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
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
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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
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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
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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
AHRQ PSO Event Reporting
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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
AHRQ PSO Event Reporting
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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
AHRQ PSO Event Reporting
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AHRQ PSO Event Reporting
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AHRQ PSO Event Reporting
Risk RDE can be used to report safety events remotely.
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Risk Event function is populated via Remote Data Entry.
AHRQ PSO Event Reporting
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Then, the qualified Risk Event notifications appear on a Worklist…
AHRQ PSO Event Reporting
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…and the PSO Event Focus is automatically created with
Risk Event data automatically populating applicable fields.
AHRQ PSO Event Reporting
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Some additional data is delivered to fields on other tabs.
AHRQ PSO Event Reporting
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Event-specific data is entered by PSO Toolkit users.
AHRQ PSO Event Reporting
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Data not delivered automatically will be entered by a user.
AHRQ PSO Event Reporting
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The PSO Mapper is used to translate data in Risk to…
AHRQ Common Formats terminology.
AHRQ PSO Event Reporting
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Extraction File is created for selected Facilities and PSOs.
AHRQ PSO Event Reporting
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Extraction File is stored in the application directory.
AHRQ PSO Event Reporting
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CDA-format files meet AHRQ Common Formats 1.1 & 1.2 specifications.
AHRQ PSO Event Reporting
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AHRQ PSO Event Reporting
Reports are to be transmitted as prescribed by your PSO.
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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
AHRQ PSO Event Reporting
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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.
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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.
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NHSN SSI Reporting Surgery User Fields – Procedures
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NHSN SSI Reporting Infection Control User Fields – Infections
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NHSN SSI Reporting Infection Control User Fields – Infections
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NHSN SSI Reporting Infection Control User Fields – Infections
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NHSN SSI Reporting Process Focus Study – Mapper
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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
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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.
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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.
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NHSN CLABSI/CAUTI Toolkit
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NHSN CLABSI/CAUTI Toolkit
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NHSN CLABSI/CAUTI Toolkit
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NHSN CLABSI/CAUTI Toolkit
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NHSN CLABSI/CAUTI Toolkit
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NHSN CLABSI/CAUTI Toolkit
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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.
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PA Referral Toolkits
Executive Health Resources
Accretive PAS®
Two separate toolkits:
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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+
PA Referral Toolkits
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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
PA Referral Toolkits
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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
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PA Referral Toolkits Executive Health Resources
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PA Referral Toolkits Accretive PAS®
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Referral is sent to
external PA when
you click SAVE
PA Referral Toolkits Initiating a Referral
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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)
PA Referral Toolkits
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Comments
PA Referral Toolkits
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Inbound Transaction
• Status Updates
• Status Dates/Times
• Disposition
• Disposition Dates/Times
• Vendor Comments
• Final letter
PA Referral Toolkits
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Status Updates and Disposition
PA Referral Toolkits
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Future Directions
• Dependent on feedback from clients and vendors
PA Referral Toolkits
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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
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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
EHR-Integrated RAC Appeals
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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
EHR-Integrated RAC Appeals
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EHR-Integrated RAC Appeals Hospital Tab
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EHR-Integrated RAC Appeals EHR Tab
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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
EHR-Integrated RAC Appeals
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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.
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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
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AHA RACTrac Reporting Encounter Focus Study – MIDAS+ AHA RACTRAC
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AHA RACTrac Reporting Process Focus Study – MIDAS+ AHA RACTRAC INCEPTION
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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
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Toolkit Documentation
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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
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