phdsc payer type work group 2005 phdsc annual business meeting washington d.c. may 24, 2005

PHDSC PHDSC Payer Type Work GroupPayer Type Work Group

2005 PHDSC Annual Business Meeting2005 PHDSC Annual Business Meeting

Washington D.C.Washington D.C.

May 24, 2005May 24, 2005

PHDSC Payer Type Work GroupPHDSC Payer Type Work Group

PHDSC Payer Type Work GroupPHDSC Payer Type Work GroupOrganized July 20, 2000Organized July 20, 2000

Co-Chairs:Co-Chairs:

Amy Bernstein, Sc.D.Amy Bernstein, Sc.D.Acting ChiefActing ChiefAnalytic Studies Branch/Office of Analysis and EpidemiologyAnalytic Studies Branch/Office of Analysis and EpidemiologyCenters for Disease Control and Prevention (CDC)Centers for Disease Control and Prevention (CDC)National Center for Health Statistics (NCHS)National Center for Health Statistics (NCHS)

Judy Parlato, M.B.A., B.S.N., R.N.Judy Parlato, M.B.A., B.S.N., R.N.Clinical AdvisorClinical AdvisorMassachusetts Division of Health Care Finance & PolicyMassachusetts Division of Health Care Finance & Policy


Payer Type WG Committee MembersPayer Type WG Committee MembersRoxanne Andrews, Ph.D.Roxanne Andrews, Ph.D.Center for Delivery, Organization and MarketsCenter for Delivery, Organization and MarketsAgency for Healthcare Research and QualityAgency for Healthcare Research and Quality

Starla Ledbetter, MHSA, RHIA, PMPStarla Ledbetter, MHSA, RHIA, PMPMIRCal Project Manager/OSHPD HIPAA CoordinatorMIRCal Project Manager/OSHPD HIPAA CoordinatorCalifornia Office of Statewide Planning &DevelopmentCalifornia Office of Statewide Planning &Development

Ginger CoxGinger CoxResearch Analyst IIResearch Analyst IICalifornia Office of Statewide Planning &DevelopmentCalifornia Office of Statewide Planning &Development

Denise Love, M.B.A.Denise Love, M.B.A.Executive DirectorExecutive DirectorNational Assoc of Health Data Organizations (NAHDO)National Assoc of Health Data Organizations (NAHDO)

Bob Davis Bob Davis Consultant Consultant National Center for Health Statistics (NCHS)National Center for Health Statistics (NCHS)

Claudia Steiner, M.D., M.P.H.Claudia Steiner, M.D., M.P.H.Senior Research PhysicianSenior Research PhysicianAgency for Healthcare Research and Quality (AHRQ)Agency for Healthcare Research and Quality (AHRQ)

Marjorie Greenberg, M.A.Marjorie Greenberg, M.A.Chief, Classifications and Public Health Data Standards Chief, Classifications and Public Health Data Standards Centers for Disease Control and Prevention (CDC)Centers for Disease Control and Prevention (CDC)National Center for Health Statistics (NCHS)National Center for Health Statistics (NCHS)

Charles WentzelCharles WentzelStatisticianStatistician

Pennsylvania Health Care Cost Containment CouncilPennsylvania Health Care Cost Containment Council

H. Joanna Jiang, Ph.D.H. Joanna Jiang, Ph.D.Center for Delivery, Organization and MarketsCenter for Delivery, Organization and Markets

Agency for Healthcare Research and QualityAgency for Healthcare Research and Quality

Michelle Williamson, B.S., B.S.N., R.N.Michelle Williamson, B.S., B.S.N., R.N.Health Informatics SpecialistHealth Informatics SpecialistCenters for Disease Control and Prevention (CDC)Centers for Disease Control and Prevention (CDC)National Center for Health Statistics (NCHS)National Center for Health Statistics (NCHS)

Hetty Khan, M.S., B.S.N., R.N.Hetty Khan, M.S., B.S.N., R.N.Health Informatics SpecialistHealth Informatics SpecialistCenters for Disease Control and Prevention (CDC)Centers for Disease Control and Prevention (CDC)National Center for Health Statistics (NCHS)National Center for Health Statistics (NCHS)


Goals of the Committee Goals of the Committee

To create a payer type standard for reporting payer data for To create a payer type standard for reporting payer data for health care services. health care services.

The payer standard will allow for consistent comparison of the The payer standard will allow for consistent comparison of the payment category from various data sets and across different payment category from various data sets and across different types of providers.types of providers.

The payer type standard will be flexible, expandable and allow The payer type standard will be flexible, expandable and allow for different levels of detail.for different levels of detail.

The payer standard will be one that all providers can use.The payer standard will be one that all providers can use.


Need for Payer TypologyNeed for Payer Typology There is currently no national standard for reporting and There is currently no national standard for reporting and

classifying source of payment data.classifying source of payment data.

Existing ASC X12N 837 categories in the subscriber section Existing ASC X12N 837 categories in the subscriber section are currently neither mutually exclusive nor comprehensive.are currently neither mutually exclusive nor comprehensive.

Ability to compare source of payment data across databases is Ability to compare source of payment data across databases is critical to policymakers and researchers examining effects of critical to policymakers and researchers examining effects of payment policy.payment policy.

PlanID is not expected to meet the Committee’s goals.PlanID is not expected to meet the Committee’s goals.


Accomplishments to DateAccomplishments to Date

Developed a flexible and expandable Payer Developed a flexible and expandable Payer Typology for reporting and analyzing payer data Typology for reporting and analyzing payer data called “Possible Source of Payment Typology”called “Possible Source of Payment Typology”

main category with sub-categories containing finer detail, main category with sub-categories containing finer detail, allowing sub-categories to be rolled up if necessary.allowing sub-categories to be rolled up if necessary.

Refinement of the PHDSC Payer TypologyRefinement of the PHDSC Payer Typology..


PHDSC Payer Typology PHDSC Payer Typology RefinementRefinement

Collaboration with The Agency for Healthcare Research Collaboration with The Agency for Healthcare Research and Quality (AHRQ), Hospital Cost and Utilization Project and Quality (AHRQ), Hospital Cost and Utilization Project (HCUP) (HCUP)

AHRQ/HCUP review of current state Payer reporting AHRQ/HCUP review of current state Payer reporting practices for 33 states using the PHDSC Payer Typology as practices for 33 states using the PHDSC Payer Typology as the framework. the framework.

Modifications from review made to the PHDSC Typology. Modifications from review made to the PHDSC Typology.

Further revisions from Bob Davis, Technical Consultant for Further revisions from Bob Davis, Technical Consultant for NAHDO & AHRQ.NAHDO & AHRQ.


Future DirectionsFuture Directions

Review additional feedback on the updated Typology.Review additional feedback on the updated Typology.

Develop list of possible organizations for maintenance of the Develop list of possible organizations for maintenance of the Typology.Typology.

Develop case to support Work Group’s Payer Typology as an Develop case to support Work Group’s Payer Typology as an external code source for X12 standards.external code source for X12 standards.

Respond to NPRM PlanID when released for comment:Respond to NPRM PlanID when released for comment:

incorporate PHDSC’s Typology into mechanics of PlanID system incorporate PHDSC’s Typology into mechanics of PlanID system

leveraging support from Consortium members in this effort.leveraging support from Consortium members in this effort.


Updated Payer TypologyUpdated Payer Typology

Updated Payer Typology is available on the Updated Payer Typology is available on the PHDSC website at:PHDSC website at:

http://phdatastandards.info/about/committees/payer.htmhttp://phdatastandards.info/about/committees/payer.htm

Additional comments on the Payer Typology can be Additional comments on the Payer Typology can be sent to: sent to: [email protected]@cdc.gov. .

phdsc payer type work group 2005 phdsc annual business meeting washington d.c. may 24, 2005

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