SPARCS Evolution

External Users Meeting

March 20, 2018

2

Agenda

• Data format changes

• New, modified and dropped variables

• Available resources

• Timeframe of changes

3

Data Model Changes –

FLAT FILE to All Payer Database(APD) Table ‘like’ Files

SPARCS FLAT FILE

APD Table likeSPARCS Data files

We will provide users with a map between Flat File to new

APD Table like files

OLD MODEL NEW MODEL

4

More Efficient:

• Old system required you to read in the entire file

• New system, you use what you need:

• If doing counts of APR-DRGs by Discharge Year, use

only DRG file

• Linking between files is same as if in database

• Use ‘|’ (pipe) delimiter rather than physical position in file

• Removes empty spaces

Reason for Change

5

SPARCS 14 Files are based on

the 14 APD Tables:

• CLAIM

• CONDITION_CODE

• DIAG

• DRG

• LOCATION

• NDC

• OCCURRENCE

• OCCURRENCE_SPAN

• PAYOR

• PROC

• PROVIDER

• RACE

• REV

• VALUE

Data Format Changes

6

Data Format Changes

• CLAIM table/file

• 132 fields

• Inpatient and Outpatient are combined

• Claim_type I for Inpatient and A,E, and O for Outpatient

• Ability to link to other tables is by:

• CLM_TRANS_ID -> unique ID of the claim. Never changes (vast

improvement over discharge number)

• UPIDE -> unique ID of the patient; UPID + DOB + SEX

• Discharge_year -> identifies the discharge year

• Claim_type –> identifies type of SPARCS data

7

Data Format Changes

• CONDITION_CODE table/file

• 16 fields

• Contains

• Cond_cd -> a condition relating to an institutional claim that may

affect payer processing.

• Approximately 200 available codes.

• Examples include:

• ’01’ – Military Service related

• ‘17’ – Homeless

• ‘19’ – Child has mother’s maiden name

8

Data Format Changes

• CONDITION_CODE table/file (cont.)

• Examples include:

• ‘31’ thru ‘35 – Student

• Full, Part, Day, Night

• ‘A2’ thru ‘A5’ - Special Programs

• Disability, Family Planning, PHCP, SFF

• ‘B3’ – Pregnancy Indicator

• ‘B4’ – Admission Unrelated to Discharge on Same Day

• ‘P1’ – Do Not Resuscitate (DNR)

• ‘P7’ – Admission from Emergency Department

9

Data Format Changes

• DIAG table/file

• 21 fields

• Non-common fields are:

• DX_TYPE_CD -> describes if Admitting, Primary, Other, External

Cause/Place, Reason for Visit

• SEQ_ID -> is the reported order of the diagnosis codes reported

for that type.

• Diagnosis_group -> The CCS grouper

10

Data Format Changes

• DIAG table/file – cont.

• Non-common fields are:

• ICD_TYPE_CD -> describes if ICD-9 (pre Oct1, 2015) or ICD-10

(on/after Oct 1, 2015)

• POA_ID -> the present on admission code. Going forward, is

required for Primary Diagnosis

11

Data Format Changes

• DRG table/file

• 42 fields

• Historically, contains the previous, current and future versions of that

year’s DRGs

• Federal (MS)

• All Payor (AP)

• All Payor Refined (APR)

• Going forward, only current version of APR and MS will be produced

• APR produced for both with and without POA.

12

Data Format Changes

• DRG table/file cont.

• For all three DRG types, it contains the

• Diagnosis Risk Grouping (DRG) and

• Major Diagnosis Classification (MDC)

• For APR, also present are:

• Severity of Illness (SOI) and

• Risk of Mortality (ROM) are also present

• EAPG has been removed

13

Data Format Changes

• LOCATION table/file

• 26 fields

• Contains

• Pat_addr_city

• Pat_addr_st ->

• Character abbreviation of State

• Pat_addr_cnty_cd ->

• Now FIPS codes; NYS only

• Pat_addr_cntry_cd ->

• Country Code; other than USA

14

Data Format Changes

• NDC table/file

• 21 fields

• Contains

• NDC -> drug code

• NDC_unit_cnt -> Unit count of drug

• NDC_unit_type -> Type of unit

• Pres_numb -> Prescription number

15

Data Format Changes

• OCCURRENCE table/file

• 17 fields

• Contains

• Occur_cd -> identifies a significant event relating to a claim

• Accident

• Medical Condition

• Insurance Related

• Service Related

• Occur_dt -> Date of the event

16

Data Format Changes

• OCCURRENCE table/file (cont.)

• Examples of codes include:

• ‘01’ thru ’05’ – Accident

• ‘06’ – Crime Victim

• ‘09’ – Start of fertility treatments

• ‘26’ – Date SNF bed became available

• ‘41’ – Date of Pre-Admission Testing

• ‘42’ – Date of Discharge

• ‘55’ – Date of Death

17

Data Format Changes

• OCCURRENCE_SPAN table/file

• 18 fields

• Contains

• Occur_span_cd-> identifies a significant event relating to a claim

over a period of time

• Observation stays

• Skilled Nursing (SNF) stays

• Patient Liability for Non-covered Days

• Occur_span_from_dt -> date event started

• Occur_span_thru_dt -> date event ended

18

Data Format Changes

• OCCURRENCE _SPAN table/file (cont.)

• Examples of codes include:

• ‘71’ – Prior Stay Dates

• ‘74’ – Non-covered Level of Care/Leave of Absence Dates

• ‘75’ – SNF Level of Care Dates

• ‘M3’ – ICF Level of Care

19

Data Format Changes

• PAYOR table/file

• 46 fields;

• Contains

• Payr_src_cd -> Source of Payment;

• Payr_typology_cd -> Source of Payment Typology

• Pol_numb -> Insurance Policy Number

• Payr_name -> Payor’s Name

• Payr_ID -> The National ID for the insurance company

• Src_pymt_cd -> the Claim Filing Indicator

• Provider_id -> facility’s ID assigned by the insurance company

20

Data Format Changes• PROC table/file

• 31 fields

• Contains

• Proc_grp_cd -> The CCS grouper

• Proc_cd -> contains ICD-9/10 and CPT/HCPC procedure codes

• ICD-9/10 only applicable for IP data

• CPT/HCPC are 5 digits and OP only

• Proc_dt -> Date the ICD-9/10 procedure occurred

• Preadmit_ind -> Indicates if occurred pre or post admission

• Preop_days and postop_days -> days between admission and

procedure dates.

21

Data Format Changes• PROC table/file (cont.)

• Contains

• Code_modifier_1 -> is the CPT/HCPC modifier 1

• Code_modifier_2 -> is the CPT/HCPC modifier 2

• Code_modifier_3 -> is the CPT/HCPC modifier 3

• Code_modifier_4 -> is the CPT/HCPC modifier 4

• These four data elements should NOT be used in conjunction with the

procedure data elements as there are derived from REV table fields.

• Unit_type_cd

• Unit_qty

• Chrg_Tot_amt

• Chrg_nocvrd_amt

22

Data Format Changes• PROVIDER table/file

• 23 fields

• Contains

• St_lic_numb -> Historical State license of provider, not collected

going forward

• New fields include:

• Prov_last_name -> Provider’s last name

• Prov_first_name -> Provider’s first name

• Prov_NPI -> Provider’s NPI

• Prov_type_cd -> Type of Provider (i.e. Attending)

• Reported for by Claim and Service levels

23

Data Format Changes• RACE table/file

• 18 fields

• Pat_ethnic_cd -> old classification of Ethnicity

• Pat_race_cd -> old classification of Race

• Each are repeated for each sequence

• Race_ethnic_cd -> CDC description of Race and Ethnicity

• Can report up to 10 combined

• Minimum of 1 reported for each

24

Data Format Changes• RACE table/file cont.

• If a discharge/visit has 1 ethnicity (Unknown) and 3 races (Thai,

Fujian, and White) reported code is 4; so ‘seq’ 1 thru 4 are present

• Patient_ethnicity (9) is same for all four ‘seq’

• Patient_race (MR) is same for all four ‘seq’

• Race_ethnicity is reported as follows:

• E9 (seq=1),

• R2.18 (seq=2),

• R4.03.001 (seq=3), and

• R5 (seq=4)

25

Data Format Changes• REV table/file

• 24 fields

• Contains

• Rev_cd -> indicates the service being charged for

• Rev_type -> indicates accommodation (A) or Ancillary (R)

• Unit_type_cd -> indicates days (DA) or units (UN)

• Unit_qty -> the number of times the service was provided

• Chrg_svc_amt -> the charge for that service

• Svc_nocvrd_amt -> portion of service charge not covered by

insurance

• Svc_dt -> the date the service was provided

26

Data Format Changes• VALUE table/file

• 17 fields

• Contains

• VAL_CD -> code describing the measure

• ‘37’ – Units of Blood furnished

• ‘39’ – Units of Blood Replaced

• ‘50’ – Number of Physical Therapy Visits

• ‘54’ – Newborn Birth Weight in Grams

• ‘69’ – State Charity Care Percent

• VAL_AMT -> the amount/value of the measure

• 4 units

• 2500 grams

27

What Other Changes?Many changes to Data Elements

• There are New, Dropped, and Modified Fields

– New

• NPI (State License Number is not being collected going forward)

• Marital Status

• If approved for addresses, data will be geocoded

– Dropped

• Expected Reimbursement; Principal and Other 1&2

– Modified

• Newborn Indicator (following WHO definition)

27

28

• Mapping document on SPARCS website

• Data Dictionary

• Code to download files into SAS

• National Uniform Billing Committee (NUBC) manual

• NUBC.org

Reference Materials

29

30

31

Important Dates & Timeline

32

Important Dates February 2018

10 years of SPARCS data (2007 – Sept 30th 2017) loaded to the new APD Relational

data format.

March 26, 2018New SPARCS intake system begins accepting data in the new format. Asking facilities

to focus on Q4 discharge dates (Oct 1, 2017 to Dec 31, 2017).

April 2018(beginning of month)

1st upload of data in the new format to the APD SPARCS relational data model.

April 30, 20181st compliance milestone. All facilities are required to have at least one accepted claim

for each claim type.

May 2018

1st complete monthly upload of data, collected in the new format, to the APD SPARCS

relational data model.

Historical SPARCS data (1982 – 2006) loaded to the new APD Relational data format.

APD stakeholders meeting (May 16th) being held in Albany

(https://www.health.ny.gov/technology/all_payer_database/).

June 2018 Begin sending out data extracts in the new format.

33

Data Application Process

• Applying for data will remain the same• SPARCS.requests@health.ny.gov

• Limited and identifiable files available

• Identifiable requests will need Data Governance Committee(DCG) approval

33

March 19, 2018 34

Contact InformationJohn Piddock, Director SPARCS OperationsBureau of Health Informatics

Division of Information and Statistics

Office of Quality and Patient Safety

Scott Franko, Bureau DirectorBureau of Health Informatics

Division of Information and Statistics

Office of Quality and Patient Safety

Liz Villamil, Assistant Bureau Director

Bureau of Health Informatics

Division of Information and Statistics

Office of Quality and Patient Safety

Chitra Iyer, Project Manager Bureau of Health Informatics

Division of Information and Statistics

Office of Quality and Patient Safety