Center for Medicare & Medicaid Innovation • Grant funds for projects provided for in ACA • Approved projects must – Lower cost – Improve quality • Why this remains challenging for providers 31
Center for Medicare & Medicaid Innovation: Themes • Doing less – Better Back Care – SMARTCare • Coordinating care/reducing visits – e-Consults and e-Referrals • Why should we expect the hospital to fix everything? – Medical respite care for homeless 32
Patient-Centered Outcomes Research Institute • Funds Clinical Effectiveness Research • Findings may not be construed as mandates, guidelines, or recommendations for payment, coverage, or used to deny coverage. “Our projects will emphasize approaches that use electronic health records (EHRs) to identify those at high risk of poor outcomes and system-based outreach programs to deliver high-quality, patient-centered care to those most in need.” -- Dr. Ethan Halm 33
Comparative Effectiveness of FIT, Colonoscopy, and Usual Care Screening Strategies Aim: Optimize colon cancer screening through personalized regimens in an integrated safety- net clinical provider network serving a large and diverse population of under- and uninsured patients in Dallas “The best test is the test that gets done” - CDC 34
Transforming Care at Parkland • Customizing care to improve outcomes and efficiency • Question the status quo – Outpatient Antibiotic Treatment ( Video) – Parkland Center for Clinical Innovation • Readmission work – Community Connections – Sharing savings with community partners • Predicting sepsis among hospitalized /ED patients 35
OPAT: Data Analysis 2009 - 2013 OPAT: 987 patients Home Health: 264 patients Inpatient: 404 patients Primary diagnosis : no difference between all 3 groups with p=.728 Note: OPAT stands for Outpatient Parenteral Antimicrobial Therapy 36
OPAT: Clinical Outcomes Outcome OPAT Home Health P-value 30 day all cause 17% 28% <.01 readmissions: 2011 60 day all cause 24% 37% <.01 readmissions: 2012 180 day all cause 37% 52% <.01 readmissions: 2013 Deceased: Overall 4% 11% .002 37
OPAT: Summary • Decreased length of stay (LOS) • Reduces risk of hospital acquired infections with shortened LOS and transition to home setting • Safe and Effective • Gives patients a choice • Implications for other resource limited settings to think ‘outside the box’ of the hospital to deliver care and improve resource utilization 38
Transforming Care at Parkland • Customizing care to improve outcomes and efficiency • Question the status quo – Outpatient Antibiotic Treatment OPAT Video – Parkland Center for Clinical Innovation • Readmission work – Community Connections – Sharing savings with community partners • Predicting sepsis among hospitalized /ED patients 39
Summary • Health care is expensive and unaffordable for the entire U.S. population given current practices • Pressure to provide ongoing access while reducing costs • Systems must create scale and influence across the continuum of care • Systems must be able to measure results and report in clear, simple terms 40
Questions? 41
Texas Healthcare Transformation and Quality Improvement Program Waiver Lisa Kirsch Medicaid / CHIP Deputy Director for Healthcare Texas Health & Human Services Commission
Texas Healthcare Transformation and Quality Improvement Program Waiver September 18, 2014 Lisa Kirsch, Chief Deputy Medicaid/CHIP Director
1115 Transformation Waiver Overview • Five Year Waiver 2011 – 2016 • Managed care expansion • Allows statewide Medicaid managed care services – STAR, STAR+PLUS, and children’s dental managed care • Supplemental financing component • Preserves historic upper payment limit (UPL) hospital funding under a new methodology • Uncompensated Care (UC) Pool ($17.6 billion) • Delivery System Reform Incentive Payment (DSRIP) Pool ($11.4 billion) • Creates Regional Healthcare Partnerships (RHPs) 44
20 RHPs 45
Waiver Goals Advance the Triple Aim: 1) Better care for individuals (including access, quality and health outcomes) 2) Better health for populations 3) Reduced per person costs of providing care Texas DSRIP focuses on both the Medicaid and Low Income Uninsured populations 46
DSRIP Progress to Date • Waiver approved - December 2011 • 20 Regional Healthcare Partnerships (RHPs) established - May 2012 • Technical assistance summit - August 2012 • Key protocols approved - August/September 2012 • RHP Plans submitted to HHSC - December 31, 2012 • 20 RHP Plans with over 1300 Category 1 & 2 projects submitted to CMS Spring 2013 • Initial approval of most 4-year projects - May 2013 47
DSRIP Progress to Date • DSRIP reporting opportunities - August and October 2013, April 2014 • Over 220 3-year projects received initial CMS approval - May 2014 • Revised Category 3 outcomes framework negotiated between CMS and HHSC – February 2014 • Category 3 outcomes finalized for each Category 1 or 2 project – August 2014 • Regional learning collaborative events – 2013/2014 • Independent Assessor/Compliance Monitor contractor on board - June 2014 • Midpoint assessment review started – August 2014 48
DSRIP Status • There are 1,491 approved and active DSRIP projects. • 1,274 4-year projects • 217 3-year projects • Major project focuses: • Over 25% - behavioral healthcare • 20% - access to primary care • 18% - chronic care management and helping patients with complex needs navigate the healthcare system • 9% - access to specialty care • 8% - health promotion and disease prevention 49
DSRIP Status • Through July 2014, DSRIP participants have earned payments of about $2.58 billion all funds for submission of plans and metric achievement for demonstration years (DYs) 2 and 3. • The next opportunity to report on DSRIP achievement will be in October 2014 for payment in January 2015. • HHSC will be scheduling webinars for early October related to October reporting, including how to fill out the new Category 3 baseline template and updated Quantifiable Patient Impact (QPI) template 50
DSRIP Projects – Measuring Success • Texas is one of the first states to do DSRIP • Protocols allow providers to select metrics for each project and what is measured varies across projects • HHSC will be working with providers, stakeholders and evaluator to identify best practices • Along with the metrics reported, other data from providers also will inform the success of projects • The level of collaboration among healthcare providers and other systems continues to evolve 51
DSRIP Projects – Measuring Success • Learning collaboratives, including regional and statewide • HHSC’s formal evaluation of the waiver • An interim evaluation report is due to CMS in 2015 • DSRIP metrics reporting • Quantifiable Patient Impact (QPI) metrics DY3-5 • Category 3 – improvement in outcome measures related to each project in DY4-5 • Midpoint assessment beginning now to evaluate the progress of the projects so far, and to determine if they require any modifications or technical assistance to be successful 52
DSRIP Projects – Measuring Success Category 3 Outcomes • It was a challenge to develop an appropriate menu and achievement methodology given the variety of Texas DSRIP providers and Category 1 & 2 projects • Over 300 approved measures • Most measures have a measure steward (AHRQ, NCQA, CDC, NQF) and are validated • Some measures were created based on evidence-based guidelines and practices • In general, denominators will be on a population larger than the population served by the Category 1 or 2 project • The direct correlation between the outcome and Category 1 or 2 intervention will vary by project and size of denominator compared with number served by the project 53
Waiver Extension/Renewal • The Texas Transformation Waiver is a 5-year Medicaid demonstration waiver from 2011-2016. • The Transformation Waiver includes Texas' largest Medicaid managed care programs (STAR and STAR+PLUS, plus children’s dental managed care), the Uncompensated Care (UC) pool and the Delivery System Reform Incentive Payment (DSRIP) pool. • To continue these programs and pools, Texas must request a waiver renewal/extension. 54
Waiver Renewal • The waiver expires on September 30, 2016. • Per the Texas waiver terms: • HHSC must submit a transition plan to the Centers for Medicare & Medicaid Services (CMS) by March 31, 2015, based on the experience with the DSRIP pools, actual uncompensated care trends in the State, and investment in value based purchasing or other reform options. • HHSC must submit a renewal request to CMS no later than September 30, 2015, to request to extend/renew the waiver. • A waiver renewal request must: • Meet public notice requirements. • Include a demonstration summary, demonstration objectives, and provide evidence of how objectives were met. 55
Pool Transition Plan Due March 2015 • For the March transition plan submission, HHSC plans to convey the continued need for both UC and DSRIP funds in Texas. • Texas’ UC burden has not decreased, and the existing funding sources do not offset all UC costs for Medicaid and indigent patients. • Regarding DSRIP, more time is needed to evaluate project outcomes and lessons learned. • Texas’ almost 1500 projects received initial approval from mid -2013 through mid-2014. • Outcomes baseline data will be reporting later this year to measure outcomes improvements in years 4 & 5 of the waiver. • Early results indicate many promising projects, but more information is needed to identify best practices and how to sustain and replicate them. 56
Timeline to Develop Renewal Request • HHSC will work with Texas stakeholders to develop the waiver renewal request. • HHSC will use information from this summit, the Executive Waiver Committee, and a forthcoming stakeholder survey to get input about the future of the DSRIP program. • HHSC plans to begin to draft the renewal request this year prior to the 84 th Legislative Session. • Texas Legislative Session – January-May 2015 • HHSC will hold stakeholder meetings regarding the renewal request around the state during summer 2015. • Renewal request due to CMS September 30, 2015 • If Texas submits a 3-year renewal request with no changes to the waiver terms and conditions, CMS has six months to approve or deny. • If Texas requests a 5-year renewal, then both HHSC and CMS may request changes to the current waiver terms and conditions. 57
DSRIP Considerations DSRIP issues to consider for renewal • A strength of Texas' DSRIP program is its regional approach to delivery system reform, with different types of providers working together to improve care. • HHSC plans to work to further align its quality strategy for Medicaid managed care and DSRIP. • How to build on the RHP structure to further strengthen and support systems of care? • Given the time it took to get the DSRIP program off the ground and the deadline for submitting the renewal request, we need to work together to show how DSRIP is improving care for individuals, particularly for Medicaid and low-income uninsured patients, as well as population health. • Project-level data, preliminary outcomes information, learning collaboratives, midpoint assessment results, formal waiver evaluation 58
DSRIP Considerations A possible scenario for the DSRIP renewal ask: • Request to continue existing projects that are demonstrating success (but did not get approved and underway until mid- DY2 through mid-DY3). • Give these projects more time to demonstrate outcomes improvement • Allow time to identify best practices • Develop a strategic plan to further align DSRIP initiatives and Medicaid managed care. • For DSRIP funds not allocated to projects as of DY5: • Use for new, promising initiatives or to enhance successful projects? • Establish shared bonus pool for high-performing RHPs? 59
Themes to Consider Based on September Statewide Summit • DSRIP is a substantial federal investment – Texas needs to demonstrate the value of the investment • Need to continue to move to strengthen healthcare systems – a community of providers coordinating across the care continuum • Outcomes measurement is important – consider some funding for shared outcomes at the RHP and/or State level? • Sustainability going forward – how to take what’s being learned through DSRIP, sustain/replicate best practices, and embed these practices into everyday Medicaid business? • Texas is at the forefront of DSRIP renewal (CA is a year ahead of TX) – need to think what the next phase of DSRIP could look like to build on what we’ve learned so far 60
Next Steps • Types of questions that will be included in the DSRIP survey to be released soon: • After this initial waiver term ends, would you support continuing the projects that are active at that time to improve healthcare delivery in Texas? • Would you recommend any structural or administrative changes to the DSRIP program? • Would you recommend any financing changes to the DSRIP program? • Would you recommend any changes regarding how HHSC handles DSRIP requirements for large/urban providers vs. small/rural providers? • Would you support an incentive bonus pool for RHPs with particularly strong achievement? If so, what measures would you recommend for demonstrating regional achievement? • Do you have suggestions on how to further align DSRIP with Medicaid managed care? 61
Waiver Communications • Find updated materials and outreach details: • http://www.hhsc.state.tx.us/1115-waiver.shtml • Submit questions to: • TXHealthcareTransformation@hhsc.state.tx.us 62
Break: 15 Minutes Let's Work Together
Population Health through Regional Collaboration Kristin Jenkins, JD President, Dallas-Fort Worth Hospital Council Foundation
Population Health Improvement through Regional Information Sharing and Collaboration RHP 9 Learning Collaborative September 18, 2014
Lessons in Collaboration www.dfwhcfoundation.org
Mission To serve as a catalyst for continual improvement in community health and healthcare delivery through education, research, communication, collaboration and coordination. Vision Act as a trusted community resource to expand knowledge and develop new insight for the continuous improvement of health and healthcare . www.dfwhcfoundation.org 67
General Collaboration Information Non-profit foundation affiliated with Dallas-Fort Non-profit foundation affiliated with Dallas-Fort Worth Hospital Council Information & Quality Services Center in existence for 14 years Service contracts in place with Business Associate Agreements 80+ facilities participate Data submitted to the Texas Healthcare Information Collaborative Information used by all participants and shared with the community www.dfwhcfoundation.org
Contributing Facilities and Patients www.dfwhcfoundation.org
How much data is captured in the DFWHC Data Warehouse? www.dfwhcfoundation.org 70
Foundation Structure Information and Quality Community Health Services Collaborative Collaborative North Texas Board of Regional Texas Quality Trustees Extension Initiative Center Workforce Development Research Collaborative Center www.dfwhcfoundation.org 71
Foundation Committee Structure DFWHC Foundation Board of Trustees North Texas Regional Extension Texas Quality Initiative Advisory Center Advisory Board Board North Texas Health Community Workforce Research Information and Health Advisory Collaborative Quality Collaborative Collaborative Committee www.dfwhcfoundation.org
Committee Sub-Structure for Data Management/Use North Texas Information and Quality Services Product Patient Safety IS Technical Research Nominating Development/Data and Quality Advisory Committee Committee Committee Committee Users Group www.dfwhcfoundation.org
www.dfwhcfoundation.org Page 74
General Description of Information Submitted • Claims from all participating hospitals • “Blinding” of patient identifiers • No blinding of any other data elements • All payers - including self-pay patients • All patient encounters except – outpatient lab – hospital-based outpatient clinic www.dfwhcfoundation.org
Inpatient Claims Information • North Texas Data from 2003 to Present • Texas State Data 2004 to Present • Case level detail • Diagnosis codes 1-25 • Procedure codes 1-25 • All Charge Data (Total Charge only in Texas State Data) • Physician ID and Name (Not included in Texas State Data) www.dfwhcfoundation.org
Outpatient Claims Information • North Texas Data from 2006 to Present – 44 volunteer hospitals 2006 -2009 – All Facilities beginning Q4 2009 • Case level detail • Diagnosis codes 1-25 • Procedure codes 1-25 • All Charge Data www.dfwhcfoundation.org
Physician ID and Name ER Encounters with NYU Algorithm Outpatient Claims Observation, GI and Cardiology Information Encounters Unique to DFWHC Foundation www.dfwhcfoundation.org
Regional Enterprise Master Patient Index (REMPI) • Probabilistic electronic tool that matches patient encounters across hospitals and systems when applied to the Information and Quality Services Center Data Set • Identification and analysis of patient activity regardless of encounter location or payer • Readmissions • ER utilization • Imaging utilization www.dfwhcfoundation.org
• Regional STS Certified Clinical Data Registry • > 90% of North Texas CABG and AVR Encounters • REMPI Matching to Claims Texas Warehouse Information Quality Initiative www.dfwhcfoundation.org
Lessons in Collaboration www.dfwhcfoundation.org
Business Intelligence Quality Metrics – Hospital Engagement Network and AHRQ Measures Improvement of Cardiovascular Services Readmission Analyses ER “Frequent Flyer” Reports Market segment assessments – by service line, physician and geography Community Health Needs Assessments and Regional Community Health Improvement Reporting ACO Alignment Information Regional Health Information Exchange Support Grants/Research Compliance and Duplicates www.dfwhcfoundation.org
• Run on THCIC State Data – About 1 year lag to most current quarter • Run on DFWHC Region Wide data – About 2.5 months lag to end of most current month www.dfwhcfoundation.org
Using the Information -Community and Population Health Management • Chronic Conditions • Emergency Room Utilization • Form 990 Analyses – Community Benefit • 1115 Waiver Metrics www.dfwhcfoundation.org
Lessons in Collaboration www.dfwhcfoundation.org
Emergency Room Use Examples Emergency Room Visits increasing in North Texas at a rate higher than population growth • Population Increases in Tarrant and Dallas Counties from 2010 through 2012: 3.9% and 3.6%, respectively* • Increase in ER visits in North Texas 2010 through 2012: 15.25% (see next slide) ER Use is an expensive proposition for the insured population and the tax payer Upcoming Policy Considerations: 1. Impact of the ACA on Health and Cost 2. Local solutions for local health needs 3. Competitive market for economic growth – healthy workforce and healthy community *Source: http://aspe.hhs.gov/health/reports/2014/MarketPlaceEnrollment/Feb2014/ib_2014feb_enrollment.pdf www.dfwhcfoundation.org
Evaluation of High ER Use by Patients Using the REMPI….. And the volume of ER Visits made by those patients www.dfwhcfoundation.org
Statistics of ER cases, Diabetes prevalence and Payer information for high ER visit Zip codes in Dallas and Tarrant counties Counties Dallas Tarrant High ER visits Zip 75216 75217 75243 76119 76112 codes Number of Patients 6954 7615 6423 5716 4711 ER cases 22500 23839 20688 19163 16622 %Diabetes Prevalence in 15% (3027) 14.1% (2943) 8.2% (1591) 11% (2108) 10.2% (1706) ER visitors (number of cases with Diabetes) Dialysis/end stage kidney 1.18% (266) 0.77%(184) 0.42%(87) 0.88%(169) 1.06% (117) complications Insured 2943 2959 2404 3014 2841 Medicaid 7590 8115 7981 7408 5829 Medicare 3143 2459 1691 1979 1903 Uninsured 8945 10049 8555 6605 5992 www.dfwhcfoundation.org
Demographic Information of the Patients in high ER visit Zip codes in Dallas and Tarrant Counties Counties Dallas Tarrant High ER visits Zip codes 75216 75217 75243 76119 76112 6,954 7,615 6,423 5,716 4,711 Number of Patients 22,500 23,839 20,688 19,163 16,622 ER cases 43 / 5 40 / 5 38 / 5 41 / 5 39 / 5 Average Age Adult vs. Pediatric 18,212 / 4,288 17,675 / 6,164 15,186 / 5,502 13,971 / 5,192 13,241 / 3,421 Cases 13,914 7,716 11,860 10,597 9,440 Black 5,351 9,566 4,782 3,919 3,195 Other White 3,220 6,520 3,564 4,399 3,928 Race 9 19 341 213 51 Asian or Pacific Islander American Indian / Eskimo / 6 18 142 35 8 Aleut 6,061 8,937 4,401 3,821 1,962 Hispanic or Latino Ethnicity 16,439 14,902 16,283 15,334 14,656 Not Hispanic or Latino 7,316 7,625 6,302 6,631 5,528 Emergent 5,391 5,960 5,140 4,394 3,644 Indeterminate 2,734 2,986 2,673 2,614 2,432 NYU Injury 2,810 3,017 3,114 2,246 2,085 Non-emergent 4,248 4,252 3,459 3,277 2,933 Other 53,091,917 59,211,405 49,671,622 45,301,906 41,567,840 Charges Total Charge Average Charge 2,360 2,484 2,401 2,364 2,501 www.dfwhcfoundation.org
ER Hot Blocks in zip code 75216 www.dfwhcfoundation.org
Demographic information for the Hot Blocks in zip code 75216 3000 Block 2700 Block 3500 Block 3300 Block 2900 Block Hot blocks E E E OVERTON SOUTHERN E KIEST Zip 75216 LEDBETTER LEDBETTER RD OAKS BLVD BLVD DR DR Patients 202 158 100 87 77 ER cases 525 407 303 243 233 Cases Average Age 39 / 7 38 / 5 40 / 7 39 / 3 30 / 4 Adult vs. Pediatric Cases 431 / 94 329 / 78 239 / 64 191 / 52 182 / 52 Black 332 283 199 147 157 Race Other 187 116 87 91 72 White 6 8 17 5 4 Not Hispanic 383 338 257 215 208 or Latino Ethnicity Hispanic or 142 69 46 28 25 Latino 162 128 105 77 77 Emergent 111 117 59 66 71 Indeterminate NYU Non-emergent 80 54 46 32 26 Injury 69 44 37 33 21 Other 103 64 56 35 38 Total Charge 1,061,538 784,330 844,011 567,963 407,853 Charges 2,022 1,927 2,786 2,337 1,750 Avg Charge www.dfwhcfoundation.org
Clinical information of the Patients with high ER visits in zip code 75216 Top Patient 1 2 75216 Review 18 17 ER cases BMC University - 15 TH Dallas - 13 HCA Med City Dallas - 2 BMC University - 1 TH Dallas - 1 PHS Parkland - 1 Hospitals Visited K Dal Reg Med Cen - 1 MHS Dallas MC - 1 Cervicalgia Acute bronchitis Bronchitis, not specified as Abdominal pain, epigastric acute or chronic Diabetes mellitus without Neck sprain and strain mention of complication, type II or unspec type Top 5 Primary Diagnosis codes Sprain and strain of Periapical abscess without unspecified site of sinus shoulder and upper arm Unspecified disorder of the Other acute postoperative teeth and supporting pain structures Total Charge 85,624 21,917 4,757 1,289 Average Charge 5 12 Emergent Indeterminate 3 3 NYU Non-emergent 3 1 4 0 Injury 3 1 Other Payer information Medicare Medicaid www.dfwhcfoundation.org
Demographic information for the Hot Blocks in zip code 75217 200 Block 100 Block S 300 Block N 200 Block S Hot blocks 9700 Block STONEPOR MARDEAUX JIM MILLER JIM MILLER Zip 75217 BRUTON RD T DR LN RD RD Patients 155 130 85 90 85 ER cases Cases 490 399 237 239 221 Average Age 37 / 6 34 / 7 32 / 4 34 / 7 38 / 5 Adult vs. Pediatric Cases 399 / 91 303 / 96 207 / 30 173 / 66 181 / 40 Black 316 243 111 142 136 Race Other 162 151 124 74 79 White 12 5 2 23 6 Not Hispanic 400 303 205 168 159 or Latino Ethnicity Hispanic or 90 96 32 71 62 Latino Emergent 143 144 73 82 84 Indeterminate 118 90 48 71 42 NYU Non-emergent 101 52 36 30 31 Injury 50 48 33 22 23 Other 78 65 47 34 41 1,120,587 892,353 579,708 667,821 578,728 Total Charge Charges Avg Charge 2,287 2,236 2,446 2,794 2,619 www.dfwhcfoundation.org
Clinical information of the Patients with high ER visits in zip code 75217 Top Patient 1 2 75217 Review 49 22 ER cases BMC University - 29 BMC University - 22 MHS Charlton MC - 16 Hospitals Visited Tenet Doctors Hosp - 2 Dal Reg Med Cen - 2 Headache Headache Migraine, unspecified without mention of intractable migraine Other acute pain without mention of status migrainosus Top 5 Primary Diagnosis Unspecified essential codes Acute pharyngitis hypertension Sprain and strain of Abdominal pain, unspecified site of back unspecified site Diabetes with unspecified Sprain and strain of complication, type I unspecified site of hand [juvenile type] 93,524 65,260 Total Charge 1,909 2,966 Average Charge 2 6 Emergent Indeterminate 4 5 40 2 NYU Non-emergent 2 5 Injury 1 4 Other Payer information Medicare Medicaid www.dfwhcfoundation.org
Demographic information for the Hot Blocks in zip code 75243 11600 9600 Block 9700 Block 9300 Block 9900 Block Hot blocks Block FOREST FOREST SKILLMAN ADLETA Zip 75243 AUDELIA LN LN ST BLVD RD Patients 484 349 284 292 228 ER cases Cases 1312 1088 762 743 659 Average Age 34 / 4 34 / 4 32 / 4 33 / 5 35 / 4 Adult vs. Pediatric 834 / 478 798 / 290 545 / 217 615 / 128 493 / 166 Cases Black 634 700 462 581 478 Other 382 230 184 123 91 255 155 116 39 87 Race White Asian or 25 3 0 0 2 Pacific Islander Not Hispanic 947 898 586 621 535 or Latino Ethnicity Hispanic or 365 190 176 122 124 Latino Emergent 390 399 252 215 191 Indeterminate 344 261 167 210 176 Non- NYU 193 170 126 114 97 emergent Injury 169 119 77 65 103 216 139 140 139 92 Other Total Charge 2,938,617 2,744,064 1,668,263 1,677,357 1,545,803 Charges Avg Charge 2,240 2,522 2,189 2,258 2,346 www.dfwhcfoundation.org
Clinical information of the Patients with high ER visits in zip code 75243 Top Patient 1 2 75243 Review 62 53 ER cases TH Dallas - 22 BRMC Plano - 8 HCA Med City Dallas - 22 HCA MC Plano - 8 Hospitals Visited BMC Garland - 12 PHS Parkland - 7 PHS Parkland - 5 TH Plano - 7 UTSW St. Paul - 1 TH Allen - 5 Abdominal pain, Urinary tract infection, site unspecified site not specified Chest pain, other Headache Top 5 Primary Diagnosis Chest pain, unspecified Acute bronchitis codes Abdominal pain, other Nausea with vomiting specified site Painful respiration Thoracic sprain and strain Total Charge 316,385 202,065 5,103 3,813 Average Charge 41 14 Emergent 10 17 Indeterminate NYU Non-emergent 3 8 4 10 Injury 4 4 Other Medicaid Uninsured Payer information www.dfwhcfoundation.org
ER Dashboards - Quality Data Following is a look at the top uninsured patients with a COPD diagnosis in the past year. www.dfwhcfoundation.org
New York University Algorithm (NYU) case counts and Total Charges of ER cases in North Texas in 2010-2012 ER Patients in North Texas 2010 2011 2012 Number of Patients* 1,240,553 1,326,211 1,402,052 ER cases** 2,009,755 2,204,780 2,316,305 Diabetes Prevalence in ER visitors (number of cases 151,556 (8.19%) 173,867 (7.63%) 187,901(7.46%) with Diabetes and Percent Prevalence) Dialysis/end stage kidney complications 24,296 28,693 33,279 Emergent *** 630,759 680,392 724,861 Indeterminate 418,193 464,627 485,108 Injury 436,816 469,059 473,246 Non-emergent 213,742 241,231 258,625 NYU Case Counts Mental Health 42,266 47,366 54,309 Alcohol 10,374 11,577 12,264 Substance Abuse 3,984 4,972 5,819 Unclassified 253,621 285,556 302,073 Charges Total Charge 5,403,037,974 6,293,336,132 6,911,427,074 *number of out patient emergency room patients during 2010-2012 ** number of ER visits made by these unique patients during 2010-2012 *** preventable and non-preventable as well as primary care treatable emergent visits www.dfwhcfoundation.org
NYU Algorithm – Non-Emergent Encounters • Emergent/Primary Care Treatable - Based on information in the record, treatment was required within 12 hours, but care could have been provided effectively and safely in a primary care setting. The complaint did not require continuous observation, and no procedures were performed or resources used that are not available in a primary care setting (e.g., CAT scan or certain lab tests) • Non-emergent - The patient's initial complaint, presenting symptoms, vital signs, medical history, and age indicated that immediate medical care was not required within 12 hours www.dfwhcfoundation.org
Single County OP ED Cases www.dfwhcfoundation.org
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