DHS 120.21 HistoryHistory: 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 120.22DHS 120.22 Utilization, charge and quality reports. DHS 120.22(1)(1) Data sources. The utilization, charge and quality reports shall be based on four broad types of data: DHS 120.22(1)(a)(a) Facility-level data derived from all of the following sources: DHS 120.22(1)(c)(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. DHS 120.22(1)(d)(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. DHS 120.22(2)(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: DHS 120.22(2)(a)(a) A summary of patient-related data and how that data compares to similar data from the previous year. DHS 120.22(2)(b)(b) A reader’s guide to the report’s data containing an explanation of data sources, terms, concepts and data limitations. DHS 120.22(2)(c)(c) An overview of utilization and charge information in Wisconsin, including an explanation of the difference between patient retail charges and patient discounted charges. DHS 120.22(2)(f)(f) Tables for individual health care providers providing both unadjusted data and data adjusted for patient severity. DHS 120.22(2)(g)(g) An explanation of how data are adjusted for patient severity. DHS 120.22(3)(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. DHS 120.22(4)(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: DHS 120.22(4)(a)(a) The average charge, adjusted for severity, for selected medical or surgical treatments. DHS 120.22(4)(b)(b) The health care provider’s charges for selected services, adjusted for severity. DHS 120.22(4)(c)(c) Possible areas for future research, such as variations among health care providers in utilization or charges. DHS 120.22(4)(d)(d) Quality indicators that can be associated with variations in care delivery, including complication rates, volume of procedures and patient satisfaction. DHS 120.22(4)(e)(e) A description of why charges vary among health care providers. DHS 120.22 HistoryHistory: 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 120.23(1)(1) Data sources. The consumer guide shall draw on the following data sources: DHS 120.23(1)(a)(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. DHS 120.23 NoteNote: The bureau of health information was renamed the bureau of health information and policy.
DHS 120.23(1)(b)(b) Databases of other department agencies, including those of the division of health care financing and the bureau of quality assurance. DHS 120.23 NoteNote: The bureau of quality assurance was renamed the division of quality assurance.
DHS 120.23(1)(c)(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. DHS 120.23(1)(d)(d) Other private sector information available through various websites. DHS 120.23(1)(e)(e) Federal databases, including those of the health care financing administration. DHS 120.23(2)(2) Contents. The consumer guide shall contain information on all of the following: DHS 120.23(2)(a)(a) How to find and choose a doctor, hospital, health care plan, nursing home or other health care provider. DHS 120.23(2)(b)(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. DHS 120.23(2)(c)(c) Where to learn about specific conditions, illnesses or injuries. DHS 120.23(2)(d)(d) Other websites and related information sources that provide information on health care questions. DHS 120.23(3)(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. DHS 120.23(4)(4) Suggested use of the consumer guide. Some suggestions for using the report are as follows: DHS 120.23(4)(a)(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: DHS 120.23(4)(a)5.5. Measures of financial strength, such as profit margins and administrative versus medical costs. DHS 120.23(4)(a)6.6. Clinical process and outcome measures, such as those required for accreditation by the national committee for quality assurance or participation in the Wisconsin medical assistance program. DHS 120.23(4)(a)8.8. Consumer satisfaction core measures from the consumer assessment of health plans or other satisfaction surveys. DHS 120.23(4)(b)1.1. If available to the department, the following information about a physician and a health care provider specified in s. DHS 120.15 (1) shall be contained in the consumer guide and may supplement other factors such as the consumer’s age, health status, mobility and financial resources as important factors consumers might consider when selecting a health care provider: DHS 120.23(4)(b)1.b.b. License or certification status, if applicable, including date of initial licensure or certification, credential suspensions or revocations. DHS 120.23(4)(b)1.e.e. Practice information including name of practice, location, telephone number and hours spent at location. DHS 120.23(4)(b)1.f.f. Whether the provider renders services to patients insured through medicare or medical assistance. DHS 120.23(4)(b)1.h.h. The names and addresses of facilities at which the provider has been granted privileges, if applicable. DHS 120.23(4)(b)1.i.i. Usual and customary charges for office visits, routine tests and diagnostic work-ups, preventive measures and frequently occurring procedures. DHS 120.23(4)(b)1.k.k. Volume of surgical procedures for those specific procedures where the department has determined, based on existing scientific evidence, that surgical outcomes are related to volume of procedures performed, if applicable. DHS 120.23(4)(b)2.2. The department shall provide consumers with information regarding how to assess the information specified in subd. 1. and what additional questions consumers may want to ask the health care provider. DHS 120.23(4)(c)1.1. If available to the department, the following information about a health care facility shall be contained in the consumer guide and may supplement other factors such as the consumer’s age, health status, mobility and financial resources as important factors in selecting a hospital, nursing home, hospice or other health care facility: DHS 120.23(4)(c)1.m.m. If applicable, performance measures such as complication rates, volume of procedures, patient satisfaction and last report of facility surveys of care delivered.
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