Michigan Department of Community Health

Director James K. Haveman

2013 Treatment Episode Data Set (TEDS) Reporting Supplementary Guidance

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Purpose

These slides are intended to boil down the 21-page coding instructions into bullet point statements. The selection and emphasis in this presentation will address only those areas where there has been confusion.

Contact person at MDCH for questions or concerns is Phil Chvojka at

chvojkap@michigan.gov

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Overview

Specific guidance on Each Field can be found in the CODING INSTRUCTIONS For: Treatment Episode Data Set (TEDS)

These instructions are on the Internet at http://www.michigan.gov/documents/mdch/Coding_Instructions_TEDS_398729_7.pdf

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TEDS Admission and Discharge Records

• TEDS uses a “capture--recapture” approach to data collection

• Client data are collected on the first date of service (admission) at each licensed site... and then re-collected on the last date of service (discharge)

• This allows tracking of changes during the course of treatment and allows us to demonstrate improved outcomes

• It means that what is reported at admission WILL be compared to what is reported at discharge

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Snapshot in Time

• Admission field responses should reflect the known status on the reported date of admission in the record

• Discharge field responses should reflect the known status on that reported date of discharge in the record

• If there is no variation in what is reported from admission to discharge, it raises a red flag

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Three Types of Fields

Let’s borrow the concepts of Constants and Variables from algebra:• Constants do not change (like the number of hours in

a day...always 24)• Variables do change (like the reported high

temperature for each day)• There is also a special type of constant called the

“Primary Key Fields”

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TEDS Constants

For TEDS, constants are collected only once, typically only at admission (examples)• Referral Source• County of Residence • Date of Birth (DOB)• Sex • Race• Ethnicity• Military Status

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TEDS Constants (continued)

Plus a few “honorary constants” are only collected at admission (examples)• Marital Status• Education (00 to 25 years)• Currently in Training• Number of Dependents• Total Annual Income• Primary Language Spoken

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TEDS Variables

The TEDS variables are collected first at admission and then at discharge. Of primary importance are the ones used to calculate National Outcome Measures (NOMS):• 30-day use of Primary Substance • Employment Status• Living Arrangement• Total Recent 30-Day Arrests• Attendance at Self-Help Groups

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TEDS Variables (continued)

• Variables are collected at both admission and discharge because the answers can and do change

RULE: “Never pre-fill a discharge variable with what was reported at admission”

Automatically reporting the same data for a field at discharge with what was collected at admission defeats the purpose for “capture-recapture”

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TEDS Primary Key Fields

These fields are in both the admission and discharge records...and are required to match for successful batch processing• CA Payer ID (CA only issue)• Provider License Number (CA only issue)• CA Client ID (CA only issue)• SSN (provider and CA)• Beneficiary ID (provider and CA issue)• Date of Admission (provider and CA issue)

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Reporting the Admission Date in the Discharge Record

Of those primary key fields listed, the one that’s crucial for data entry is the Month, Date, and Year of Admission.

It’s reported both at admission and at discharge...and they must match exactly in both places for the discharge record to process

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Beneficiary (Medicaid/ABW ID)

• Ten Digit Beneficiary ID covers both Medicaid and ABW

• Report the Beneficiary ID in the admission record, if known, even if Medicaid or ABW is not the actual known payer

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County of Residence

• Avoid using the 96 (Homeless) code, if at all possible (use “Living Situation” to report homelessness)

• Even if the person has no fixed address, please code the county in which he/she is located (for example, the location of a shelter).

• If the shelter/location is in a different county than the treatment facility, use the county where he/she lives. As a last resort, use the county of the facility.

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Primary Substance of Abuse = 00 (None)

• When you report that the person admitted had no substances involved in treatment, this must be defended

• How can it be defended? With either “Co-dependent” = Yes, or with an “Other Factor” of Adult Child, Significant Other, or Gambling Addiction

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Number of Prior Treatments

• Include only treatment admissions and not assessment services

• These should be episodes and not changes in levels of care

• Answers the question, “How many times have you tried to address this problem via treatment at any provider?”

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Employment Status at Admission and Discharge

Reporting employment status for students who have no current job:• Under age 18 = Not Applicable• Over Age 18 = Not in the Labor Force

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Detailed Not In Labor Force

• Use only when Employment Status = 4 (Not in competitive labor force)

Make sure if a student (college) is over the age of 18 that Detailed Not in the Labor Force is coded with 2 =Student

This is being missed systematically. Feds use this for Employment/Education NOM

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Number of Dependents

• Number of dependents claimed on federal tax return

• Only report zero if the client is reported as a dependent on another person’s federal tax return ( i.e. dependent minors)

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Total Annual Income at Admission

• This is estimate of income for 12-months prior to admission

• Only legally earned taxable and non-taxable income should be reported

• If client is single, indicate the total amount of gross income of the individual; if client is married, indicate the total of the client and spouse

• For a minor client, indicate the 12-month income of the parent(s)

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Opioid Replacement Part of Treatment at Admission

• Only reply with “1= Methadone Yes” if you are an approved methadone dispensing site

• The license number listed in the record MUST be an approved methadone provider; so only these sites should have the ability to code “yes”

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TEDS Reporting Discharge Date

• The reported date of discharge is also the “last date of contact or billable service”

• When a case is administratively discharged after a period of inactivity, the reported discharge date reverts back to that last date of contact or the last date of a billable service

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Discharge Reason

• Discharge reason is unique in that it is only collected once at discharge

“Death” means the death of the person in treatment....not the death of a relative or friend

We should not see a re-admission for persons reporting the reason for discharge as “death”

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A New Approach to Consider

• In 2013, for the same six-digit provider license number...the reported service category at discharge does NOT have to match the service category at admission

• Example: A person receives detox, short-term residential, and outpatient from the same provider under one license

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Reporting 30-Day Windowat Discharge

Only consider events that occurred since admission when reporting the “previous 30-day window” at discharge for: • PSA Frequency of Use• SSA Frequency of Use • TSA Frequency of Use• Recent (30-Day) Total Arrests • Recent (30-Day) Possession/Sales Arrests • Recent (30-Day) DUI/DWI • Attendance at Self Help Programs

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Reporting 30-Day Windowat Discharge (continued)

• Only take into consideration events that occurred after the admission date – Never count events in the discharge record that took place before treatment began (before the admission date)

• Those pre-admission events would have been captured already at admission

• Again, If the length of stay is less than 30 days, do not go back past the admission date to capture use or arrests or self-help group attendance

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Other Considerations

• There will be instances where you will have to use your judgment on how to code unique situations

• Trust your judgment and select your best answer

• The discharge record is there to track changes from admission and only looks at events that take place after the admission date

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And Some Kudos

Your efforts on TEDS reporting have allowed Michigan to show that, for persons in treatment,

there are consistent improvements in use patterns, employment, homelessness, social

support/self help, and arrests