Illinois Hospital Association

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June 28, 2007

Illinois Consumer Guide Rules Adopted June 26, 2007

The Illinois administrative rule covering the Consumer Guide was adopted on June 26, 2007. The Consumer Guide evolved out of legislation passed and signed into law in 2005 under the Health Finance Reform Act. To see rule, click here.

Please note that IHA will be hosting a telephone conference call on the new Consumer Guide rules on July 12 at 10:00 a.m. for all Illinois hospitals. Details on the call will be sent to all hospital contacts.

Please be aware that IHA’s COMPdata has been working with hospitals to prepare them for the expanded reporting of information since late 2006. Detailed training sessions continue to be held throughout the state along with data collection Webinars. Since early this year, COMPdata has been ready to receive the expanded data and established an electronic testing environment with electronic feedback reports for all hospitals and their vendors to test their submissions before the new reporting requirements go into place with January 1, 2008 patient discharges and cases.

The Consumer Guide has three major components and associated requirements for hospitals reporting data to the Illinois Department of Public Health (IDPH), including:

  • Expansion of Hospital Reported Data - horizontally and vertically.
  • Consumer Guide With Publicly Available Performance Information by Hospital and Ambulatory Surgical Treatment Center
  • Release of Provider Data at a non-identifiable patient level

Expansion of Hospital Reported Data
While the information reported by hospitals expanded about a decade ago to include ambulatory surgical data, the elements required to be submitted for each patient case has not changed in over two decades. The Consumer Guide rules for inpatient reporting now expands the elements to include many reported in the HIPAA claims for inpatient care. Expanded elements include, but are not limited to the following:

  • Up to and including 25 diagnoses codes and 25 procedure codes
  • Race and ethnicity using federal OMB standards (similar requirements for CMS HQA and Joint Commission Core Measurements)
  • Present on Admission Code for all inpatient diagnoses codes – identifying whether a condition occurred prior to hospital admission, during hospital stay, not clinically determined, unknown, or not required (i.e., Pregnancy, tumors, etc.)
  • Birthweight of newborns in grams
  • E-Codes (external cause of injury codes – including poisoning, falls, etc.)
  • And several more HIPAA elements
    •

    Additionally, starting with January 1, 2009 cases, hospitals will be required to submit all emergency room and observation cases to IDPH.

    Consumer Guide with Publicly Available Information
    The rules do not provide detailed specification on the public Consumer Guide due to the flexibility built into the law to modify publicly reported information in response to the changing environment. The Consumer Guide, a report to be posted on IDPH's web site, will include at least 60 conditions and procedures, including volume of cases, average charges, risk-adjusted mortality rates, complications, hospital infections and surgical infections.

    Prior to information being shared with the public, hospitals and ambulatory surgical treatment centers (ASTCs) will be provided opportunities to review and comment on their data. Once a data submission period is ‘closed’, hospitals and ASTCs will not have an opportunity to change the data, but will be provided an opportunity to provide public comments. As time frames for reporting data will be critically important for providers to meet, the upcoming conference call on July 12th will provide details on all time lines.

    Release of Provider Data
    IDPH will be releasing non-identifiable patient level data to requesting parties under the rules outlined in the new Consumer Guide rules. Please note that the rules do allow for access to limited non-identifiable patient level data by various entities, including researchers, commercial information companies, health plans, media, etc. The levels of access and ability to disseminate information are described in the rules and will be covered on the July 12 conference call.

    IHA will continue to keep you current with all of the public information and impending changes affecting hospitals as well as provide you resources and tools to help navigate through this fast changing environment. Details on the July 12 conference call at 10:00 a.m. on the new Consumer Guide rules will be sent to all Illinois hospitals during the week of July 2.

    Staff Contact: Pat Merryweather: (630) 276-5590