HEALTH CARE COST CONTAINMENT COUNCIL Application of APR-DRG Grouper Software [27 Pa.B. 1616] Under Act 89 of 1986, as amended by Act 34 of 1993, the Council is required to ''collect and disseminate data reflecting provider quality and provider service effectiveness . . . and to continuously study quality of care systems.'' (Sec. 5(d)(4))
The Council, through regulation, adopted the Pennsylvania Uniform Claim and Billing Form (currently PA-UB92) under Sec. 6(b) and (c). Included in the PA-UB92 is data element 21 (provider service effectiveness and provider quality) which is currently captured by mandating the use of the MediQualTM system to supply these quality indicators.
Our act also requires that, under most circumstances, the release of data, whether in report or ''raw data'' format, include these measures.
In carrying out its duties to ''continuously study quality of care systems,'' the Council has obtained from 3M their APR-DRGTM Grouper software, which offers an alternative measurement for provider quality and provider service effectiveness based upon the currently collected PA-UB92 administrative dataset.
The Council intends to apply the APR-DRG Grouper to all patient level in-hospital admissions data starting with January 1, 1996 discharges and to add the APR-DRG ''severity of illness'' indicator and ''risk of mortality'' indicator to its internal database for the purpose of evaluating the effectiveness of these measures.
In order to encourage additional evaluation, the Council intends to add these data elements to its publicly releasable datasets as additions to, and not in substitution for, the required MediQual data elements. This proposed addition requires no further data to be collected or supplied by the data source.
Under section 6(e) of the act, which outlines the process the Council must follow in adding data elements, the Council hereby gives notice that it proposes to add two additional fields to both its internal and its publicly releasable databases, using the 3M APR-DRGTM Grouper; a ''severity of illness'' indicator and a ''risk of mortality'' indicator (measured as values between 1--4) as supplemental data elements to be used to measure provider service effectiveness and provider quality for Pennsylvania Uniform Claims and Billing data element 21 (Section 6(c)(21)), beginning with January 1, 1996 in-hospital discharges and continuing through December 31, 1996 discharges.
The Council has obtained and attached a cost benefit analysis indicating that these additions will have no additional cost to data sources, and minimal additional cost to Council.
The Council proposes to include these additional data elements with its public release of its First Quarter 1996 database.
A cost benefit analysis was conducted by the Council to determine what additional costs to the data sources or to the Council would be associated with utilizing the 3M APR-DRGTM software and adding the APR-DRG severity of illness indicator and the risk of mortality indicator (as measures of provider service effectiveness and provider quality). The following represents the results of this analysis:
1. The Council has contracted with 3M to license the APR-DRG software application at no cost to the Council. The current license runs for 1 year and may be extended by the agreement of both parties;
2. The data sources are already required to collect these data elements which are submitted to the Council and are necessary for the 3M software (all standard PA-UB92 data elements). There is no additional cost to the data sources involved in this proposal;
3. The costs to the Council to install the 3M APR-DRGTM software, to run the data through this system, and to report these two data elements are minimal. According to the programming department, the Council would not incur any additional costs to collect these data. Once the initial software has been loaded, there would be no additional expenses to run the data through it. This task would become part of the normal processing cycle and day to day staff activity.
ERNEST J. SESSA,
Executive Director[Pa.B. Doc. No. 97-490. Filed for public inspection March 28, 1997, 9:00 a.m.]
