HEALTHCARE IN KENTUCKY:
A Report of the
Operations and Activities of
The Cabinet for Health and Family Services
Related to Health Data Collection for
Hospital Inpatient Discharge and
Outpatient Services
July 1, 2010 – June 30, 2011
Cabinet for Health and Family Services
Office of Health Policy
September 2011
Table of Contents
Executive Summary 3
Cabinet Secretary’s Advisory Committee (SAC) 3
Health Services Data Advisory Subcommittee (DAS) 3
Health Care Information Center 4
Facilities Submitting Data 5
Legislation 5
Administrative Regulations 5
Response to Requests for Summary Data and Reports 5
Public Use Data Sets 10
Executive Summary
KRS 216.2929 requires “The Cabinet shall at least annually, on or before October 1, submit a report on the operation and activities of the cabinet under KRS 216.2920 to 216.2929 during the preceding fiscal year, including a copy of each study or report required or authorized under KRS 216.2920 to 216.2929 and any recommendations relating thereto.” The Office of Health Policy (OHP) within the Cabinet for Health and Family Services (CHFS) has been charged with ensuring compliance with KRS 216.2920 to 216.2929. Therefore, this report is submitted in compliance with this requirement.
Cabinet Secretary’s Advisory Committee (SAC)
Pursuant to KRS 216.2923, the Secretary of the Cabinet for Health and Family Services shall appoint and convene a permanent cabinet advisory committee. The committee advises the secretary on the collection, analysis, and distribution of consumer-oriented information related to the health care system, the cost of treatment and procedures, outcomes and quality indicators, and policies and regulations to implement the electronic collection and transmission of patient information (e-health) and other cost-saving patient record systems. The committee met three times during the fiscal year 2011:
1. July 22, 2010 - agenda items: Status of data submissions for ambulatory facilities; discuss draft free-standing Ambulatory Facility Report; update on (Inpatient Outpatient Data Submission System) IPOP implemented in July, 2010; status of new data reporting manuals and update to data reporting regulation (900 KAR 7:030); discuss emergency department utilization report; and proposed changes to website.
2. December 14, 2010 - agenda items: Non-compliant facilities from July 1, 2009 through June 30, 2010; status of ambulatory facilities that have yet to begin submitting data; proposed changes to health information website using MONAHRQ software; update on IPOP implementation; discussion of designation of a primary CPT code; acquisition of claims data from other states; status of regulation 900 KAR 7:030 (data reporting by health care providers); and discuss use of data received from ambulatory facilities.
3. April 19, 2011 – agenda items: Update on data submissions to IPOP; update on moving submitted data from IPOP to InfoSuite; update on status of 900 KAR 7:030; discussion of implementation of Kentucky Brain and Spinal Cord Injury Central Registry; introduction of staff responsible for evaluation of an All Payor Claims Database (APCD); discussion regarding changes to data released as part of Public Use Data Sets; and preview of proposed new web pages created using MONAHRQ software.
Health Services Data Advisory Subcommittee (DAS)
KRS 216.2923 also specifies that the cabinet advisory committee shall utilize the Health Services Data Advisory Committee as a subcommittee to advise the cabinet on technical matters, including a review of administrative regulations, proper interpretation of the data, and the most cost-efficient manner in which it should be published and disseminated to the public, state and local leaders in health policy, to health facilities, and to health-care providers. The committee met three times during fiscal year 2011:
1. July 12, 2010 - agenda items: Status of data submissions for ambulatory facilities; discuss draft free-standing ambulatory facility report; update on IPOP implementation; status of 900 KAR 7:030 (data reporting regulation); and discuss emergency department utilization report.
2. November 30, 2010 – agenda items: Non-compliant facilities from July 1, 2009 through June 30, 2010; status of ambulatory facilities that are still not reporting; proposed changes to the Health Information website using MONAHRQ; update on IPOP implementation; discussion of designation of primary CPT; and status of 900 KAR 7:030.
3. March 22, 2011 – agenda items: Update from Governor’s Office of Electronic Health Information regarding implementation of Kentucky Health Information Exchange; discussion of new CPT/HCPCs codes for inclusion in next revision to data reporting manuals; update on data submissions to IPOP; discussion of implementation of Kentucky Brain and Spinal Cord Injury Central Registry; introduction of staff responsible for evaluation of an All Payor Claims Database (APCD); discussion regarding changes to data released as part of Public Use Data Sets; and preview of proposed new web pages created using MONAHRQ software.
Health Care Information Center
KRS 216.2923 requires the cabinet to publish and make available information on charges for health care services and the quality and outcomes of health care services. KRS 216.2929 also requires CHFS to make available on its website information on charges for health care services at least annually in understandable language with sufficient explanation to allow consumers to draw meaningful comparisons between every hospital and ambulatory facility, differentiated by payor if relevant, and for other provider groups as relevant data becomes available.
In response to these requirements, a website was developed by the Office of Health Policy (OHP) which may be accessed at http://chfs.ky.gov/ohp/healthdata/ . The Agency for Healthcare Research and Quality has developed new software called MONAHRQ that creates comprehensive web pages to display information related to Inpatient Quality Indicators, Prevention Quality Indicators, Patient Safety Indicators, and Pediatric Quality Indicators, as well as utilization by hospital(s) or county by Major Diagnostic Category (MDC), Medicare Severity Diagnosis Related Group (DRG), Condition, or by Procedure. This software displays the results in standardized user friendly web pages, and consumers may view results from any state utilizing MONAHRQ, and the results will be displayed in a visually similar manner. Kentucky is the fourth state to implement this MONAHRQ. Data is displayed for 2008, 2009, and 2010.
Facilities Submitting Data
Prior to 2008 only hospitals and their affiliated ambulatory surgery centers submitted data related to Inpatient Hospital Discharges and Ambulatory Surgeries. In 2008 hospitals began submitting Emergency Department data and other outpatient services records which contained specific CPT codes related to procedures such as MRI, CAT scans, mammograms, etc. At that time, OHP began contacting free-standing ambulatory surgery centers, ambulatory care centers, mobile health services providers, and specialized medical technology services providers to determine if they also performed the new specified procedures and were, therefore, required to submit administrative claims data. By June 30, 2011, 132 hospitals, and 50 free-standing ambulatory facilities were compliant with data reporting requirements. Periodically additional ambulatory facilities will be added as new licenses are granted to these type of facilities.
Legislation
No legislative changes have occurred during the past year.
Administrative Regulations
An amended 900 KAR 7:030, Data reporting by health care providers, was filed in September, 2010. The amendments to the regulation were required to incorporate by reference new data reporting manuals for hospitals and ambulatory facilities. Updated manuals were necessary as facilities began submitting data via a new data collection software product called IPOP. The Kentucky Hospital Association and the facilities submitting data participated with the Office of Health Policy in drafting language for the amendment and revised manuals.
An amended 900 KAR 7:030 was filed again in April, 2011. The amendments to the regulation were required to incorporate by reference new data reporting manuals for hospitals and ambulatory facilities in order to add newly created procedure codes. The draft language designed to include the new codes was reviewed by all facilities submitting data to the Office of Health Policy prior to being included in the data reporting manuals.
Response to Requests for Summary Data and Reports
The following list represents summaries and reports that have been disseminated by the Office of Health Policy between July 1, 2010 and June 30, 2011 using the Kentucky Inpatient Discharge data and the Outpatient Services data. Many were created in response to requests from researchers, policy makers, and the general public, while others were created at the request of other agencies within the Cabinet for Health and Family Services (the requesting party is listed in parentheses):
1. Colonoscopy by gender, primary payor group, and patient age group. 2009 (Department for Public Health, CHFS).
2. Inpatient Hospital Discharges for Colon Cancer and Rectal Cancer by gender, primary payor group, patient age group, and race. 2009 (Department for Public Health, CHFS)
3. Inpatient Hospital Discharges by Ohio Residents for Mental Health MS-DRGs, 2007 to 2009. Four reports - by year by Patient Age Group, by year by county, by year by facility, and by year by MS-DRG. (New Heights Group).
4. Emergency Department utilization by Rockcastle County Kentucky residents by primary payor, and for selected primary diagnosis codes, 2009. (Kentucky Primary Care Association).
5. Inpatient Hospital Discharges by Daviess, Hancock, McLean, and Ohio county residents for Asthma by race and ethnicity. 2009. (Department of Public Health, CHFS).
6. Emergency Department utilization by Bath, Menifee, and Montgomery County Kentucky residents and for all Kentucky residents by primary payor, and for selected primary diagnosis codes, 2009. (Kentucky Primary Care Association).
7. Inpatient Hospital Discharge records with specified ICD-9 Diagnosis Codes in Any Diagnosis Field. Inpatient Hospital Discharge records with specified ICD-9 Procedure codes in Any Procedure Code Field. 2009 (Department of Public Health, CHFS).
8. Inpatient Hospital Discharge Reports. 2009. (American Heart Association/American Stroke Association).
- All Cardiovascular Disease by patient area development district.
- All Cardiovascular Disease by Patient County.
- All Cardiovascular Disease by hospital.
- Heart Failure by patient area development district
- Heart Failure by Patient County.
- Heart Failure by hospital.
- Stroke and TIA by patient area development district.
- Stroke and TIA by Patient County.
- Stroke and TIA by hospital.
- ST Elevated MI by patient area development district.
- ST Elevated MI by Patient County.
- ST Elevated MI by hospital.
9. Inpatient Hospital Discharges with a procedure of circumcision by Payor. 2009 (Department of Medicaid Services).
10. Inpatient Hospital Discharges with primary diagnosis of diabetes by race, gender, ethnicity, and age group within Area Development District. 2008, 2009, 2010 (Office of Health Equity, Department of Public Health).
11. Emergency Department Utilization with primary diagnosis of diabetes by race, gender, ethnicity, and age group within Area Development District. 2008, 2009, 2010 (Coordinator, Office of Health Equity, Department of Public Health).
12. Inpatient and Emergency Department Utilization reports, 2010 (Epidemiologist, Lexington-Fayette County Health Department).
- Top 10 diagnoses for Inpatient hospital discharges, patient age 0 to 17, in Fayette County.
- Top 10 diagnoses for Inpatient hospital discharges, patient age 0 to 17, in Kentucky.
- Top 10 diagnoses for Emergency Department Utilization, patient age 0 to 17, in Fayette County.
- Top 10 diagnoses for Emergency Department Utilization, patient age 0 to 17, in Kentucky.
13. Primary Influenza and Pneumococcal Hospitalizations by Admit Source, July - December 2009 (Alicia Tindall, Department of Public Health).
14. Discharges from Jefferson County Hospitals to Skilled Nursing Facilities, 2009 (Christopher East Health Care)
a. Facility by MDC
b. Facility by Primary Payer
c. Facility by Discharge Status
15. Any COPD Diagnosis, Inpatient Cases and Rate per Population, 2005-2009 (Department for Public Health)
16. Dog bite related Emergency Department Encounters compared to all injury related Emergency Department Encounters, 2009 (Department of Public Health)
a. Cases and rates per population
b. Discharge Status
c. Patient Age
17. Primary Asthma, Kentucky Residents, Age Groups by year, 2000 - 2009 (Department of Public Health)
18. Primary COPD, Kentucky Residents, Age Groups by year, 2000 - 2009 (Department of Public Health)
19. Primary Asthma, Kentucky Residents, Age Groups by Patient ADD by year, 2000 - 2009 (Department of Public Health)
20. Primary COPD, Kentucky Residents, Age Groups by Patient ADD by year, 2000 - 2009 (Department of Public Health)
21. Any Asthma, Kentucky Residents, Age Groups by Patient ADD by year, 2000 - 2009 (Department of Public Health)
22. Any COPD, Kentucky Residents, Age Groups by Patient ADD by year, 2000 - 2009 (Department of Public Health)
23. Hepatitis A, B, C and Other Inpatient by year, Cases and Total Charges, January 2007 - September 2009 (Department of Public Health)
24. Any Hepatitis C Inpatient by year and facility, Cases and Total Charges, KY Residents, January 2007 - September 2009 (Department of Public Health)
25. Any Hepatitis A, B, C and Other ED Encounter by year, Cases and Total Charges, Kentucky Residents, January 2008 - September 2009 (Department of Public Health)
26. Any Hepatitis C Inpatient by year and facility, Cases and Total Charges, KY Residents, January 2008 - July 2010 (Department of Public Health)
27. Any Hepatitis C ED Encounter by year and facility, Cases and Total Charges, KY Residents, January 2008 - July 2010 (Department of Public Health)
28. Any Hepatitis C Inpatient: Cases, Total Charges, Patient Days, Average Charges, Average LOS by Discharge Quarter and Facility ADD, KY Residents, July 2009 - June 2010 (Department of Public Health)
29. Any Hepatitis C Emergency Department Encounters, Total Charges, Average Charges by Discharge Quarter and Facility ADD, KY Residents, July 2009 - June 2010 (Department of Public Health)
30. All Kentucky Emergency Department Encounters by Age Groups, 2008 - 2009 (Department of Public Health)
31. All Inpatient Discharges by Age Groups, 2008 - 2009 (Department of Public Health)
32. Primary Asthma, Kentucky Residents, 2000 - 2009, Ages 0 - 24 (Department of Public Health)
a. Age Groups by Year
b. Patient Sex by Year
c. Patient County by Year
d. Patient ADD by Year
e. Patient Race by Year
33. Primary Asthma, Kentucky Residents, 2000 - 2009 (Department of Public Health)
34. Discharge Year by Age Groups by Gender by Patient ADD (Department of Public Health)
35. Discharge Year by Age Groups (different age groups) by Gender by Patient ADD (Department of Public Health)
36. Discharge Year by Gender by Patient County (Department of Public Health)
37. Discharge Year by Gender, Ages 0 - 17 (Department of Public Health)
38. Discharge Year by Gender, Ages 18+ (Department of Public Health)