Functional Changes in MDR
and M2
Wendy Funk, Kennell and Associates
wfunk@kennellinc.com
Functional Changes in MDR/M2
1)Context: MDR and M2 are two of the most important
systems used by MHS analysts today.
2)Purpose: This presentation will updates users on
changes in these systems that have occurred recently or
are about to occur.
3)Outcome: After attending this session, participants will
meet the objectives described on the next slide.
FOR OFFICIAL USE ONLY
2
Functional Changes in M2
• Objectives:








Characterize new features currently available in M2 BOXI
Describe the M2 Appointment Table
Describe the direct care dental data
List the sources of data in the purchased care dental table
Characterize the types of deployment data in M2
Describe data type specific changes
Describe the CDR Data Retention Project
List changes that are upcoming.
3
Functional Changes in M2
• M2 switched to a newer version of software this
year
 Older version of M2 was no longer supported by Business
Objects
 There was a desire by some to change to a Web-based
tool.
 The M2 FPG voted that the Web version of M2 did not
meet functional requirements
 So DHSS deployed a Web-tool (WebI) and the Desktop
version of BOXI called “DeskI”
FOR OFFICIAL USE ONLY
4
Functional Changes in M2
• DeskI is very similar to Business Objects 5.1.7
 Querying works the same way
• Differences include
 Method of logging on
 Retrieving and working with corporate reports
 Sending and receiving reports
 Ability to use the results of a query as a subquery
FOR OFFICIAL USE ONLY
5
Using Results from a Query
in a Subquery
• BO 5.1.7 performed subqueries
 Users could use an “in list” command and then build a
new query to retrieve data from M2.
 Now, users can use an existing query in the “in list”
condition.
• Consider the following:
 You want to write a report to include only procedure
code descriptions that are in the main query, so that you
can make a detail object out of them.
FOR OFFICIAL USE ONLY
6
Using Results from a Query
in a Subquery
• Main Query:
Radiology Procedures at Camp
Pendleton in FY 2011.
• Insert a report to get
descriptions
FOR OFFICIAL USE ONLY
7
Using Results from a Query
in a Subquery
• When building the procedure
code description report, we
get an option “Select Query
Results”
FOR OFFICIAL USE ONLY
8
Using Results from a Query
in a Subquery
• After pressing “Select
Subquery Results”
• Select Query 1
FOR OFFICIAL USE ONLY
9
Using Results from a Query
in a Subquery
• After Selecting Query 1, M2 provides a list of
elements, and the user select which one to use as a
filter.
• The advantage here is that you only get codes that
you want returned. There will be no extraneous
rows after creating the detail associated with
procedure code.
FOR OFFICIAL USE ONLY
10
Using Results from a Query
in a Subquery
• Final Look: Right
before hitting run
FOR OFFICIAL USE ONLY
11
Using Results from a Query
in a Subquery
• Final Steps:
Link procedure codes
FOR OFFICIAL USE ONLY
12
Using Results from a Query
in a Subquery
Create a detail object
Use slice and dice to bring into report.
FOR OFFICIAL USE ONLY
13
Using Results from a Query
in a Subquery
FOR OFFICIAL USE ONLY
14
Functional Changes in M2
• WebI is “sort of” similar to Business Objects
5.1.7
 Querying is very similar
 No slice and dice, but most functionality still
available
 Significant differences in handling of data (i.e.
saving, etc)
• Some functionality that is not available in WebI:
 User – Defined Objects
 Use of local data
 Less flexibility in saving files
FOR OFFICIAL USE ONLY
15
Functional Changes in M2
• There are some new features in BOXI (both
WebI and DeskI)
 Infoview Web Portal.
 Ability to save data to the server rather than
locally (good for PHI/PII)
 Ability to develop dashboards and other
customized views
• Some issues with BOXI
 Significant issues with run-times. Improvements
lately!
 Browser updates can cause problems.
FOR OFFICIAL USE ONLY
16
New Publishing Feature of BOXI
Navy Analytics Newsletters
FOR OFFICIAL USE ONLY
17
Navy Analytics Newsletter
• Navy BUMED sponsored newsletter for analysts and
other users of data.
 8 are published per year.
 Topics include:
Issue
Content
1
Mental Health
2
Populations
3
Data Quality
4
Obstetrics
5
Pharmacy
6
Medical Home
7
Financial Management
FOR OFFICIAL USE ONLY
18
New Publishing Feature of BOXI
• Corporate Reports Handbook
• See Conference Website for
slides on Corporate Reports
FOR OFFICIAL USE ONLY
19
Functional Changes in M2
• Business Objects has told DoD that they will cease
to support DeskI at some point in the future.
 DHSS would like to switch to only WebI soon.
 Business Objects is working to close the
“functionality gap” between WebI and DeskI
 DHCAPE will approve the switch to WebI when
the gap is closed.
FOR OFFICIAL USE ONLY
20
Recent Changes
FOR OFFICIAL USE ONLY
21
New Data Tables
• Appointment Table:




Direct care appointments only
Contains a record for each appointment in CHCS.
Includes cancellations, left w/o being seen, etc.
Prepared from the TRICARE Operations Center (TOC) data
feeds that are used for reporting of access to care
measures.
 Populated from FY 2005+ like other data tables.
 Updated weekly.
 Used to prepare “inferred encounters” also.
22
New Data Tables
• Ideas for using this new table:
 Can be looked at to track no-show rates
 Can be used to look at historical compliance with access to
care standards. Can trend from FY 2005+
 Can be used to track compliance with access standards for
specific populations that are not separately identified by
the TOC.
 Can be used to look at scheduled appointment times,
compared with E&M codes recorded in CAPER.
 Can be used to determine if particular specialties or PCMs
are having access to care issues.
23
Unused Appointments at One
Navy MTF in One FM (Top Clinics)
Code
Clinic
# Wasted
Total
Waste Rate
BAR
PHYSICAL MEDICINE
1,785
7,181
25%
BFD
MENTAL HEALTH
1,562
5,926
26%
BGZ
FAMILY MEDICINE NEC
1,525
9,054
17%
BCB
OB/GYN
1,083
5,827
19%
BLA
PHYSICAL THERAPY
1,051
3,653
29%
BDZ
PEDIATRIC CARE NEC
764
5,035
15%
EKA
AMB CARE PATIENT ADMIN
737
2,361
31%
FOR OFFICIAL USE ONLY
24
Tracking Compliance with
Access Standards
• Compare length of time
from date appointment
made, to date of
appointment.
• Use “Length of Time Until
Appointment”
• M2 won’t let you
calculate yourself.
FOR OFFICIAL USE ONLY
25
Tracking Compliance with
Access Standards
• Retrieve
appointment type,
length of time until
appointment.
• Used only Specialty
Appointments at
one MTF in one
month
• Created a local
variable to group
lengths of time.
FOR OFFICIAL USE ONLY
26
Tracking Compliance with
Access Standards
Met the Access
to Care
Standard for
Specialty
Appointments
94% of the
time.
FOR OFFICIAL USE ONLY
27
Tracking Compliance with
Access Standards
• One MTF, One
Month
• Number of
Appts outside
the access
standard by
provider.
FOR OFFICIAL USE ONLY
28
New Data Tables
• Direct Care Dental:
 New table, as of November 2011.
 Detailed encounter data for dental care.
 Generally contains Army and Air Force data, for now
anyway (exception is National Military Medical Center
Walter Reed)
 This is because Navy doesn’t generally capture dental data
(DENCAS) in sufficient detail - person level procedure data
is not generally captured in the Navy.
 There are plans later, to add dental weighted values to the
MEPRS table, which will be for all three Services.
29
Dental Encounters in M2 by
DMISID Military Service
Navy Workload is
entirely the new Walter
Reed
FOR OFFICIAL USE ONLY
30
Dental Encounters in M2
Walter Reed and Bethesda
FOR OFFICIAL USE ONLY
31
Dental Encounters For Navy
Beneficiaries by Other Services
FY
ADFM
RET
OTH
AD
Total
2009
12,641
4,123
8,485
140,063
165,312
2010
12,941
4,564
12,803
138,395
168,703
2011
18,492
9,056
20,640
178,512
226,700
2012
11,301
5,294
11,758
105,033
133,386
FOR OFFICIAL USE ONLY
32
Global Changes
• Addition of Deployment Information
 Source of deployment information is DMDC.
 Deployment related data elements have been appended to all detail
data tables in M2.
• Ever Deployed Flag (OCO): Indicates whether the beneficiary had been
deployed as of the reporting date in the record.
• OCO Deployed Flag: Indicates if the beneficiary is currently in deployed
status as of the reporting date in the record.
 Particularly useful with population data because deployed cohorts
aren’t generally receiving care through the DHP. This allows you to
take the deployed out of denominators when calculating things like
PMPM Costs, or Utilization/Enrollee.
33
Global Changes
• Cumulative OCO Deployed Days: Indicates how many days the member
had been deployed in total, since 9/11/2011.
 Many studies has shown this to be associated with poor outcomes.
• Days Since Most Recent Deployment:
 To assist in finding beneficiaries who may be vulnerable due to a
recent return.
 Could also be used to track who needs a Post Deployment Health ReAssessment.
34
Using M2 Deployment Flags
% of Active Duty OCO Deployed at Beginning of FY12
Service
N
Y
Total
% Deployed
Army
583,358
139,474
722,832
19%
Coast Guard
43,471
447
43,918
1%
Air Force
338,322
32,514
370,836
9%
Marines
190,766
21,755
212,521
10%
Navy
206,802
10,232
217,034
5%
Navy Afloat
108,627
20,497
129,124
16%
6,866
0%
1,703,131
13%
Unknown
All
6,866
1,478,212
224,919
FOR OFFICIAL USE ONLY
35
Using M2 Deployment Flags
• Navy created a special DMISID to be used for enrollments of deployed
service members, rather than keeping the member enrolled at their home
port.
 The top enrollment site for Navy/Marines deployed is “6992” – Active
Duty Navy with 33K enrollees
 Fort Bragg has 11K enrollees that were deployed at the beginning of
FY 2012. Fort Hood had 20K.
 Wreaks havoc on analysts use of the data b/c the people being called
“enrolled” don’t generally have an opportunity to receive health care
from the DHP.
FOR OFFICIAL USE ONLY
36
Using M2 Deployment Flags
% of Army Enrollees at MTFs who are deployed at the time the
enrollment was reported.
FOR OFFICIAL USE ONLY
37
Using M2 Deployment Flags
Navy MTFs with the Largest Deployed Population at Beginning of
FY 2012
N
Y
% AD
Deployed
NMC PORTSMOUTH
72,671
10,067
12%
NMC SAN DIEGO
66,387
5,389
8%
NH BREMERTON
10,882
2,883
21%
NH JACKSONVILLE
16,915
2,747
14%
NH CAMP LEJEUNE
48,083
2,101
4%
38,474
1,494
4%
Catchment Area
WALTER REED NMMC
FOR OFFICIAL USE ONLY
38
Using M2 Deployment Flags
% of Navy AD Workload for Members who have been deployed - Top 5 Clinics.
Clinic
N
Y
Total
% Dep
PT/OT
329,960
327,658
657,618
50%
Flight Medicine
86,538
84,396
170,934
49%
Mental Health
386,025
335,076
721,101
46%
Orthopedics
217,163
170,854
388,017
44%
Public Health
196,523
151,052
347,575
43%
FOR OFFICIAL USE ONLY
39
Using M2 Deployment Flags
Admissions for Members Deployed at the Time of
Admission – Most Frequent MTFs
FY
2006
2007
2008
2009
2010
2011
2012
Walter Reed
709
747
732
616
644
276
Bethesda
318
385
137
159
276
185
59
FOR OFFICIAL USE ONLY
BAMC
275
405
271
202
163
349
155
Landstuhl
3,045
3,702
2,635
2,392
2,715
2,748
790
40
Global Changes
• Transition of Tnex to T3
 Complicated contract changes occurring with the
TRICARE MCS Contracts
 Numerous awards / protests / appeals, etc…
 Decided to put both T3 and Tnex Regions into M2.
 Tnex region (HSSC Region) has not changed.
 However, the old region data elements (populated with
01, 02, 03, etc) are now filled with the T3 region.
 Gives users the flexibility to report either way.
 Historical regions have been removed from M2
altogether.
41
Data-Type Specific Changes
Standard Inpatient Data Record:
• Renamed Service Date to Discharge
Date:
 Technically, this is a disposition
date.
• Added Sponsor Service, Aggregate:
 Can identify Navy Afloat with
this.
• Added Diagnosis 9 – Diagnosis 20
• Added Procedure 9 – Procedure
20.
MTFs with the most
dispositions for Navy Afloat
Service Members
Name
NMC PORTSMOUTH
NMC SAN DIEGO
Dispositions
1,669
896
TRIPLER AMC
337
NH JACKSONVILLE
165
NH YOKOSUKA
103
42
Data-Type Specific Changes
TED-Institutional:
• Added diagnosis codes 9-11
 Total of 12 Dx fields now.
• Added Sponsor Service,
Aggregate:
 Can identify Navy Afloat
with this.
TED-Non
Institutional:
• Added Sponsor
Service,
Aggregate:
 Can identify
Navy Afloat
with this
MS-DRGs in the Network for
Navy Afloat Service Members
M S-DRG Description
Admits
NON-ACUTE, DRG N/A
1,996
VAG DELIVERY W/O CC
1,544
ESOPHAGITIS, OTHER GI
1,247
FX, SPRN, STRAN EXC FEMUR
656
APPENDECTOMY W/O CC
390
43
Data-Type Specific Changes
Ancillary (MTF Lab and Rad):
• Renamed related record ID to be appointment record ID.
• Added inpatient record ID, however this element seems to have some
issues.
• (Ancillary cost data seems highly suspect at this time).
Referral:
• Added appointment date and date appointment made.
 Can be used to track access standards.
 (Math issues with dates)
• Renamed referral FY and referral FM to FY and FM, respectively.
Pharmacy (PDTS):
• Changed sponsor service, common to sponsor service, aggregate
• Renamed NPI Type 2 to Pharmacy NPI.
44
Data-Type Specific Changes
• Users were encouraged to switch from using SADR for professional
encounter reporting, to using CAPER.
• Changes were made to the CAPER data in M2 to make it more user
friendly.
 Renamed data elements for consistency purposes.
 Formatted diagnosis codes to be consistent with the reference tables
and other data files.
• Dropped several RVU elements:
 Examples: Individual Work RVU, Simple Work and PE RVU
• Renamed PE RVU (13) to PE RVU, Non-Provider Affected (13)
• Dropped APC Aggregate Weight (5)
• Hid PPS Earnings related data fields because they were not properly
maintained (more later)
45
Data-Type Specific Changes
CAPER:
• New RVU elements for direct care.
 New aggregate measures, provider specific measures for direct care
only.
 All new elements have work, PE and total components
 Many of the old RVU elements are still available also.
 No changes were made to purchased care.
 As a result, still best to compare enhanced RVUs (13) in CAPER with
enhanced RVUs in TEDs.
 But new fields are helpful for direct care only type work.!
46
CAPER RVUs
CAPER:
•
•
•
PPS and Business Plans use the new Provider Aggregate RVU (PAR).
Edit logic is now incorporated into RVU assignment! Makes it difficult to track
coding issues.
PAR incorporates all 13 Procedure Codes.
 Initially, only 5 procedure codes were considered with enhanced RVUs. For most
records, this will have no impact but for some, there will be positive gain as a result.
•
PAR incorporates Procedure Code Modifiers:
 Previously, only lab/rad modifiers and some DME were used. In the Provider Aggregate
RVU, the following modifiers are considered.
 Bilateral, Unrelated E&M, discontinued services, unusual services
•
Incorporates Discounting:
 100% credit for highest weight procedure, 50% credit for all others.
 Whether a procedure’s RVU is discounted depends on the CMS Payment Status
Indicator for the code.
4/9/2015
47
Data-Type Specific Changes
CAPER:
 Treatment of Nurse Only workload is different with PAR
• Nurse only workload has always been credited in M2, but was not used in PPS
in 2011.
• In 2012, the PAR will have the nurse logic built in.
• Most nurse workload won’t count but there are some procedures that will
(i.e. flu shots)
• These can be identified in M2 in the CPT/HCPCS reference table.
4/9/2015
48
Data-Type Specific Changes
CAPER:
 Provider Adjustments are made with PAR
• With enhanced RVUs, credit was only given for the primary provider.
• In PAR, providers receive credit for all care they participate in, though not
always at full credit.
• Nurses only receive credit for some specific CPT/HCPCS codes.
4/9/2015
49
Data-Type Specific Changes
CAPER:
• Provider (appointment & add’l providers 1 – 4)
 Up to 5 providers
• Proc 1 RVU (NPA) – Proc 12 RVU (NPA)
 Up to 3 E&M codes and 10 procedures
 NPA = Non-Provider Affected
• There were also additional procedure specific and provider specific RVU
elements added to M2
• These are difficult to use because M2 has multiple procedures and
providers per CAPER.
4/9/2015
50
Data-Type Specific Changes
CAPER:
• Using multiple provider / multiple procedure data is not easy the way
CAPER is shaped.
• How many RVUs were done for procedure X in the MHS?
CAPER
1
2
3
4
5
1.
2.
3.
Proc 1
A
X
A
S
X
Procs
Proc 2
Proc 3
A
X
A
C
X
L
Proc 4
B
D
M
Proc 1
1
0.5
3
0.3
0.5
RVUs
Proc 2
Proc 3
1
0.5
2
1.3
1
0.6
Create a query that returns all procedures and all
procedure-specific RVUs.
Slice and dice looking at each procedure and
whether or not it = “X” or not. If so, count the
RVUs, if not ignore them.
Add results together to get total RVUs.
4/9/2015
Proc 4
1.5
0.6
0.2
CAPER
1
2
3
4
5
Total
Proc X RVUs
0.5
0.5
1
0
0.5
2.5
51
Impact of RVU Changes this FY
Clinical Area
Encounters
BA: Medicine
BB: Surgery
BC: OB/GYN
BD: Pediatrics
BE: Orthopedics
BF: Mental Health
BG: Family Practice
BH: Primary Care
BI: ER
BJ
BK
BL: PT/OT
6 % overall drop in RVUs
1,230,266
460,862
497,413
604,342
385,940
717,736
1,791,372
3,190,616
398,481
170,294
24,529
656,657
Avg PAR
RVU
Avg ET (5) % Change
2.41
3.73
2.56
2.26
2.51
1.92
1.74
1.98
2.63
2.06
1.94
2.30
FOR OFFICIAL USE ONLY
2.46
3.82
2.84
2.08
2.63
2.60
1.71
1.98
2.56
2.04
1.95
2.38
-2%
-2%
-10%
8%
-5%
-26%
1%
0%
2%
1%
-1%
-3%
52
Provider Aggregate RVU Case Mix
Tx Svc
2009
2010
2011
2012
Army
0.95
0.94
0.94
0.96
AF
0.91
0.92
0.91
0.93
Navy
0.99
0.98
0.95
0.98
FOR OFFICIAL USE ONLY
53
Navy MTFs with the Highest
Provider Aggregate RVU Case Mix
Tmt Parent DMIS ID Name
NH OKINAWA
NH GUAM
WALTER REED NMMC
NMC SAN DIEGO
NH GUANTANAMO BAY
NH JACKSONVILLE
NH YOKOSUKA
NMC PORTSMOUTH
NH BREMERTON
FOR OFFICIAL USE ONLY
Case Mix
1.14
1.10
1.09
1.06
1.06
1.05
1.05
1.02
1.01
54
New MDR Changes
FOR OFFICIAL USE ONLY
55
MDR Changes
• Clinical Data Repository (CDR) Data Retention Project
 Clinical Data Mart provided access to information from the Clinical
Data Repository through a Business Objects Interface.
 The CDM was shut down in the summer of 2011 due to issues with
funding and data quality.
 Importance of access to clinical data was not addressed initially by
committees that approved the shut down
 MDR Interim Solution:
 DHCAPE team of MDR requirements developers were tasked to
use data feeds that had gone to CDM from CDR, to create MDR
data files with clinical information.
 Project began in summer 2011
 Documentation provided was either incomplete or non-existent.
 Most data files have been implemented.
FOR OFFICIAL USE ONLY
56
MDR Changes Available from
CDR Retention Project
For AHLTA coded appointments, linkable to appointment CAPER
Data File
Comtemt
Patient
Needed to correct CDR patient identification errors
Vitals
Height, weight, BP, tobacco, pulse ox, etc.
Meds
Inpatient and Outpatient
Historical Procs
Self Reported Historical Procedures
Medications
Inpatient and Outpatient Medications
Chemistry
Lab Chemistry Orders and Results
Immunizations
Immunization history from AHLTA
FOR OFFICIAL USE ONLY
57
MDR Changes Available from
CDR Retention Project
• Still in development:




Radiology (with Results)
Microbiology
Pathology
Other Past Medical History
FOR OFFICIAL USE ONLY
58
MDR Changes
• Defense Medical Human Resources System
 A new person level file has been made available with staffing
information.
 Will be helpful for understanding staff reporting of labor hours.
 Is getting considerable attention for tracking timesheet MEPRS
code reporting vs. workload MEPRS code reporting.
• Re-introduction of Ill, Injured and Wounded File
 Can be used to track returning service members with various warrelated conditions.
• Primary Care Medical Home Cohort File
 Combines DEERS and CHCS data to arrive at a Primary Care Medical
Home Cohort.
 Can be used matched against any other file in the MDR to
determine care provided to PCMH enrollees.
FOR OFFICIAL USE ONLY
59
Next M2 Update
FOR OFFICIAL USE ONLY
60
Next M2 Update
• Primary Care Medical Home Requirement
 Requirement is to flag all detail records as to PCMH status (PCMH
Flag, MEPRS Code, MTF NCQA Accreditation Level) for indicated
patient.
 Based on CHCS data, matched with DEERS, to weed out DQ errors
(from MDR file).
 PCMH data file is already available in the MDR
 M2 will implement PCMH in phases.
 Enrollment flags will be made available in direct care data in late
June.
 Other files not yet scheduled.
 Enrollment report is in Infoview.
FOR OFFICIAL USE ONLY
61
Next M2 Update
•
The TMA Privacy Office recently reclassified the M2 Person ID
as personally identifiable information (PII)
 When presented in conjunction with health data, the Person
ID now constitutes Protected Health Information (PHI)
 Person ID is currently available in both the restricted and
unrestricted versions of M2.
 In the future, DEERS Person ID will become a restricted
element.
 Psuedo-versions of person IDs (includes PCM ID and
Provider EDIPN) will be available and non-psuedo versions
will be hidden for non-’restricted’ users.
 Not in June, yet. Initial work is just beginning.

FOR OFFICIAL USE ONLY
62
Next M2 Update
•
Removal of SADR Detail
•
•
CAPER Original Extract Date
•
•
•
•
•
Users will only be able to use CAPERS in M2
Tells when the site originally sent the CAPER
Useful for tracking compliance with reporting standards.
Must download record level data to a tool outside of M2 to
use this element as date math doesn’t work in M2 (Original
Extract Date – Encounter Date).
Hopefully this will be fixed in the future.
CAPER Provider Skill Types:
•
Tells whether the provider is a clinician, professional, etc.
FOR OFFICIAL USE ONLY
63
FOR OFFICIAL USE ONLY
64