory problems as a
  result of projected climate change
• Linkhttp//www.mountsinai.org/Research?citypeNew
  sciid05032009

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AFOOFA - University

• Brandeis University, Schneider Institute for
  Health Policy-
• Dr. Christopher P. Tompkins
• Value Based Purchasing (VBP) Measures Support
  Contract
• Precarious Pricing System for Hospital Services
• Escalating Health Care Spending Is it Desirable
  or Inevitable?
• Where http//sihp.brandeis.edu/

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AFOOFA - Consumer / Patient

• Hospital Profile-
• http//hospitals.nyhealth.gov/
• Managed Care Performance - http//www.health.stat
  e.ny.us/
• nysdoh/healthinfo/mcp.htm
• Newspapers
• NY Times
• Buffalo News
• Daily News
• Where http//sihp.brandeis.edu/

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AFOOFA Loyal to all
NYS DOH Disease Research, Surveillance, Rate
Setting, etc.
Consumer / Patient
Physician
Medical Facility
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Recall Two Websites for SPARCS

• WWW Contains Data Dictionary, References,
  Audit Submission Reports
• http//www.health.state.ny.us/statistics/sparcs
• Secure Website Health Commerce System -
  contains facility specific information
• https//commerce.health.state.ny.us/hpn/sparcs/spa
  rcs.html

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What is New on WWW?

• F.A.Q.s
• Resource Links
• Present on Admission (POA)
• http//www.cdc.gov/nchs/icd9.htm
• Information Bulletins
• Updates on SPARCS-837, a PC based submission
  program
• Training Material 101 and 102

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(No Transcript)
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HCS

• General Information for facilities
• Updates on current disease-related issues
• Contact information
• HPN Coordinators
• SPARCS reports
• Submission Reports
• Quality Reports
• Performance Metrics

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What is New on HCS?

• Continue to Develop Quality Section
• Present on Admission (POA)
• Race Ethnicity
• Physician License (Operating, Attending, Other)
• Acute Myocardial Infarction (AMI) Reports 3
  4
• Duplicates Report

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What is New on HCS? (2)

• Performance Metrics Section
• PPC (Potentially Preventable Complications)
• Link to Tools
• Updates to SPARCS-837 PC Application
• Health Facility Information System (HFIS)
• License Lookup

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Data Quality Reports

• Reports pertain to specific data elements
• By type of data set IP, AS, and ED
• Reports to be updated at scheduled intervals
• Reports for monitoring improvements in submission
  and data quality

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POA Reports

• Inpatient Only
• POA by Payer Report
• Payer Medicare, Medicaid, Other
• 6-month snapshots of data
• POA by Indicator Criteria Report
• related to Potentially Preventable Complications
  (PPC) Project
• created by 3M
• Remember POA affects reimbursement for Medicaid
  and Medicare

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Physician License Reports

• All data types
• IP, AS and ED
• For three data elements Attending, Operating,
  Other
• New Pre-Edit 6/1/09
• Criteria for Threshold
• 90 match to current New York State Department of
  Education file
• By current year of discharge/visit
• Current month and two previous months

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Race Ethnicity Reports

• All data types
• IP, AS and ED
• Crosstab of two data elements
• Criteria for Threshold
• Examining unknown and other related to US
  population census
• Use the census information based on county where
  the facility is located

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SPARCS Emergency Dept.Medical Record Audit

• NYSDOH Asthma Surveillance and Evaluation Team -
  study completed 2009
• ED Charts compared 2003-2004 and 2005
• Results
• Quality of ED administrative data is very good
• Race information questionable
• Hospitals with high ED volume have tendency of
  having lower data accuracy

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Results (cont.) Match to Medical Chart
Data Element 2003-2004 2005

• Age (2)
• Sex
• Race
• Payment Source
• ZIP Code
• Patient Disposition
• Primary Diagnosis

• 96.8
• 98.7
• 57.8
• 56.9
• 93.2
• 97.4
• 92.2

• 96.8
• 98.7
• 49.8
• 61.1
• 89.0
• 88.5
• 99.5

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Performance Metrics Reports

• Reports are designed to assist your facility with
  a variety of topics related to
• Facility performance
• Analysis of the health care provided to your
  patients
• All HCS account holders at your facility can view

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List of Performance Metrics Reports

• Reports are currently for INPATIENT data
• 1. Comparison of your Institutional Cost Report
  (ICR) and SPARCS Inpatient data
• 2. Agency for Healthcare Research and Quality
  (AHRQ) measures
• Mortality for Inpatient Procedures Indicators (6)
  
• Mortality for Inpatient Condition Indicators (7)
• Procedure Utilization Indicators (7)
• 3. PPC - Potentially Preventable Complications
  Reports
• 4. PPR- Potentially Preventable Readmissions
  Reports - coming soon

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Focus on Improving Your SPARCS Data

• Focus on problem areas
• Use the Data Quality, Performance Metrics or your
  own internal reports
• Current focus
• POA (Inpatient)
• Physician License Number
• (all data types)

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Changes for 2010

• New License Code Descriptions
• Use of NYS Education Department profession code
  prefix on registered license numbers for all
  medical professions
• Expands codes for providers in the outpatient
  clinic arena
• Appendix J being replaced with NYS Education
  valid profession codes

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Changes for 2010 (2)

• New License Code Descriptions Examples
• VALID Ranges
• SPARCS Code becomes NYS Education
• Physician
• 00000001-00300000 060000001 -0000000
• 00900000-00999999 060900000 -0999999
• SPARCS Physician Prefix was 00 now becomes
  060

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Changes for 2010 (3)

• Changes in Prefix Examples
• SPARCS Code becomes NYS Education
• Physician 00 Medicine 060
• Medicine, 3yr 061
• Podiatrist 20 Podiatry
  065
• Nurse/Midwife 60 Nurse 022
• Midwife 028
• NYS License Lookup http//www.op.nysed.gov/opsearc
  hes.htm or our site

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Changes for 2010 (4)

• Improvements in Payer Data Elements edits
• Appendix K (Commercial Insurance Company Numbers-
  NAIC and DOH) to be replaced
• Appendix L (Blue Cross and Blue Shield) to be
  replaced
• Source of Payment edit will be revised for
  Payer ID and Provider ID associated with Medicaid
  funded health care
• Source of Payment Typology I, II, III will
  reflect same edits

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What is ComingExpanded Collection of Outpatient
Clinic Data

• Why the need to collect?
• Federal Government pays 50 of Medicaid
  Reimbursement
• Upper Payment Limits as a condition of payment
  Federal Government requires State to analyze
  Medicaid Reimbursement using Medicare (Federal)
  Reimbursement Principles
• Accurate diagnostic, procedure code and other
  data are essential to this analysis
• Outpatient Reimbursement
• New York is examining an overhaul of Medicaid
  ambulatory reimbursement methodologies
• Data from all payers to be utilized

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Outpatient Clinic Collection (cont.)

• Goals
• Minimal workforce effect by collecting only those
  data elements that are necessary for research and
  evaluation
• Criteria
• Use the industry format standards (UB04
  X12-837)
• Do not collect data elements without sufficient
  justification

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DraftDefining a Clinic Visit Occurrence

• A bill is generated for the health care provided.
• The services must be in the medical chart
  (charted).

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DraftDefining a Clinic Visit Occurrence (2)

• A Face-to-Face meeting with a licensed provider
• Cannot accept dental providers at this time
• Provider must be acting independently
• Provider must exercise professional judgment

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DraftDefining a Clinic Visit Occurrence (3)

• And per provider type
• One medical
• One mental health
• One health education
• One substance abuse
• One case management
• One of each type.

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Outpatient Clinic Collection (cont.)

• How you can help
• Stakeholders participation at regional meeting
• June 8th 3-4 pm Adams Mark Hotel
• June 9th 1-3 pm Buffalo DOH Regional Office
• In the new computer system, what functions would
  assist your facility?
• Training needs

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All for One, One for All

• Your SPARCS data
• represents a clear picture
• of the patient care that
• is truly provided at
• your facility.

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Contact Information
www.health.state.ny.us/statistics/sparcs Laura
Dellehunt Paul Albertson John McDevitt John
SkeRRiTT Kathy Kosek Phone (518)
473-8144 1-800-638-3808 Fax (5
18) 486-3518 E-mail sparcs_at_health.state.ny.us
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All for one!!! One for all!! Treat yourself!
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Any Questions ?