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(c) Guide to Wisconsin hospitals report.
(d) Uncompensated health care services report.
(e) Consumer guide.
(f) Hospital quality indicators.
Note: The Department’s web address is: http://www.dhs.wisconsin.gov
(2)Prohibition on early release of reports. If the department releases drafts of any of the standard reports to health care providers for comment, health care providers or subsequent holders of the drafts may not release these reports or data elements from the reports.
(3)Open records applicability.
(a) Except as prohibited under par. (b), the data used to compile the reports under this chapter are not subject to inspection, copying or receipt as specified in the open records provisions under s. 19.35 (1), Stats. When the department completes the reports and distributes them to the governor and legislature the reports shall be publicly available.
(b) Data collected under ss. DHS 120.11 to 120.16 shall not be subject to inspection, copying or receipt as specified in the open record provisions under s. 19.35 (1), Stats.
History: Cr. Register, December, 2000, No. 540, eff. 1-1-01; CR 03-033: am. (3) (b) Register December 2003 No. 576, eff. 1-1-04.
DHS 120.21Guide to Wisconsin hospitals.
(1)Data sources. The guide to Wisconsin hospitals shall be based on data derived from all of the following sources:
(a) The annual hospital fiscal year survey.
(b) The annual survey of hospitals.
(2)Contents.
(a) General. The guide to Wisconsin hospitals shall present descriptive financial, utilization and staffing information about individual Wisconsin hospitals, as well as summary and trend information for selected aggregate data.
(b) Hospital information. The guide shall present and interpret all of the following information for all Wisconsin hospitals individually and in the aggregate:
1. Income statement data.
2. Payer source.
3. Hospital type.
4. Average inpatient stay.
5. Number of outpatient visits.
6. Balance sheet data.
7. Occupancy rate.
8. Number and type of beds set up and staffed.
9. Number of discharges.
10. Number of inpatient days.
11. Average census.
12. Number of full-time equivalent staff by occupational category.
13. Type of inpatient service.
14. Type of ancillary or other hospital service.
15. Hospital analysis area.
16. Hospital volume group.
(c) Explanatory information. In addition to the information specified under par. (a), the guide shall present all of the following information:
1. A glossary of terms used in the guide.
2. Caveats, data limitations and technical notes associated with the guide.
3. A copy of the department’s annual survey of hospitals.
4. A copy of the department’s hospital fiscal survey.
(3)Report dissemination. The department shall distribute the paper version of the report at no charge to the governor, the legislature and a board-approved list of individuals and agencies. The department shall make the paper version of the report available for purchase by others. The department shall make available from the department’s website an electronic version of the report at no charge.
(4)Suggested uses of report. The guide may be used in a variety of ways. Examples of how to use the guide include all of the following:
(a) As a tool to evaluate the fiscal health and operating efficiency of hospitals in Wisconsin.
(b) In conjunction with other department data on hospital inpatient discharges and ambulatory surgeries, to evaluate levels of reimbursement or coverage provisions.
(c) In conjunction with other information, to determine patterns of hospital service availability statewide. Service availability patterns, in turn, can help policy-makers and others identify mechanisms that may enhance service accessibility and availability, such as targeting reimbursement incentives or establishing new or additional health service programs.
(d) As a resource document for persons wishing to conduct research or collect information on hospital utilization, services and finances.
History: Cr. Register, December, 2000, No. 540, eff. 1-1-01; CR 03-033: am. (1) (a) Register December 2003 No. 576, eff. 1-1-04.
DHS 120.22Utilization, charge and quality reports.
(1)Data sources. The utilization, charge and quality reports shall be based on four broad types of data:
(a) Facility-level data derived from all of the following sources:
1. The annual hospital fiscal year survey.
2. The annual survey of hospitals.
(b) Workforce practice information collected under ss. DHS 120.13 (4) and 120.14.
(c) Patient information derived from billing forms submitted by health care providers. Patient information may include any data element contained in billing forms except those that might allow a patient to be identified. Data elements include patient age, gender, county, diagnoses, procedures, charges and expected payer. Hospital data elements also include source and type of admission and discharge status.
(d) Information collected from the department of safety and professional services regarding practices, specialties, education and licensing, certification and credential revocation and suspension information of individual health care providers licensed to practice in Wisconsin.
(2)Contents. The utilization, charge and quality reports summarize utilization, charge and quality data on patients treated by health care providers in Wisconsin during the most recent calendar year. The report contains information on services provided to hospital inpatients, the primary reasons for hospitalization, length of stay, expected pay source, discharge status, volume of procedures, charges for services received, and the most common diagnostic conditions. The report also contains selected utilization, charge and quality indicators for individual hospitals and makes comparisons to previous year data, thereby assisting readers in understanding where changes are occurring. The report devoted to outpatient data contains utilization and charge data for patients undergoing selected surgical procedures at hospitals, freestanding ambulatory surgery centers and physician’s offices. The section of the report devoted to emergency department data contains utilization and charge data for patients in emergency departments at hospitals. Some of the specific contents of the reports include the following topics:
(a) A summary of patient-related data and how that data compares to similar data from the previous year.
(b) A reader’s guide to the report’s data containing an explanation of data sources, terms, concepts and data limitations.
(c) An overview of utilization and charge information in Wisconsin, including an explanation of the difference between patient retail charges and patient discounted charges.
(d) Information on quality indicators.
(e) Information on injury codes.
(f) Tables for individual health care providers providing both unadjusted data and data adjusted for patient severity.
(g) An explanation of how data are adjusted for patient severity.
(h) A list of health care facilities or providers.
(3)Report dissemination. The department shall distribute a paper version of the reports at no charge to the governor, the legislature and a board-approved list of individuals and agencies. The department shall make the paper version report available for purchase by others. The department shall make available from the department’s website an electronic version of the report at no charge.
(4)Suggested uses of report. Comprised of summary data, the report provides either totals or averages. The report can provide health care providers, consumers, researchers and policymakers with a basis for facility and health care provider comparisons, trend analyses, utilization and charge summaries. Examples of information the report may contain include all of the following:
(a) The average charge, adjusted for severity, for selected medical or surgical treatments.
(b) The health care provider’s charges for selected services, adjusted for severity.
(c) Possible areas for future research, such as variations among health care providers in utilization or charges.
(d) Quality indicators that can be associated with variations in care delivery, including complication rates, volume of procedures and patient satisfaction.
(e) A description of why charges vary among health care providers.
(f) Trends in health care utilization and charges.
(g) Reasons for physician visits.
History: Cr. Register, December, 2000, No. 540, eff. 1-1-01; CR 01-051: am. (2) (intro.), Register September 2001 No. 549 eff. 10-1-01; CR 03-033: am. (1) (a) 1. Register December 2003 No. 576, eff. 1-1-04; correction in (1) (d) made under s. 13.92 (4) (b) 6., Stats., Register February 2012 No. 674.
DHS 120.23Consumer guide.
(1)Data sources. The consumer guide shall draw on the following data sources:
(a) Bureau of health information databases, including those related to inpatient stays, ambulatory visits, physician encounters, facility financial and services information and health care provider workforce data.
Note: The bureau of health information was renamed the bureau of health information and policy.
(b) Databases of other department agencies, including those of the division of health care financing and the bureau of quality assurance.
Note: The bureau of quality assurance was renamed the division of quality assurance.
(c) Databases of other state agencies, including the office of the commissioner of insurance for information related to health plan finances, market conduct, complaints and grievances, and quality indicators.
(d) Other private sector information available through various websites.
(e) Federal databases, including those of the health care financing administration.
(2)Contents. The consumer guide shall contain information on all of the following:
(a) How to find and choose a doctor, hospital, health care plan, nursing home or other health care provider.
(b) How to get health insurance or enroll in medicare, medical assistance, badgercare or family care and where to go with health care coverage or payment questions or problems.
(c) Where to learn about specific conditions, illnesses or injuries.
(d) Other websites and related information sources that provide information on health care questions.
(3)Report dissemination. The department shall make available from the department’s website an electronic version of the consumer guide at no charge. The department shall distribute a paper, summary version of the consumer guide at no charge to the governor, the legislature and a board-approved list of individuals and agencies. The department shall make the paper, summary version of the consumer guide available for purchase by others.
(4)Suggested use of the consumer guide. Some suggestions for using the report are as follows:
(a) Health care plan. If available to the department, the following types of data for individual health care plans shall be contained in the consumer guide and may supplement consumers’ age, health status, mobility and financial resources as important factors consumers should consider when selecting a health care plan:
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Published under s. 35.93, Stats. Updated on the first day of each month. Entire code is always current. The Register date on each page is the date the chapter was last published.