42_Section_L_Exhibit_L-6_TQMC_Workload_Report_2012-2014_5-19-15.xlsx

XLSX spreadsheet 42 KB Posted May 19, 2015

Attached to: TRICARE Quality Monitoring Contract (TQMC)
Solicitation number: HT9402-15-R-0005
Issued by: Defense Health Agency

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Section L Exhibit L-6

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2012 - 12 Mo period of Workload

2012 - 12 month period of TRICARE WORKLOAD REPORT
TQMC HT9402-15-R-0005 Section C paragraph reference		Total	January Cases Completed	February Cases Completed	March Cases Completed	April Cases Completed	May Cases Completed	June Cases Completed	July Cases Completed	August Cases Completed	September Cases Completed	October Cases Completed	November Cases Completed	December Cases Completed	Median	Mean	Standard Deviation
Retrospective Reviews	Mental Health Record Reviews	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.00
Section C, Para 6.5.1.	Retro Reviews	14,293	1628	830	624	1202	1295	1426	1604	1148	1521	1600	1041	374	1249	1191	392.38

Standards of Care Reviews	MTF SOC with Malpractice	114	4	19	13	6	15	10	6	6	12	8	7	8	8	10	4.25
Section C, Para 6.5.5., 6.5.5.5., and	MTF SOC - Active Duty	124	3	4	0	7	26	8	6	10	12	8	26	14	8	10	7.90
6.5.6. respectively	Quality of Care Reviews	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.00

Transition Asst. Mgt. PGM	TAMP Reviews	1	0	0	0	0	1	0	0	0	0	0	0	0	0	0	0.28
Section C, Para 6.5.4
TMA Reviews Section C, Para 6.5.3.1.	Internal Reviews	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.00
TMA Reviews	Urgent External Reviews	15	2	0	0	1	2	4	2	0	0	2	1	1	1	1	1.16
TMA Reviews	Routine External Reviews	211	11	15	18	30	17	22	28	15	14	11	17	13	16	18	5.89
	Routine External Reviews											1
												1

Reconsiderations/Appeals	Recon/Appeals (Medical Necessity)	636	58	61	56	45	60	52	57	52	38	59	45	53	55	53	6.79
Section C, Para 6.5.2.
Hearing Support	Pre-Hearing Preparations (Hours)	35	1	0	1	0	0	0	0	0	0	0	0	33	0	3	9.08
Section C, Para 6.5.3.1.	Hearing Appearance (Hours)	9	1	0	0	0	0	0	0	0	0	0	0	8	0	1	2.20
	Post-Hearing (Hours)	4	1	0	0	0	0	0	0	0	0	0	0	3	0	0	0.85
	Transcription of Expert Witness (Hours)	11	0	0	1	0	0	0	0	0	0	0	0	10	0	1	2.75
TRAVEL Section C, Parax 6.1.13 and 9.0	Travel for Meetings	1	0	0	0	0	0	0	0	0	0	0	0	1	0	0	0.28
Reports
	Monthly Concerns and Workload Report	12	1	1	1	1	1	1	1	1	1	1	1	1	1	1	0.00
	Monthly Facilities Listing Report	12	1	1	1	1	1	1	1	1	1	1	1	1	1	1	0.00

Quaterly Contractor Performance Report	4	1	0	0	1	0	0	1	0	0	1	0	0	0	0	0.47
Quarterly IQMP Report	4	1	0	0	1	0	0	1	0	0	1	0	0	0	0	0.47

Section C, para 6.3.1.4	HEDIS Annual Audit and Report	1	0	0	0	0	0	0	0	0	0	1	0	0	0	0	0.28
	Annual IQMP	1	0	0		0	1	0	0	0	0	0	0	0	0	0	0.29

Studies Section C Para 6.7.	Short Evolving Practices Assessement	2	0	0	0	0	1	0	0	0	0	0	1	0	0	0	0.37
	Long Evolving Practices Assessement	5	0	1	0	0	0	3	0	0	1	0	0	0	0	0	0.86

Studies Section C, Para .6.6.1.	Focus Studies (completion value = total staff hours	618	160	0.0	0.0	0	42.00	42.00	42.00	262.50	68.00	0	2	0	22	52	77.78
Clinical Quality Improvement Administrative Studies.

BH Facility Certifications	BH Fac. Certification Application Reviews	44	3	0	13	2	4	6	6	0	6	2	2	0	3	4	3.57
Section C, Para 6.4.	BH Fac. Cert. (On-site Surveys)	20	2	3	3	0	0	1	2	2	2	2	1	2	2	2	0.94

Research Study Activities
	Case and Study Workload Totals	1878	935	731	1297	1466	1576	1757	1498	1676	1699	1145	522	1482	1348	412.79

Section L, Exhibit L-6 TQMC Workload Report (2012-2014)

TQMC HT9402-15-R-0005, Section L, Exhibit L-6 Page &P of &N

2013 - 12 Mo period of Workload

2013 - 12 month period of TRICARE WORKLOAD REPORT
TQMC HT9402-15-R-0005 Section C paragraph reference		Total	January Cases Completed	February Cases Completed	March Cases Completed	April Cases Completed	May Cases Completed	June Cases Completed	July Cases Completed	August Cases Completed	September Cases Completed	October Cases Completed	November Cases Completed	December Cases Completed	Median	Mean	Standard Deviation
Retrospective Reviews	Mental Health Record Reviews	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.00
Section C, Para 6.5.1.	Retro Reviews	9,264	1495	1483	1477	1092	433	498	0	398	1340	755	166	127	627	772	552.25

Standards of Care Reviews	MTF SOC with Malpractice	146	14	2	18	12	18	11	13	5	25	15	11	2	13	12	6.49
Section C, Para 6.5.5., 6.5.5.5., and	MTF SOC - Active Duty	128	13	6	2	14	18	14	18	11	6	22	4	0	12	11	6.71
6.5.6. respectively	Quality of Care Reviews	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.00

Transition Asst. Management Program	TAMP Reviews	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.00
Section C, Para 6.5.4
Appeals & Hearings Reviews 6.5.3	Internal Reviews	4	0	0	0	0	0	0	0	0	1	3	0	0	0	0	0.85
	Urgent External Reviews	13	0	2	1	3	2	0	3	1	0	0	0	1	1	1	1.11
	Routine External Reviews	122	11	12	17	14	14	12	4	9	5	7	11	6	11	10	3.85
	Routine External Reviews

Reconsiderations/Appeals	Recon/Appeals (Medical Necessity)	421	58	35	40	36	43	26	32	29	37	26	29	30	34	35	8.62
Section C, Para 6.5.2.
Hearing Support	Pre-Hearing Preparations (Hours)	1	0	0	0	0	0	1	0	0	0	0	0	0	0	0	0.28
Section C, Para 6.5.3.1.	Hearing Appearance (Hours)	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.00
	Post-Hearing (Hours)	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.00
	Transcription of Expert Witness (Hours)	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.00
TRAVEL Section C, Parax 6.1.13 and 9.0	Travel for Meetings	1	0	0	0	0	0	0	0	0	0	0	1	0	0	0	0.28
Reports
	Monthly Concerns and Workload Report	12	1	1	1	1	1	1	1	1	1	1	1	1	1	1	0.00
	Monthly Facilities Listing Report	12	1	1	1	1	1	1	1	1	1	1	1	1	1	1	0.00

Quaterly Contractor Performance Report	4	1	0	0	1	0	0	1	0	0	1	0	0	0	0	0.47
Quarterly IQMP Report	4	1	0	0	1	0	0	1	0	0	1	0	0	0	0	0.47

Section C, para 6.3.1.4	HEDIS Annual Audit and Report	1	0	0	0	0	0	0	0	0	0	1	0	0	0	0	0.28
	Annual IQMP	2	0	0		0	1	1	0	0	0	0	0	0	0	0	0.39

Studies Section C Para 6.7.	Short Evolving Practices Assessement	5	0	1	0	2	1	0	0	0	0	0	1	0	0	0	0.64
	Long Evolving Practices Assessement	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.00

Studies Section C, Para .6.6.1.	Focus Studies (completion value = total staff hours	307	0	0.0	0.0	45.75	20.00	36.75	47.50	37.50	43.00	38	38	0	37	26	19.18
Clinical Quality Improvement Administrative Studies.

BH Facility Certifications	BH Fac. Certification Application Reviews	80	2	3	2	4	3	14	9	4	4	7	26	2	4	7	6.75
Section C, Para 6.4.	BH Fac. Cert. (On-site Surveys)	18	2	1	1	1	2	2	1	2	1	2	2	1	2	2	0.50

Research Study Activities
	Case and Study Workload Totals	1599	1547	1560	1228	557	618	132	499	1464	880	291	171	749	879	548.84

1st Qtr 2nd Qtr 3rd Qtr 4th Qtr

Direct Care ORYX Measure Chart Abstractions	49,818	17289	16438	16091	16438	16598.4408476123	616.4162554638
Section C, Para 6.3.3.

Exhibit L-6 TQMC Workload Report

TQMC HT9402-15-R-0005, Section L, Exhibit L-6

2014 - 12 Mo period of Workload

2014 - 12 month period of TRICARE WORKLOAD REPORT
TQMC HT9402-15-R-0005 Section C paragraph reference		Total	January Cases Completed	February Cases Completed	March Cases Completed	April Cases Completed	May Cases Completed	June Cases Completed	July Cases Completed	August Cases Completed	September Cases Completed	October Cases Completed	November Cases Completed	December Cases Completed	Median	Mean	Standard Deviation
Retrospective Reviews	Mental Health Record Reviews	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.00
Section C, Para 6.5.1.	Retro Reviews	6,170	0	22	137	191	52	156	277	354	355	900	1791	1935	234	514	645.52

Standards of Care Reviews	MTF SOC with Malpractice	131	5	11	3	6	6	6	9	6	6	24	23	26	6	11	7.99
Section C, Para 6.5.5., 6.5.5.5., and	MTF SOC - Active Duty	84	4	1	3	4	2	2	0	1	2	20	22	23	3	7	8.56
6.5.6. respectively	Quality of Care Reviews	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.00

Transition Asst. Management Program	TAMP Reviews	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.00
Section C, Para 6.5.4
Appeals & Hearings Reviews 6.5.3	Internal Reviews	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.00
	Urgent External Reviews	8	0	1	1	3	2	0	0	0	0	0	0	1	0	1	0.94
	Routine External Reviews	239	3	5	5	196	3	4	7	3	3	6	1	3	4	20	53.11
	Routine External Reviews

Reconsiderations/Appeals	Recon/Appeals (Medical Necessity)	341	23	22	35	39	17	37	28	35	36	36	21	12	32	28	8.72
Section C, Para 6.5.2.
Hearing Support	Pre-Hearing Preparations (Hours)	1	0	0	0	0	0	0	1	0	0	0	0	0	0	0	0.28
Section C, Para 6.5.3.1.	Hearing Appearance (Hours)	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.00
	Post-Hearing (Hours)	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.00
	Transcription of Expert Witness (Hours)	1	0	0	0	0	0	0	1	0	0	0	0	0	0	0	0.28
TRAVEL Section C, Para 6.1.13 and 9.0	Travel for Meetings	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.00
Reports
	Monthly Concerns and Workload Report	12	1	1	1	1	1	1	1	1	1	1	1	1	1	1	0.00
	Monthly Facilities Listing Report	12	1	1	1	1	1	1	1	1	1	1	1	1	1	1	0.00

Quaterly Contractor Performance Report	4	1	0	0	1	0	0	1	0	0	1	0	0	0	0	0.47
Quarterly IQMP Report	4	1	0	0	1	0	0	1	0	0	1	0	0	0	0	0.47

Section C, para 6.3.1.4	HEDIS Annual Audit and Report	1	0	0	0	0	0	0	0	0	0	1	0	0	0	0	0.28
	Annual IQMP	0	0	0		0	0	0	0	0	0	0	0	0	0	0	0.00

Studies Section C Para 6.7.	Short Evolving Practices Assessement	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.00
	Long Evolving Practices Assessement	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.00

Studies Section C, Para .6.6.1.	Focus Studies (completion value = total staff hours	534	30	70.5	47.0	47	47.00	47.50	47.50	42.50	42.50	43	42	28	45	45	10.06
Clinical Quality Improvement Administrative Studies.

BH Facility Certifications	BH Fac. Certification Application Reviews	53	6	2	7	7	7	7	2	2	6	3	2	2	5	4	2.29
Section C, Para 6.4.	BH Fac. Cert. (On-site Surveys)	16	1	1	1	0	2	2	1	2	2	1	2	1	1	1	0.62

Research Study Activities
	Case and Study Workload Totals	76	138	241	497	140	264	378	448	455	1038	1906	2033	413	634	644.36

1st Qtr 2nd Qtr 3rd Qtr 4th Qtr Median Mean Std Dev

Direct Care ORYX Measure Chart Abstractions	93,872	29850	22583	22561	18878	22572	23148	4597.241854
Section C, Para 6.3.3.

Exhibit L-6 TQMC Workload Report

TQMC HT9402-15-R-0005, Section L, Exhibit L-6

File details come from the government source that posted it. Updated Nov 14, 2017.