Functional Changes in MDR and M2

Functional Changes in MDR

and M2

Wendy Funk, Kennell and [email protected]

FOR OFFICIAL USE ONLY2

Functional Changes in MDR/M2

1)Context: MDR and M2 are two of the most important systems used by MHS analysts today.

2)Purpose: This presentation will updates users on changes in these systems that have occurred recently or are about to occur.

3)Outcome: After attending this session, participants will meet the objectives described on the next slide.

3

Functional Changes in M2

• Objectives: Characterize new features currently available in M2 BOXI Describe the M2 Appointment Table Describe the direct care dental data List the sources of data in the purchased care dental

table Characterize the types of deployment data in M2 Describe data type specific changes Describe the CDR Data Retention Project List changes that are upcoming.



• M2 switched to a newer version of software this year Older version of M2 was no longer supported by Business

Objects There was a desire by some to change to a Web-based

tool. The M2 FPG voted that the Web version of M2 did not

meet functional requirements So DHSS deployed a Web-tool (WebI) and the Desktop

version of BOXI called “DeskI”



• DeskI is very similar to Business Objects 5.1.7 Querying works the same way

• Differences include Method of logging on Retrieving and working with corporate reports Sending and receiving reports Ability to use the results of a query as a subquery


Using Results from a Query in a Subquery

• BO 5.1.7 performed subqueries Users could use an “in list” command and then build a

new query to retrieve data from M2. Now, users can use an existing query in the “in list”

condition.• Consider the following:

You want to write a report to include only procedure code descriptions that are in the main query, so that you can make a detail object out of them.



• Main Query:Radiology Procedures at Camp

Pendleton in FY 2011.

• Insert a report to get descriptions


• When building the procedure code description report, we get an option “Select Query Results”




• After pressing “Select Subquery Results”

• Select Query 1


• After Selecting Query 1, M2 provides a list of elements, and the user select which one to use as a filter.

• The advantage here is that you only get codes that you want returned. There will be no extraneous rows after creating the detail associated with procedure code.




• Final Look: Right before hitting run



• Final Steps:Link procedure codes


Create a detail objectUse slice and dice to bring into report.






• WebI is “sort of” similar to Business Objects 5.1.7 Querying is very similar No slice and dice, but most functionality still

available Significant differences in handling of data (i.e.

saving, etc)• Some functionality that is not available in WebI:

User – Defined Objects Use of local data Less flexibility in saving files



• There are some new features in BOXI (both WebI and DeskI) Infoview Web Portal. Ability to save data to the server rather than

locally (good for PHI/PII) Ability to develop dashboards and other

customized views • Some issues with BOXI

Significant issues with run-times. Improvements lately!

Browser updates can cause problems.


New Publishing Feature of BOXI

Navy Analytics Newsletters


Navy Analytics Newsletter

• Navy BUMED sponsored newsletter for analysts and other users of data. 8 are published per year. Topics include:

Issue Content

1 Mental Health

2 Populations

3 Data Quality

4 Obstetrics

5 Pharmacy

6 Medical Home

7 Financial Management


New Publishing Feature of BOXI

• Corporate Reports Handbook• See Conference Website for

slides on Corporate Reports



• Business Objects has told DoD that they will cease to support DeskI at some point in the future.

DHSS would like to switch to only WebI soon. Business Objects is working to close the

“functionality gap” between WebI and DeskI DHCAPE will approve the switch to WebI when

the gap is closed.


Recent Changes

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New Data Tables

• Appointment Table: Direct care appointments only Contains a record for each appointment in CHCS. Includes cancellations, left w/o being seen, etc. Prepared from the TRICARE Operations Center (TOC) data

feeds that are used for reporting of access to care measures.

Populated from FY 2005+ like other data tables. Updated weekly. Used to prepare “inferred encounters” also.

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New Data Tables

• Ideas for using this new table: Can be looked at to track no-show rates Can be used to look at historical compliance with access

to care standards. Can trend from FY 2005+ Can be used to track compliance with access standards for

specific populations that are not separately identified by the TOC.

Can be used to look at scheduled appointment times, compared with E&M codes recorded in CAPER.

Can be used to determine if particular specialties or PCMs are having access to care issues.


Unused Appointments at One Navy MTF in One FM (Top Clinics)

Code Clinic#

Wasted TotalWaste Rate

BAR PHYSICAL MEDICINE 1,785

7,181 25%

BFD MENTAL HEALTH 1,562

5,926 26%

BGZ FAMILY MEDICINE NEC 1,525

9,054 17%

BCB OB/GYN 1,083

5,827 19%

BLA PHYSICAL THERAPY 1,051

3,653 29%

BDZ PEDIATRIC CARE NEC

764 5,035 15%

EKA AMB CARE PATIENT ADMIN

737

2,361 31%


Tracking Compliance with Access Standards

• Compare length of time from date appointment made, to date of appointment.

• Use “Length of Time Until Appointment”

• M2 won’t let you calculate yourself.



• Retrieve appointment type, length of time until appointment.

• Used only Specialty Appointments at one MTF in one month

• Created a local variable to group lengths of time.



Met the Access to Care

Standard for Specialty

Appointments 94% of the time.



• One MTF, One Month

• Number of Appts outside the access standard by provider.

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New Data Tables

• Direct Care Dental: New table, as of November 2011. Detailed encounter data for dental care. Generally contains Army and Air Force data, for now

anyway (exception is National Military Medical Center Walter Reed)

This is because Navy doesn’t generally capture dental data (DENCAS) in sufficient detail - person level procedure data is not generally captured in the Navy.

There are plans later, to add dental weighted values to the MEPRS table, which will be for all three Services.


Dental Encounters in M2 by DMISID Military Service

Navy Workload is entirely the new Walter

Reed


Dental Encounters in M2 Walter Reed and Bethesda


Dental Encounters For Navy Beneficiaries by Other Services

FY ADFM RET OTH AD Total

2009 12,641 4,123 8,485 140,063 165,312

2010 12,941 4,564 12,803 138,395 168,703

2011 18,492 9,056 20,640 178,512 226,700

2012 11,301 5,294 11,758 105,033 133,386

33

Global Changes

• Addition of Deployment Information Source of deployment information is DMDC. Deployment related data elements have been appended to all detail

data tables in M2.• Ever Deployed Flag (OCO): Indicates whether the beneficiary had been

deployed as of the reporting date in the record.• OCO Deployed Flag: Indicates if the beneficiary is currently in deployed

status as of the reporting date in the record. Particularly useful with population data because deployed cohorts

aren’t generally receiving care through the DHP. This allows you to take the deployed out of denominators when calculating things like PMPM Costs, or Utilization/Enrollee.

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Global Changes

• Cumulative OCO Deployed Days: Indicates how many days the member had been deployed in total, since 9/11/2011. Many studies has shown this to be associated with poor outcomes.

• Days Since Most Recent Deployment: To assist in finding beneficiaries who may be vulnerable due to a

recent return. Could also be used to track who needs a Post Deployment Health Re-

Assessment.


Using M2 Deployment Flags

Service N Y Total%

Deployed

Army 583,358 139,474 722,832 19% Coast Guard 43,471 447 43,918 1%

Air Force 338,322 32,514 370,836 9%

Marines 190,766 21,755 212,521 10%

Navy 206,802 10,232 217,034 5% Navy Afloat 108,627 20,497 129,124 16%

Unknown 6,866 6,866 0%

All 1,478,212 224,919 1,703,131 13%

% of Active Duty OCO Deployed at Beginning of FY12



• Navy created a special DMISID to be used for enrollments of deployed service members, rather than keeping the member enrolled at their home port. The top enrollment site for Navy/Marines deployed is “6992” – Active

Duty Navy with 33K enrollees Fort Bragg has 11K enrollees that were deployed at the beginning of

FY 2012. Fort Hood had 20K. Wreaks havoc on analysts use of the data b/c the people being called

“enrolled” don’t generally have an opportunity to receive health care from the DHP.



% of Army Enrollees at MTFs who are deployed at the time the enrollment was reported.



Navy MTFs with the Largest Deployed Population at Beginning of FY 2012

Catchment Area N Y

% AD Deploye

d

NMC PORTSMOUTH 72,671

10,067 12%

NMC SAN DIEGO 66,387

5,389 8%

NH BREMERTON 10,882

2,883 21%

NH JACKSONVILLE 16,915

2,747 14%

NH CAMP LEJEUNE 48,083

2,101 4%

WALTER REED NMMC 38,474

1,494 4%



% of Navy AD Workload for Members who have been deployed -- Top 5 Clinics.

Clinic N Y Total % Dep

PT/OT 329,960 327,658 657,618 50%

Flight Medicine 86,538 84,396 170,934 49%

Mental Health 386,025 335,076 721,101 46%

Orthopedics 217,163 170,854 388,017 44%

Public Health 196,523 151,052 347,575 43%


FYWalter Reed Bethesda BAMC Landstuhl

2006 709 318 275 3,0452007 747 385 405 3,7022008 732 137 271 2,6352009 616 159 202 2,3922010 644 276 163 2,7152011 276 185 349 2,7482012 59 155 790

Using M2 Deployment FlagsAdmissions for Members Deployed at the Time of Admission – Most Frequent MTFs

41

Global Changes

• Transition of Tnex to T3 Complicated contract changes occurring with the

TRICARE MCS Contracts Numerous awards / protests / appeals, etc… Decided to put both T3 and Tnex Regions into M2. Tnex region (HSSC Region) has not changed. However, the old region data elements (populated with

01, 02, 03, etc) are now filled with the T3 region. Gives users the flexibility to report either way. Historical regions have been removed from M2

altogether.

42

Data-Type Specific Changes

Standard Inpatient Data Record:•Renamed Service Date to Discharge Date:

Technically, this is a disposition date.

•Added Sponsor Service, Aggregate: Can identify Navy Afloat with

this.•Added Diagnosis 9 – Diagnosis 20•Added Procedure 9 – Procedure 20.

NameDisposition

s NMC PORTSMOUTH 1,669 NMC SAN DIEGO 896

TRIPLER AMC 337

NH JACKSONVILLE 165

NH YOKOSUKA 103

MTFs with the most dispositions for Navy Afloat Service Members

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TED-Institutional:•Added diagnosis codes 9-11

Total of 12 Dx fields now.•Added Sponsor Service, Aggregate:

Can identify Navy Afloat with this.

TED-Non Institutional:•Added Sponsor Service, Aggregate:

Can identify Navy Afloat with this

M S-DRG Description Admits

NON-ACUTE, DRG N/A 1,996

VAG DELIVERY W/O CC 1,544

ESOPHAGITIS, OTHER GI 1,247

FX, SPRN, STRAN EXC FEMUR

656

APPENDECTOMY W/O CC

390

MS-DRGs in the Network for Navy Afloat Service Members

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Ancillary (MTF Lab and Rad):•Renamed related record ID to be appointment record ID. •Added inpatient record ID, however this element seems to have some issues.•(Ancillary cost data seems highly suspect at this time).

Referral:•Added appointment date and date appointment made.

Can be used to track access standards. (Math issues with dates)

•Renamed referral FY and referral FM to FY and FM, respectively. Pharmacy (PDTS):•Changed sponsor service, common to sponsor service, aggregate•Renamed NPI Type 2 to Pharmacy NPI.

45


• Users were encouraged to switch from using SADR for professional encounter reporting, to using CAPER.

• Changes were made to the CAPER data in M2 to make it more user friendly. Renamed data elements for consistency purposes. Formatted diagnosis codes to be consistent with the reference tables

and other data files.• Dropped several RVU elements:

Examples: Individual Work RVU, Simple Work and PE RVU• Renamed PE RVU (13) to PE RVU, Non-Provider Affected (13)• Dropped APC Aggregate Weight (5)• Hid PPS Earnings related data fields because they were not properly

maintained (more later)

46


CAPER:•New RVU elements for direct care.

New aggregate measures, provider specific measures for direct care only.

All new elements have work, PE and total components Many of the old RVU elements are still available also. No changes were made to purchased care. As a result, still best to compare enhanced RVUs (13) in CAPER with

enhanced RVUs in TEDs. But new fields are helpful for direct care only type work.!

04/19/2347

CAPER:•PPS and Business Plans use the new Provider Aggregate RVU (PAR). •Edit logic is now incorporated into RVU assignment! Makes it difficult to track coding issues.•PAR incorporates all 13 Procedure Codes.

Initially, only 5 procedure codes were considered with enhanced RVUs. For most records, this will have no impact but for some, there will be positive gain as a result.

•PAR incorporates Procedure Code Modifiers: Previously, only lab/rad modifiers and some DME were used. In the Provider

Aggregate RVU, the following modifiers are considered. Bilateral, Unrelated E&M, discontinued services, unusual services

•Incorporates Discounting: 100% credit for highest weight procedure, 50% credit for all others. Whether a procedure’s RVU is discounted depends on the CMS Payment Status

Indicator for the code.

CAPER RVUs

04/19/2348

CAPER:Treatment of Nurse Only workload is different with PAR

• Nurse only workload has always been credited in M2, but was not used in PPS in 2011.

• In 2012, the PAR will have the nurse logic built in.• Most nurse workload won’t count but there are some procedures that will

(i.e. flu shots)• These can be identified in M2 in the CPT/HCPCS reference table.


04/19/2349

CAPER:Provider Adjustments are made with PAR

• With enhanced RVUs, credit was only given for the primary provider.• In PAR, providers receive credit for all care they participate in, though not

always at full credit.• Nurses only receive credit for some specific CPT/HCPCS codes.


04/19/2350

CAPER:•Provider (appointment & add’l providers 1 – 4)

Up to 5 providers•Proc 1 RVU (NPA) – Proc 12 RVU (NPA)

Up to 3 E&M codes and 10 procedures NPA = Non-Provider Affected

•There were also additional procedure specific and provider specific RVU elements added to M2•These are difficult to use because M2 has multiple procedures and providers per CAPER.


04/19/2351


CAPER:•Using multiple provider / multiple procedure data is not easy the way CAPER is shaped.•How many RVUs were done for procedure X in the MHS?

CAPERProcs RVUs

Proc 1 Proc 2 Proc 3 Proc 4 Proc 1 Proc 2 Proc 3 Proc 41 A A X B 1 1 0.5 1.52 X A C D 0.5 2 1.3 0.63 A X L M 3 1 0.6 0.24 S 0.3 5 X 0.5

CAPER Proc X RVUs1 0.52 0.53 14 05 0.5

Total 2.5

1. Create a query that returns all procedures and all procedure-specific RVUs.

2. Slice and dice looking at each procedure and whether or not it = “X” or not. If so, count the RVUs, if not ignore them.

3. Add results together to get total RVUs.


Clinical Area Encounters Avg PAR

RVU Avg ET

(5) %

Change BA: Medicine 1,230,266 2.41 2.46 -2%

BB: Surgery

460,862 3.73 3.82 -2%

BC: OB/GYN

497,413 2.56 2.84 -10%

BD: Pediatrics

604,342 2.26 2.08 8%

BE: Orthopedics

385,940 2.51 2.63 -5%

BF: Mental Health

717,736 1.92 2.60 -26%BG: Family Practice 1,791,372 1.74 1.71 1%BH: Primary Care 3,190,616 1.98 1.98 0%

BI: ER

398,481 2.63 2.56 2%

BJ

170,294 2.06 2.04 1%

BK 24,529 1.94 1.95 -1%

BL: PT/OT

656,657 2.30 2.38 -3%

Impact of RVU Changes this FY

6 % overall drop in RVUs


Tx Svc 2009 2010 2011 2012

Army 0.95 0.94 0.94 0.96

AF 0.91 0.92 0.91 0.93

Navy 0.99 0.98 0.95 0.98

Provider Aggregate RVU Case Mix


Navy MTFs with the Highest Provider Aggregate RVU Case Mix

Tmt Parent DMIS ID NameCase Mix

NH OKINAWA 1.14NH GUAM 1.10WALTER REED NMMC 1.09NMC SAN DIEGO 1.06NH GUANTANAMO BAY 1.06NH JACKSONVILLE 1.05NH YOKOSUKA 1.05NMC PORTSMOUTH 1.02NH BREMERTON 1.01


New MDR Changes


MDR Changes

• Clinical Data Repository (CDR) Data Retention Project Clinical Data Mart provided access to information from the Clinical

Data Repository through a Business Objects Interface. The CDM was shut down in the summer of 2011 due to issues with

funding and data quality. Importance of access to clinical data was not addressed initially by

committees that approved the shut down MDR Interim Solution:

DHCAPE team of MDR requirements developers were tasked to use data feeds that had gone to CDM from CDR, to create MDR data files with clinical information.

Project began in summer 2011 Documentation provided was either incomplete or non-existent. Most data files have been implemented.


MDR Changes Available from CDR Retention Project

Data File Comtemt

Patient Needed to correct CDR patient identification errors

Vitals Height, weight, BP, tobacco, pulse ox, etc.

Meds Inpatient and Outpatient

Historical Procs

Self Reported Historical Procedures

Medications Inpatient and Outpatient Medications

Chemistry Lab Chemistry Orders and Results

Immunizations

Immunization history from AHLTA

For AHLTA coded appointments, linkable to appointment CAPER


MDR Changes Available from CDR Retention Project

• Still in development: Radiology (with Results) Microbiology Pathology Other Past Medical History


MDR Changes

• Defense Medical Human Resources System A new person level file has been made available with staffing

information. Will be helpful for understanding staff reporting of labor hours. Is getting considerable attention for tracking timesheet MEPRS

code reporting vs. workload MEPRS code reporting.• Re-introduction of Ill, Injured and Wounded File

Can be used to track returning service members with various war-related conditions.

• Primary Care Medical Home Cohort File Combines DEERS and CHCS data to arrive at a Primary Care

Medical Home Cohort. Can be used matched against any other file in the MDR to

determine care provided to PCMH enrollees.


Next M2 Update


Next M2 Update

• Primary Care Medical Home Requirement Requirement is to flag all detail records as to PCMH status (PCMH

Flag, MEPRS Code, MTF NCQA Accreditation Level) for indicated patient.

Based on CHCS data, matched with DEERS, to weed out DQ errors (from MDR file).

PCMH data file is already available in the MDR M2 will implement PCMH in phases. Enrollment flags will be made available in direct care data in late

June. Other files not yet scheduled. Enrollment report is in Infoview.

• The TMA Privacy Office recently reclassified the M2 Person ID as personally identifiable information (PII) When presented in conjunction with health data, the

Person ID now constitutes Protected Health Information (PHI)

Person ID is currently available in both the restricted and unrestricted versions of M2.

In the future, DEERS Person ID will become a restricted element.

Psuedo-versions of person IDs (includes PCM ID and Provider EDIPN) will be available and non-psuedo versions will be hidden for non-’restricted’ users.

Not in June, yet. Initial work is just beginning.


Next M2 Update

• Removal of SADR Detail• Users will only be able to use CAPERS in M2

• CAPER Original Extract Date• Tells when the site originally sent the CAPER• Useful for tracking compliance with reporting

standards.• Must download record level data to a tool outside of

M2 to use this element as date math doesn’t work in M2 (Original Extract Date – Encounter Date).

• Hopefully this will be fixed in the future.

• CAPER Provider Skill Types:• Tells whether the provider is a clinician, professional,

etc.


Next M2 Update


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Functional Changes in MDR and M2

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