Section 120.22. Utilization, 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 .