DataVision and CPMS Server Application Updates

May 2017 Quarterly Education Session

Conduent Healthcare

Midas Health Analytics Solutions

May 4, 2017 2

A Few Housekeeping Items

All lines are muted

Handouts were distributed to registered

participants via email

Handouts and a recording of this session

will be posted on the Midas Clients Only

Website by Friday May 5th at 2 PM Pacific

Questions will be moderated by the call

operator

Two Q & A sessions during today’s

Webinar

A FAQ document will be prepared and

posted on the Clients Only Website within

one week of this presentation

3May 4, 2017

Vicky Mahn-DiNicola RN, MS, CPHQ

Vice President Clinical Analytics

Carla McCorkle LPN, CPHQ

Product Manager, Midas Live and CPMS

JP Connelly

Analytics Operations Manager

Agenda

• DataVision Server Updates

• Midas Risk Adjustment Model

• New and Modified Measures

• Hospital Acquired Conditions

• AHRQ Measure Update

• Leapfrog Measures Update

• Value-based Purchasing Standard Report

• CPMS Server Updates

• Modifications for EBRT

• HBIPS Sampling Updates

• TJC Comprehensive Stroke Focus Study

• Hospital Inpatient Quality Measures

• Hospital Outpatient Quality Reporting Program

• Core Appropriateness of Care Indicators

• MassHealth Updates

May 4, 2017

• Q & A with Product Team

5May 4, 2017

Midas Risk Adjustment Models Version 2.0

May 4, 2017 6

Risk Model Data Currently in the Field

Risk Adjustment XRA Indicators

XRA Volume

XRA Case Mix Index

XRA Charges

XRA LOS

XRA Mortality

XRA Readmissions

XRA Complications

Version 1.1

was designed

as a temporary

crosswalk

model till we

had a year of

ICD-10 data

May 4, 2017 7

Midas Risk Adjustment Model Version 2.0

The New “Gold Standard” for ICD-10 Claims

May 4, 2017 8

Risk Model Folders Hold the “Gold Standard” Data

Version 1.0/2.0 Risk Model Data here

All new MRA (Midas Risk Adjustment) indicators have been created

Data for retained clinical clusters will have historical data summarized to

January 2015 or whatever date your server site parameter has been set to for

your weekend summary job in Midas

Encounters discharged prior to 10-1-2015 will use Version 1.0

Encounters discharged 10-1-2015 forward will use Version 2.0

Drill down to patient detail available in all new MRA indicators

Comparative data in DataVision Web Application for Version 2.0 available in

July, 2017

May 4, 2017 9

New MRA (Midas Risk Adjustment) Indicators

Version 1.0/2.0 Risk Model Data here

• All new MRA indicators have been created

• Data for retained or renamed clinical clusters will have:

historical data summarized back to January 2015 (you can run back more)

Encounters discharged prior to 10-1-2015 will use Version 1.0

• Encounters discharged 10-1-2015 forward will use Version 2.0

• Data for New clinical clusters will have data summarized back to 10-1-2015

• Drill down to patient detail available in all new MRA indicators

• Comparative data in DataVision Web App for Version 2.0 available July, 2017

May 4, 2017 10

Historical Data RetainedData must still be run back on your server prior to 10-1-2015 in order for the new MRA indicators to populate

Compiled using

Version 1.0

Gold Standard

for ICD-9 claims

Compiled using

Version 2.0 Gold

Standard for

ICD-10 claims

May 4, 2017 11

Retired XRA Medical ClustersXRA 111 Aspiration Pneumonitis

XRA 165 Immunizations and Screening

XRA 216 Other Screening for Suspected Conditions

XRA 240 Radiation and Chemotherapy

XRA 241 Rehabilitation and Device Factors Influencing Care

XRA 246 Screening and History of Mental Health Disorders

XRA 251 Signs and Symptoms of Malaise and Fatigue

Retired and New Medical Clinical Clusters

New MRA Medical ClusterMRA 273 Supervision and Care of High Risk Pregnancy

• All ICD-10 Diagnosis Codes Were

Assigned to a Medical Cluster

• Poisoning codes previously assigned as

unclassified have been repositioned into

• 237 Toxic Effects of Agents Other

than Medications

• 238 Poisoning or Adverse Effects

by Medications

All remaining MRA Clinical Clusters have

retained their same MRA numbers, although

some have been renamed for clarity

May 4, 2017 12

Retired Procedure Clusters All ICD-10 Procedure Codes Were Assigned to a Surgical Cluster

New MRA Surgical ClustersMRA 537 Plastic and Other Cosmetic Procedures

MRA 538 Musculoskeletal – Other Procedures, Head, Facial Bone

MRA 539 Musculoskeletal – Other Procedures Lower Bone

MRA 540 Musculoskeletal – Other Procedures Upper Bone

Retired XRA Surgical ClustersXRA 400 Abdominal Hysterectomy

XRA 408 Arthroscopy

XRA 411 Bone Marrow Transplant

XRA 420 Conversion of Cardiac Rhythm

XRA 423 Creation/Revision/Removal Arterioven Fistula or Vessel-Vessel Cannula

XRA 425 Debridement of Wound, Infection, or Burn

XRA 429 Diagnostic Ultrasound

XRA 430 Diagnostic and Therapeutic Radioisotopic Procedures

XRA 431 Dilatation and Curettage (D&C)

XRA 438 Extracorporeal Circulation Auxiliary to Open Heart Procedures

XRA 440 Gastrostomy Procedures

XRA 441 Genitourinary Incontinence Procedures

XRA 443 Heart and/or Lung Transplant

XRA 445 Hemorrhoid Procedures

XRA 450 Insertion Catheter/Spinal Stimulator & Injection into Spinal Canal

XRA 455 Laparoscopy

Retired XRA Surgical ClustersXRA 456 Ligation of Fallopian Tubes

XRA 463 Oophorectomy, Unilateral and Bilateral

XRA 464 Open Prostatectomy

XRA 467 Other Diagnostic Procedures on Female Organs

XRA 471 Other Excision of Cervix and Uterus

XRA 472 Other Extraocular Muscle and Orbit Therapeutic Procedures

XRA 477 Other Hernia Repair

XRA 479 Other Incision and Excision of Central Nervous System

XRA 480 Other Intraocular Therapeutic Procedures

XRA 489 Other O.R. Therapeutic Procedures on Bone

XRA 494 Other Operations on Fallopian Tubes

XRA 495 Other Operations on Ovary

XRA 496 Other Organ Transplant

XRA 497 Other Procedures to Assist Delivery

XRA 502 Other Therapeutic Procedures

XRA 507 Other Non-O.R. Gastrointestinal Therapeutic Procedures

XRA 508 Other Non-O.R. Lower GI Therapeutic Procedures

XRA 510 Other Non-O.R. Therapeutic Procedures on Skin and Breast

XRA 511 Other Non-O.R. Upper GI Therapeutic Procedures

XRA 515 Plastic Procedures on Nose

XRA 517 Procedures on the Urethra

XRA 518 Repair of Cystocele and Rectocele, Obliteration of Vaginal Vault

XRA 519 Repair of Obstetric Laceration

XRA 527 Tracheostomy, Temporal and Permanent

XRA 533 Tympanoplasty and Myringtomy

XRA 534 Upper Gastrointestinal Endoscopy, Biopsy

XRA 535 Vaginal Hysterectomy

XRA 536 Vascular Catheterization

May 4, 2017 13

• Clinical Clusters that were “retired” were retained in

main folder but end-dated to 10-1-2015

• Data will not accumulate for these measures after

10-1-2015

• New clusters will contain data for these populations

• Release notes have an appendix that will help you

see where these encounters can now be found

– E.g. Abdominal Hysterectomy used to be its own

clinical cluster. It has been retired and now both

Abdominal and Vaginal Hysterectomies will be

found in the new Hysterectomy MRA 478 cluster

Retired Clusters Using 1.0 Gold Standard End Dated

May 4, 2017 14

Archive Folders to House Version 1.0/1.1 Data

Old Version 1.0/1.1 Risk Model Data here

All XRA indicators have been retired

Data retained from January 1, 2013

Nightly summary job ends the weekend following receipt of your quarterly overlay

Drill down to patient detail no longer available from indicators

Patient detail reports can be accessed indefinitely from a distributed ReporTrack Report

Comparative data available in DataVision Web Application for discharges thru 12/31/17

May 4, 2017 15

• Risk Adjusted Facility Wide measures

using Version 1.0/1.1 moved to Archive

Folder in Facility Profile

• New measures using the new “gold

standard” of 1.0 for ICD-9 based claims

and 2.0 for ICD-10 based claims are in

facility profile folder

Retired Risk Adjustment

Measures in Facility Profile

May 4, 2017 16

• XRA indicators will stop processing starting on the day you transition to Version 2.0

• Midas will not process both 1.0/1.1 and 1.0/2.0 simultaneously on the server

• In this example, the transition date was set to February 1st. Sites transitioning mid May will have partial May data

and April readmissions will be incomplete for retired XRA indicators.

• Drill down to patient level data will not be available from profiles (designed to conserve disc space on your server)

however patient detail will be available using a distributed ReporTrack Template

• O/E Summary data will still be calculated in the DataVision Web Application through the end of CY 2017 discharges

Processing of Archived XRA indictors

May 4, 2017 17

• All 166 Version 1.0/1.1 individual complications

retired

• 64 new 2.0 complication clusters created,

representing over 300 ICD-10 diagnosis codes

“not present on admission”

• Applicable to 10-1-2015 discharges forward

Midas Risk Model Complications

May 4, 2017 18

• Headers in Standard Report Data Files

renamed to MRA Codes and Clusters

– Datavision Complications Toolpack

– DataVision Risk Model Toolpack

– DataVision Readmission Toolpack

– Data Export

• Discharges prior to 10-1-2015 will contain

MRA values

• Retired XRA clusters still accessible from

Standard Report Lookup for you to run

reports on these populations up to the

month of your conversion to Version 2.0

(data labels in worksheets will still display

MRA values)

DataVision Standard Reports

May 4, 2017 19

New Risk Model Values Focus StudyPreviously stored in Midas Encounter but not exposed to SmarTrack

• Populates for inpatient discharges only

• Populates with Version 1.0 data for

encounters discharged prior to 10-1-2015

• Populates with Version 2.0 data for

encounters discharged 10-1-2015 forward

• Exposes these encounter level variables to

SmarTrack for customized reporting and

worklist creation so your data can be more

actionable

May 4, 2017 20

Complications Tab in Risk Model Values

May 4, 2017 21

Quick Access to Risk

Model Value Focus from

Indicator Drill-down or

Patient Navigator

Step 1: Drill down

Step 2: Select encounter and go to

Focus Entry – Encounter Level

22May 4, 2017

Security for Risk Model Value Focus

• The Risk Model Values Focus Study has

securities similar to the Core Measure focus

studies.

• Clients can go into a user definition and add

“RISK MODEL VALUES” in the Focus

Restriction field, similar to the way Core focus

securities are managed

• Or go into a role and add it in the Focus

Restriction.

May 4, 2017 23

• Distributed ReporTrack Template available

for download in the Midas Clients Only

Website

• Allows you to “see” expected values for

discharges 10-1-2015 forward using both

Version 1.0 and 2.0.

• EXPECT CHANGES

– Version 1.0 was “trained” using 24M ICD-9

based encounters from 2011-2013

– Version 2.0 was “trained” using 8.4M ICD-

10 based encounters from October 2015

through September 2016

• Three different versions of this report will be

available for Midas Care Management

Versions 2011, 2012 and 2014

Comparing Version 1.1 and 2.0 Values

Account No.

Fac Code

Facility

Patient Name

Universal ID

MRN

DRG

DRG Desc

DRG Type

Principal DX

Principal DX Description

PROC1

PROC1_DATE

PROC1 Description

V 1.1 XRA Clinical Cluster Code

V 1.1 XRA Clinical Cluster Description

V 2.0 MRA Clinical Cluster Code

V 2.0 MRA Clinical Cluster Description

Start Dt

Start Tm

End Dt

End Tm

Observed LOS

V 1.1 XRA Expected LOS

V 2.0 MRA Expected LOS

V 1.1 XRA Expected Charges

V 2.0 MRA Expected Charges

V 1.1 XRA Risk of Readmission (Same Server)

V 1.1 XRA Adjusted Risk of Readmission (Any Facility)

V 2.0 MRA Risk of Readmission (Same Server)

V 2.0 MRA Adjusted Risk of Readmission (Any Facility)

V 1.1 XRA Days to Readmission

V 2.0 MRA Days to Readmission

V 1.1 XRA Individual Relative Weight

V 2.0 MRA Individual Relative Weight

V 1.1 XRA Risk of Mortality

V 2.0 MRA Risk of Mortality

Facility DC Disposition

May 4, 2017 24

c-statistic MAE

Clinical Cluster Mortality30-day

ReadmitsLOS Charges

Acute MI 0.93 0.68 (0.66) 1.47 10,617

Heart Failure 0.93 0.66 (0.61) 1.83 10,411

Pneumonia (Bacterial) 0.93 0.68 (0.64) 2.13 12,715

Pneumonia (Viral) 0.93 0.69 (0.64) 1.80 10,797

CABG 0.97 0.73 (0.64) 2.11 25,984

Total Knee Replacement 0.98 0.79 0.67 8,305

Septicemia 0.93 0.69 2.31 16,864

Overall Across All Clusters 0.91 .7056 2.12 15,972

Accuracy: Statistical Performance of Midas Risk Model Version 2.0

Some examples (values compared to CMS models shown in red)

May 4, 2017 25

Additional Technical Questions

Question Answer1. How far back will the new MRA indicators

summarize once the May overlay and the Version 2.0 software is received?

The standard run back will be to January 1, 2015. This date could be different however if

your facility has a set parameter to shorten this cycle. For example, some larger, multi-

facility clients shorten their weekend run-back cycle to July 2015. These sites should

contact Midas and discuss options so that we can assist them in running back their data

without an impact to their operations.

2. What if I want to run back my data farther

than 1/1/2015? Will this impact my memory or system performance?

You can process your MRA measures to run back farther in the Core Processing Standard

Report (there is an option to include the Midas Risk Model Measures). i.e. to re-summarize

back to 1/1/2014 you should expect this to take about 30% longer to process 12 additional

months.

3. What is the impact on my memory or disc

space with the additional Midas Risk Value Focus Study for every inpatient encounter?

Negligible in terms of memory. We have estimated that the Focus studies will require

approximately 4 MB /1000 inpatients.

4. What if I accept the Version 2.0 overlay in

May and then I change my mind? Can my

data and software get restored back to its previous state?

Similar to other risk adjustment methodologies that are updated annually, performance data

can change. This is why we have designed the transition so that your old data will be

archived and you will continue to accrue results in the DataVision Web App for both the old

XRA 1.0/1.1 version, as well as the new MRA 1.0/2.0 versions through the end of CY

2017. We would recommend that your site does a live to test copy and install Version 2.0

in that area to evaluate your results if you have compelling business requirements that

depends on patient level data using Version 1.1 results past April of 2017.

May 4, 2017 26

• Please create a support ticket requesting

prior to May 10th to delay deployment of

Version 2.0 if you do NOT want to transition

to the new gold standard of Midas Risk

Adjustment in May

• Deferring the month for your transition will

allow your XRA indicators to continue to

populate past May if this is a business

requirement for your organization

• For most clients, this will NOT be a problem

because you will continue to receive your

observed and expected values and

percentiles of performance using version

1.1 in the DataVision Web App for

discharges through the end of CY 2017

Site Parameter Allows You to Delay

Deployment of Version 2.0 Beyond May

27May 4, 2017

Questions About Updates to Midas Risk

Models Before We Move On?

28May 4, 2017

Additional Measure Updates in DataVision

May 4, 2017 29

AHRQ PSI 09 Perioperative Hemorrhage or Hematoma

• CDBR: 1907 PSI 09 Perioperative Hemorrhage or Hematoma – Per 1000 ACA

• CDBR: 1908 PSI 09 Perioperative Hemorrhage or Hematoma – Per 1000 Inpatients

• CDBR: 1909 PSI 09 Perioperative Hemorrhage or Hematoma – Per 1000 Medicare ACA

• CDBR: 1910 PSI 09 Perioperative Hemorrhage or Hematoma – Per 1000 Medicare Inpatients

One of the exclusion criteria for the denominator of PSI 09 is to remove

cases with operating room procedures for treatment of hemorrhage or

hematoma under two conditions:

1. When the ONLY operating room procedure is for treatment of perioperative

hemorrhage or hematoma

2. When the operating room procedure for treatment of perioperative

hemorrhage or hematoma occurs BEFORE other operating room

procedures for other than hemorrhage or hematoma

An error was causing cases with an operating room procedure for

treatment of hemorrhage or hematoma as the last procedure in the record

to be incorrectly excluded from the denominator. This issue has been

corrected and these cases have been restored to the denominator

Note PSI 09 is included in the PSI-90 Composite Measure, so this could

potentially impact that score.

May 4, 2017 30

New Acute Care

Musculoskeletal Mortality

Rate Measures

• CDBR:2154 Acetabular Fracture – Mortality Rate

• CDBR: 2155 Pelvic Fracture – Mortality Rate

• Note: The 30-day readmission measures in these

two profiles were corrected. An issue in Care

Management Version 8.1r6 and 2011 were not

counting readmissions to other facilities on the same

server. These measures have been corrected. This

issue did not impact any other readmission

measures in DataVision.

May 4, 2017 31

Correction to CHF Comorbidity Measure

• CDBR:087 CHF Comorbidity – Per 1000 Acute Care

Admits was changed to correct an issue introduced

in the February overlay

• The issue caused undercounting of encounters with

a secondary diagnosis of heart failure

• This issue did not impact any other comorbidity

measures in DataVision

May 4, 2017 32

Emergency Department Indicators Corrected

for Negative Values

• CDBR: 131 Emergency Department - % LOS Between 6 and 24 hours

• CDBR:132 Emergency Department - % Discharged to Outside Acute Care

• CDBR:1831 Emergency Department – ALOS (hours)

• CDBR: 2144 Emergency Department – Mortality Rate

• CDBR:2145 Emergency Department – Left Against Medical Advice

Data was not correctly excluding encounters with negative length

of stay values in the numerator or denominator.

Rare data integrity issue that impacted a small number of hospitals

Data will be automatically re-summarized back to January 2015 on

the weekend following the receipt of your quarterly May overlay or

within the time frame set by your organization’s site parameter for

the weekend summary job

May 4, 2017 33

Behavioral Health Readmission Measures Corrected

• CDBR: 139 Behavioral Health, Acute Care – Percent Readmit within 14 Days

• CDBR:704 Behavioral Health – Percent Readmit within 7 Days

• CDBR:738 Depression, Recurrent, Principal Diagnosis – Percent Readmit within 30 Days

• CDBR:745 Substance Abuse, Dependent, Principal Diagnosis – Percent Readmit within 30 Days

• CDBR:752 Depression, Single Episode, Principal Diagnosis – Percent Readmit within 30 Days

• CDBR:759 Depression, Secondary Diagnosis – Percent Readmit within 30 Days

• CDBR:766 Substance Abuse, Dependent, Secondary Diagnosis – Percent Readmit within 30 Days

• CDBR:773 Substance Abuse, Nondependent, Any Diagnosis – Percent Readmit within 30 Days

Inpatient delivery and newborn encounters were not being properly excluded from the numerator

Small impact on previously reported data

May 4, 2017 34

Hospital Acquired

Conditions Renamed

and Relocated in

Patient Safety Folder

in Navigator Tree

CDBR:1335 Total CMS Hospital Acquired

Conditions – Per 1000 Inpatients

CDBR:1337 Total CMS Hospital Acquired

Conditions – Per 1000 ACA

CDBR:1338 Total CMS Hospital Acquired

Conditions – Per 1000 Medicare ACA

CDBR:1336 Total CMS Hospital Acquired

Conditions – Per 1000 Medicare Inpatients

Definitions corrected to reflect these measures are “roll

up” measures that reflect the sum of the encounters in

the numerators for the measures above them. Measure

logic was unchanged.

New

Old

May 4, 2017 35

Leapfrog Measures for Version

7.0 Inpatient Surgery Added

• CDBR:2156 Carotid endarterectomy

• CDBR:2157 Mitral valve repair and replacement

• CDBR:2158 Open aortic aneurysm repair

• CDBR:2159 Lung resection

• CDBR:2160 Esophageal resection

• CDBR:2161 Pancreatic resection

• CDBR:2162 Rectal cancer surgery

• CDBR:2163 Hip replacement

• CDBR:2164 Knee replacement

• CDBR:2165 Bariatric surgery for weight loss

New

Archived

May 4, 2017 36

• FY 2018 baseline and

performance period data

updated from Hospital Compare

Value-based Purchasing Standard Reports Updated

37May 4, 2017

National Quality Improvement Projects

- Core Measure Updates

Focus modified• Abstract initial anatomic site as

usual

• New data element – EBRT to Different Anatomic Site During Encounter

‒ “Yes” creates a new tab

• May abstract up to 3 anatomic sites

• Optional Anatomic Site element allows for capturing of anatomic site for reporting purposes

Multiple anatomic sites for EBRT

Attribution

• At focus level, attribution tab updated to provide category assignment, provider, location, etc. at anatomic site level

• OP-33 indicator provides the total count of anatomic sites treated (denominator) and count of those receiving recommended fractionation scheme (numerator)

• The OFI indicator will count number of cases with an OFI, regardless of number of anatomic sites that did not have recommended fractionation scheme

Multiple anatomic sites for EBRT

IPFQR HBIPS Sampling

To better align with CMS’ sampling options for HBIPS, there are now

two sampling options for the HBIPS-CMS IPFQR discharge population

• Option 1 – use sampling table provided in the Inpatient Psychiatric Facility

Quality Reporting Manual

• Option 2 – Use TJC age-stratified sampling table

Currently all sampling is based on the IPFQR Manual tables. To

request age-stratified sampling, please submit a request via the Midas

Support Center.

TJC Comprehensive Stroke Focus Study

New data element – IV Thrombolytic Initiation

• Effective with July 1, 2017 discharges

Update to Arrival Date and Arrival Time elements

• Ensure abstractors are aware of change to capture arrival to Comprehensive

Stroke Center

Hospital Inpatient Quality Measures

Core Perinatal Care Focus

• New data element – History of Stillbirth

Core VTE

• VTE-5 retired as of 1/1/2017 discharges

• Leaves only VTE-6 and the Other VTE subpopulation

• Initial patient population has been modified so that only cases with Other

Diagnosis of VTE will qualify

Hospital Outpatient Quality Measures

EBRT Focus Study Changes

• For clarity, EBRT to Soft Tissue Site Only has been renamed to EBRT Used for Anything Other than Bone Mets

• Retired fields

‒ Treated with Radiosurgery or SBRT

‒ Radicular Pain

‒ Specified Patient Reason

• New Fields

‒ Cauda Equina Compression Related to Bone Mets/Treated w/EBRT

‒ Spinal Cord Compression Related to Bone Mets/Treated w/EBRT

‒ Radicular Pain Related to Bone Mets/Treated w/EBRT

Hospital Outpatient Web-Reported Measures

Modified to accrue by OP Encounter Arrival Date effective with 1/1/2017

• OP Arrival Date is required for HOP Core Measure logic

• Missing data in this field will prevent cases from being assigned to the

numerator or denominator

• Retroactive to1/1/2017 – previously abstracted cases will need to be updated

• Impacts all web-reported measures

Core Appropriateness of Care Indicators

Summary of retired indicators

New indicators

• Comprehensive Stroke

• Core Substance Use

• Core Tobacco Treatment

Core Topics VBP ORYX

Acute MI FFY 2013 – FFY 2016 Accountability Measures

PN

SCIP

Composite

MassHealth Updates

February 27, 2017 email communication from MassHealth announced

retirement of MAT-3 Elective Delivery effective with 1/1/2017 discharges

Midas has end-dated accrual of MAT-3 population effective with

12/31/2016 discharges

Population will not be checked for data quality or missing data beginning

with Q1 2017 harvest

47May 4, 2017

Time for Additional Questions

May 4, 2017 48

Closing Remarks

Handouts and a link to a recording of this

session will be emailed to all registered

participants and posted on the Midas Clients

Only Website by Friday May 5th at 2 PM Pacific

A FAQ document will be prepared and posted

on the Clients Only Website within one week of

this presentation

Additional Questions may be submitted to the

Midas Clients Only Website Support Desk

Please complete the evaluation survey link that

will be sent to you via email so that we may

have your feedback to improve future

Webinars

THANK YOU for your participation today!

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