# Presentation: 495962

## The Challenges of Collecting Hospital Encounter Data

**James A. Tomkins, MBA, MS**
**Manager of Data Collection**
**jtomkins@phc4.org**

- Pennsylvania Health Care Cost Containment Council (PHC4)

## What Does PHC4 Collect?

**Administrative Data**
**Using Modified UB92 Data Set****	****	****	****	**
**Clinical Data**
**Using CIC/MQ Atlas Software****	****	****	****	**
**Financial Data**
**From Audited Financial Reports**

- Pennsylvania Health Care Cost Containment Council (PHC4)

## What Were Our Goals To Improve The Data?

**Improve Compliance**
**More Timely Data**
**More Accurate Data**
**The Three C’s**
**Current**
**Correct**
**Complete**

- Pennsylvania Health Care Cost Containment Council (PHC4)

## How Did We Reach Those Goals?

**ACT-89 Contains Penalties****	****	****	****	****	****	****	****	**
**Both Criminal and Financial ****	****	****	****	****	**
**We Chose a Carrot****	****	****   Approach**

- Pennsylvania Health Care Cost Containment Council (PHC4)

## Published Compliance Reports
Created Incentives
Market Share Reports
Certificates of Excellence
Increased Communication 
Developed Relationships

- Created Incentives
- Market Share Reports
- Certificates of Excellence
- Increased Communication
- Developed Relationships

**What Did We Do Differently?**

- Pennsylvania Health Care Cost Containment Council (PHC4)

## How Did The Hospitals Respond?

**Second Quarter 1999**

**Third Quarter 1997**

- Pennsylvania Health Care Cost Containment Council (PHC4)

## How Did We Respond? 

**Mainframe to Client Server Environment**
**Flexible Processing**
**Internal Process Control **
**Continuous Improvement**

- Pennsylvania Health Care Cost Containment Council (PHC4)

## What Did We Do Next? 

**Published 1997 HPR Report in July 1999****	****	****	****	**
**Outcome Based Report on 15 Treatment Categories**

- Pennsylvania Health Care Cost Containment Council (PHC4)

## What Did We Follow Up With?

**Published 1998 HPR Report in December 1999****	****	****	****	**
**Used the Same 15 Treatment Categories and Methodology as Previous Report**

- Pennsylvania Health Care Cost Containment Council (PHC4)

## A Look At The Inside...

- Pennsylvania Health Care Cost Containment Council (PHC4)

## A Demonstration Project

**Our First Managed Care Report****	****	**
**We Surveyed 19 MCOs (Both Gov’t and Non Gov’t Contracts)****	****	****	**
**We Asked Plans to Provide Two HEDIS Measures as well as Our Own Measures**

- Pennsylvania Health Care Cost Containment Council (PHC4)

## Our Next Managed Care Project?

- Comprehensive Manage Care Performance Report
- Outcome Data Similar to the HPR
- “Process Information” Similar to DR

- Pennsylvania Health Care Cost Containment Council (PHC4)

## How will We Identify the Payer/Plan?

**Surveyed All Facilities****	****	****	****	****	**
**Met with Payer Advisory Group****	****	****	**
**Standardized the Payer Coding Method****	****	****	**
**Developed Edits/Validations **

- Pennsylvania Health Care Cost Containment Council (PHC4)

## How Will We Identify the Payer/Plan? (continued)

**Allows Us to Identify a Specific Payer**
**Line of Business (HMO, POS, PPO, etc.)**
**Contract Type (Commercial, Medicare & Medicaid)****	****	**
**Began Notifying Facilities in May 1999****	****	**** **
**Mailed Packets in October 1999****	****	****	**
**Initiative Begins First Quarter 2000**

- Pennsylvania Health Care Cost Containment Council (PHC4)

## And Finally . . .

**Please visit our web site at ****www.phc4.org**** for copies of all reports as well as technical notes and comments**

- Pennsylvania Health Care Cost Containment Council (PHC4)