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TRICARE Data Quality Training Course

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TRICARE Data Quality Training Course May 19, 2009 * Source: Data is Post-Feedback % Records Correct from Final Report Coding Audit, Military Health System, 27 July ... – PowerPoint PPT presentation

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Title: TRICARE Data Quality Training Course


1
DATA QUALITY MANAGEMENT CONTROL (DQMC) PROGRAM
  • TRICARE Data Quality Training Course
  • May 19, 2009

2
DQMC ProgramBriefing Purpose
  • Provide an overview of the Data Quality
    Management Control (DQMC) Program in the Military
    Health System (MHS)
  • Data quality concepts
  • Background of DQMC Program
  • Components of the DQMC Program
  • TMA Summary of Data Quality Statement metrics
  • Inspections and External Audit statistics
  • Highlight current topics and ongoing issues and
  • Conclusion.

3
DQMC ProgramData Quality Concepts
  • Attributes

4
Why Worry about Data Quality?
DQMC ProgramData Quality Concepts
One reason is external scrutiny...
DoD IG
5
DQMC ProgramData Quality Concepts
  • Problems with Information Technology (IT)
  • Typically, Data Quality is formulated as an IT
    problem ...
  • Some of our problems with data quality can be
    attributed to problems with Information
    Technology (IT)
  • Examples
  • Errors in transmission of data
  • Errors in processing data
  • Unsynchronized databases
  • But
  • The most difficult problems we face with data
    quality are not directly attributable to IT, nor
    readily fixed by IT solutions.

6

DQMC ProgramData Quality Concepts
  • A few examples of non-Information Technology
    problems causing problems with data quality
  • Lack of standardized business rules and policies
  • Inconsistent choices of codes, weights and
    algorithms
  • Lack of adequate training and education
  • Lack of adequate local data quality assurance
    and
  • Failure to set and enforce tough performance
    expectations about data quality.

7
DQMC ProgramData Quality Concepts
  • Our people have to understand both the business
    and the technology
  • Training Education Quality data requires more
    than training data-entry personnel
  • Data Quality Training Course - aimed at DQ
    Managers (offered 3 times a year)
  • MEPRS Application Data Improvement (MADI)
  • Working Information Systems to Determine Optimal
    Management (WISDOM) and
  • Providers Documentation and Coding.

8
DQMC ProgramData Quality Concepts
  • Solutions to effectively fix data problems
  • Reasonable feedback for Commanders and Users,
    such as
  • Metrics - Fast feedback to Commanders about the
    quality of their data
  • Rapid availability of data for use
  • Best Practices literature, forums, conferences
    and
  • Core competency.

9
DQMC ProgramBackground
TMA DQMC Program Implemented 01 Dec 2000 (FY
2001)
  • DoD IG identified material management control
    weakness for MHS - Directed development of data
    quality assurance and management control program
  • 2 Specific Reports
  • DoD IG report concerning the FY98 Retirement
    Liability Estimate
  • GAO Medicare Subvention Demonstration report
  • ASD (HA) concurred with DoD IG materialmanagement
    control weakness findings and
  • ASD (HA) designated TMA Resource Management
    Steering Committee to oversee the development of
    an MHS DQ Management Control Program.

10
DQMC Program Background
  • TMA Data Quality Management Control Program
  • Development of DQMC involved multiple
    workinggroups to include major system
    representatives
  • DoD comptroller, DoD IG and GAO provided
    oversight in its development
  • Program has been staffed through the Services
    with substantial input from field (former Region
    11 MTFs) and
  • Policy Memorandum signed on 29 Nov 00
    forimplementation on 01 Dec 00. Subsequently
    updated by policy memorandums dated 09 May 01,
    17 Oct 01, 05 Sep 02 and DoDI 6040.40 dated 26
    Nov 02.

11
DQMC Program Background

  • 2 Enclosures
  • DQMC Review List
  • Data Quality Statement

Department of Defense
INSTRUCTION
Regulatory GuidanceDODI 6040.40Military Health
System Data Quality Management Control Procedures
12
DQMC Program Components of Program
  • TMA DQMC Program improves data quality and
    ensures that the MTF receives credit for properly
    recording the workload.
  • Data Quality Manager Data Quality Assurance
    Team
  • DQMC Review List - Internal tool to assists MTFs
    monthly in identifying and correcting financial
    and clinical workload data problems. This list is
    prepared by the Data Quality Manager and Data
    Quality Assurance Team Enclosure 1 of DODI
    6040.40
  • Monthly Data Quality Statement Specific
    information from the DQMC Review List that the
    Commander approves for forwarding to Service DQ
    Managers and the TMA Management Control Program
    Manager Enclosure 2 of DODI 6040.40 and
  • DQMC Workgroup - TMA Chair and Service DQMC
    POCs, meets monthly- Service and TMA wide
    issues discussed and documented.

13
DQMC Program Components of Program
Active Leadership Involvement
Data Quality Managers
Rapid Feedback
Critical Success Factors
Use of Data/Metrics by the MTFs
File/Table Build Data Base Management
Timely Coding/End-Of-Day Processing
Data Reconciliation and Audits
14
DQMC Program DQ Metrics
  • TMA DQMC webpage
  • http//www.tricare.mil/ocfo/mcfs/dqmcp.cfm
  • Metrics and Report and
  • Important reference materials.
  • TMA Summary of DQ metrics
  • DQ Statements
  • Received by TMA from Services on the 10th of the
    month for the preceding months report. (Applies
    to the prior months data.) Used to create the
    TMA Service Trends spreadsheets
  • TMA Summary
  • Constructed from the Service Trends and briefed
    to both the Resource Management Steering
    Committee and TMA Senior Leadership and Service
    DSGs twice a year
  • Posted on the DQMC website and
  • Discussed at the Monthly DQMC Workgroup meetings.

15
DQMC Program DQ Metrics
  • TMA DQMC webpage
  • http//www.tricare.mil/ocfo/mcfs/dqmcp.cfm

16
DQMC Program DQ Metrics
  • The following Data Quality Statement TMA
    Summary summarizes results of the DQ Statements
    submitted by each Service for data month Jan 09
  • Metric Standards (colors) are as follows
  • Green - 95-100
  • Yellow - 80-94
  • Red - 0-79
  • Except 8e and 9 80 and above green, 10 is
    not colored
  • Color coding generally moves from red to green as
    the fiscal year progresses and issues are ironed
    out.

17
DQMC Program DQ Metrics See TMA Summary Sheet
handout - below is an example for FY 2009
18
DQMC Program Inspections/External Audits
  • DoD IG inspected -- results (Apr 01-Oct 01) were
    published in a report signed 29 Aug 02.
  • General Comments
  • Overall indifference toward the program
  • Lack of communication and timely feedback to
    identify shortfalls in performance
  • Inadequate preparation and training of the DQ
    Team for completion of the Control Review List
    and
  • Lack of monitoring to ensure proper
    implementation of the program.

19
DQMC Program Inspections/External Audits
  • DoD IG MTF Specific Comments
  • Responses to the DQ Statement andControl Review
    Lists are unreliable. Need audit / validation
    of responses in the Data QualityStatement /
    Review List
  • Lack of audit trail - no supporting
    documentation
  • Lack of accountability
  • Lack of training and
  • Inadequate dedication of resources to data
    quality.

20
DQMC Program Inspections/External Audits
  • The DOD IG Inspection raised concerns
  • Prevents Defense Health Program (DHP) and
    Office of Secretary of Defense (OSD) from
    receiving a Clean Audit Opinion
  • Puts future DHP funding in jeopardy
  • Puts Prospective Payment in jeopardy
  • Third Party Collections (TPC) placed in jeopardy
    and
  • Jeopardizes MTF Accrual Financing Reimbursement.

21
DQMC Program Inspections/External Audits
  • External Audit 2002
  • Iowa Foundation
  • The audit consisted of 50 sites, 11,254 cases
  • Unavailability of records (47)
  • Specific encounter not found in 9 of the
    records
  • Coded incorrectly, 27 70 over coded, 30
    under coded and
  • Coded correctly, 17.
  • AdvanceMed ended up with similar results
  • National Capitol Region (NCR) availability of
    records (9).

22
DQMC Program Inspections/External Audits
External Coding Audit Response Rates FY 2008
(Data Records FY 2006)
  • Audit sample consisted of 7,100 randomly selected
    records from FY 2006 data records
  • Our goal was an 85 Response Rate

23
DQMC Program Inspections/External Audits
  • Very Low
  • Violates DoDD 6040.41 (Apr 13, 2004, paragraph
    4.2.3.1 95 availability of records) andDoDI
    6040.43 (Jun 10, 2004, paragraph 5)

24
DQMC Program Inspections/External AuditsCoding
Accuracy
NR Includes Non-response records graded using
correct DRG as the only criteria
25
DQMC Program Inspections/External AuditsCoding
Accuracy
NR Includes Non-response records
26
DQMC Program Inspections/External AuditsCoding
Accuracy
NR Includes Non-response records
27
DQMC Program Current Topics
  • Some of the items currently being pursued
  • Training
  • DQ Course
  • Using M2 Data Quality Reports to Improve MTF Data
    Quality(hands-on tutorial)
  • Presented DQMC Program brief at Navy Patient
    Admin Course and UBO/UBU Conferences
  • Annual Data Quality Statement Update
  • FY09 Clarification of Coding Audit formulas
  • FY09 Addition of Duplicate Records reporting
    from Review List and
  • Internal Compliance, External Evaluation
  • MHS External Coding Audit for FY09 (FY07 data
    records).

28
DQMC Program Ongoing Issues
  • Issues being pursued
  • Medical Expense Performance and Reporting System
    (MEPRS) Timely Reporting
  • Working issues with DMHRSi
  • MHS Trouble-Ticket Management (Tier 2 3)
  • AHLTA Implementation Issues
  • Central System Table Synchronization (e.g., CPT
    Table)
  • AHLTA, CCE, CHCS
  • Coding Accuracy
  • TMA External Coding Audits.

29
DQMC Program Conclusion
  • There are many benefits to Data Quality
  • Records (with accurate documentation / coding)
  • Provide evidence of treatment and supports
    budget, reimbursement and billing
  • Support training and education
  • Facilitate quality assurance processes
  • Provide the legal defense for patients,
    providers and the MHS
  • Availability of records provides the
    communications link between providers and
    continuity of care and
  • Credit for MTF quality work.

30
DQMC Program Conclusion
  • How Can You Help?
  • Brief medical staff on command data
  • Executive Steering Committee
  • Department Division Heads
  • Develop Dashboards
  • Provide feedback to staff and use the data
  • Be well-read/knowledgeable in data quality
  • Reporting
  • Analysis
  • Network and share information

31
DQMC Program Conclusion
  • DQ POCs
  • TMA
  • Army
  • Navy (support team)
  • Air Force

32
Questions?
33
Bonus Information
34
DQMC Program Inspections/External Audits
External Coding Audit Results 2007 Targeted 6
Hospitals New Study Rules
Source Data is Post-Feedback Records Correct
from Final Report Coding Audit, Military Health
System, 27 July 2007 by STI. Note IP DRG
accuracy OP and APV EM, CPT, and ICD-9
accuracy.
35
DQMC Program Inspections/External Audits
External Coding Audit Results 2007 (Data Records
FY 2005)
These tables are excerpts from Final Report
Coding Audit, Military Health System, 27 July
2007 by STI.
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