Source of Payment Typology: A New National Standard Roxanne Andrews, PhD

1. Source of Payment Typology: A New National Standard Roxanne Andrews, PhD Chair, Source of Payment TypologySubcommittee

2. Agenda • Overview of Typology Subcommittee • Overview of Typology • Implementation of Typology • Activities over the Coming Year

3. THE SUBCOMMITTEE

4. Source of Payment Tpology Subcommittee • Subcommittee of the Data Standards Committee • Purpose: to create and refine a standard to allow consistent reporting of payer data to public health agencies for health care services and research • The Payer Typology is an early project for the Consortium (starting in 2000) with continual successes over the years

5. Typology Subcommittee Patricia Andrews Louisiana State University Health Sciences Center Louisiana Tumor Registry Amy Bernstein* CDC/NCHS Robert Bolden Georgia Hospital Association Robert Davis Consultant Sheila Frank Consultant Regina Gibson Blue Cross Blue Shield Michigan Marjorie Greenberg CDC/NCHS Tammara Jean Paul CDC/NCHS Hetty Khan CDC/NCHS Starla Ledbetter California Office of Statewide Health Planning and Development Denise Love National Association of Health Data Organizations (NAHDO) Anna Orlova Johns Hopkins School of Public Health

6. Typology Sub-Committee Charlotte Pease Maine Health Data Organization Barbara A. Rudolph University of Wisconsin - Madison Cristal Schoenfelder CA Office for Statewide Health Planning and Development Gale Scott Tampa General Hospital Castine Verrill CDC/NCCDPHP Michelle Williamson CDC/NCHS

7. SOP Typology Subcommittee Phases of Activities • Developed standard payer codes, definitions & user guide • Worked with national standards groups to have the SOP Typology accepted • ANSI X12 • NUBC • HL7 (& PHIN) • Implementation & Education/Outreach • Maintenance

8. SOURCE OF PAYMENT TYPOLOGY

9. Importance of Source of Payment Data • Source of payment data used for wide variety of public health and healthcare research • Critical need for policymakers and researchers examining effects of payment policy to compare across databases • Standardized source of payment data needed to monitor healthcare trends such as access to healthcare and treatment patterns across payer categories

10. Payer Coding for National Quality Monitoring Risk-adjusted Inpatient Heart Attack Mortality

11. Payer Coding for Tracking National Hospital Costs

12. Issues with Payer in Administrative Data Collected Today • No uniformity across states • NO DEFINITIONS FOR CONCEPTS • Missing Concepts • For example: bad debt and charity care • Overlapping Concepts • For example: Health Maintenance Organization • Obscure Concepts • For example: Central Certification

13. Current Claim Filing IndicatorList Used in 837 Implementation Guides CH Champus CI Commercial Insurance Co. DS Disability HM Health Maintenance Organization LI Liability LM Liability Medical MA Medicare Part A MB Medicare Part B MC Medicaid OF Other Federal Program TV Title V VA Veteran Administration Plan WC Workers’ Compensation Health Claim ZZ Mutually Defined / Unknown 09 Self-pay 10 Central Certification 11 Other Non-Federal Programs 12 Preferred Provider Organization (PPO) 13 Point of Service (POS) 14 Exclusive Provider Organization (EPO) 15 Indemnity Insurance 16 Health Maintenance Organization (HMO) Medicare Risk AM Automobile Medical BL Blue Cross/Blue Shield

14. Solution:Source of Payment Typology • Designed to improve the organization of the payment categories • Provides robust definitions • Hierarchical structure • Definitions for ALL the concepts • Companion User Guide for each version of the Source of Payment Typology

15. Major Payer Categories

16. Source of Payment Typology Categories: Major and Sub-classifications

17. Second Level Sub-classification

18. Third Level Sub-classification

19. Additional Level Classification

20. Additional Level Classification 20

21. IMPLEMENTATION I: Hospital Discharge Data Systems

22. States Using the Source of Payment Typology • Georgia – 2007 • Oregon – 2008 • New York – 2009

23. IMPLEMENTATION II: Quality eMeasures

24. Supplemental Data Elements in eMeasures Include Payer • Supplemental data elements are included in quality emeasures • To aggregate data to various subgroups • To compare quality across subgroups to identify disparities

25. CMS and National Quality Forum Use Typology as the Value Set for "Payer" • CMS 2014 Meaningful Use Clinical Quality Measures (CQM) require 4 supplemental data: sex, race, ethnicity, payer • NQF Measure Authoring Tool for emeasures includes "payer" as default supplemental data • National Library of Medicine includes Typology in Value Set Authority Center for 2014 CQM • Raised the issue of "intellectual property" for PHDSC Board

26. ACTIVITIES OVER THE COMING YEAR

27. Maintenance Activities • Annual maintenance meeting in spring • opportunity for public comments and requests • Typology categories and / or definitions updated every October (as needed) • Periodic Subcommittee conference call discussions of impact of insurance system changes on needed payer categories (e.g. from ACA)

28. Education/Outreach • Webinars, conference presentations, emails to target audiences • e.g., Webinar Nov 19 • Identify & take advantage of opportunities that arise • e.g., this year- PHDSC letter comments on the proposed Federal rule on the health plan ID recommended the Typology be included in the CMS registry for the plan ID

29. Questions