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HEALTHECONOMICSRESEARCH,INC. 3W0a0ltFhifatmh.AvMeAnu0e2.156t4hFloe (617)487-0200 (617)487-0202Fax UNIQUE PHYSICIAN IDENTIFICATION NUMBER (UPIN) VALIDATIONSTUDIES DocumentationForTheUPIN IntegrityAndMultiple-UPINFiles Submittedby: KillardW.Adamache,Ph.D. WilliamR.Scott,III Preparedfor AnnMeadow,Sc.D. HCFAProjectOfficer October5,1994 ThisresearchwasfundedunderDeliveryOrderNo.5oftheHCFAMasterContractNo.500-92-0020.Thestatementscontainedin thisreportaresolelythoseoftheauthorsanddonotnecessarilyreflecttheviewsorpoliciesofHCFA.Thecontractorassumes responsibilityfortheaccuracyandcompletenessofinformationcontainedinthisreport. TABLEOFCONTENTS PAGE 1.0 INTRODUCTION -1- 2.0 REGISTRYRECORDANDHCFARECORDLAYOUTS -2- 3.0 DEVELOPMENTOFTHEINTEGRITYANDMULTIPLE-UPINFILES -4- 3.1 IntegrityFileFlags -4- 3.1.1 IndividualDataElements -4- 3.1.2 LogicalConsistency -5- 3.1.3 ConsistencyofHeaderandPracticeSettingValues -6- 3.1.4 ConsistencyAcrossPracticeSettings -7- 3.2 DevelopmentoftheIntegrityFile -7- 3.3 DevelopmentoftheMultiple-UPINFile -8- 4.0 MAINTENANCEOFPROGRAMSUSEDTODEVELOPTHE INTEGRITYFILE » -9- 5.0 REPORTSCREATEDFROMTHEINTEGRITYANDMULTIPLE-UPIN FILES -10- 5.1 IntegrityFileReports -10- 5.1.1 PracticeSettingReports -11- 5.1.2 HeaderReports -12- 5.2 Multiple-UPINReport -12- TABLEOFEXHIBITS PAGE EXHIBIT1 STRUCTUREOFARECORDFORANINDIVIDUALPROVIDER WITHMULTIPLEPRACTICESETTINGS -14- EXHIBIT2 FORMATSOFREGISTRYDATAELEMENTS -15- EXHIBIT3 FLOWOFPROGRAMSTOCREATETHEINTEGRITYAND MULTIPLE-UPINFILES -16- EXHIBIT4 VARIABLENAMESFORREGISTRYDATAELEMENTS -17- EXHIBIT5 DEFINITIONOFDATAELEMENTINTEGRITYMEASURES -19- EXHIBIT6 COMPONENTSOFKEYVARIABLESFORDETECTING MULTIPLE-UPINCASES -22- EXHIBIT7 DATAELEMENTSREQUIRINGUPDATESOFBOUNDARY VALUESFORFLAGVALUES: QUARTERLYFILEAND UPDATEFREQUENCY -23- EXHIBIT8 INTEGRITYANDMULTIPLE-UPINREPORTS -24- EXHIBIT9 SAMPLEPRACTICESETTINGREPORT(EXPANDED) -25- EXHIBIT10 SAMPLEHEADERREPORT(EXPANDED) -26- EXHIBIT11 SAMPLEMULTIPLE-UPINREPORT -27- 1.0 INTRODUCTION ThePhysicianRegistrywasestablishedin1989byHCFAforthepurposeofissuing uniqueidentificationnumbers(UPINs)tothefollowingMedicareproviders: doctorsof medicine,osteopathy,dentalmedicine,dentalsurgery,podiatryandoptometry,and chiropractors. Toassistintheidentificationofindividualproviders,theRegistrycollectsa varietyofinformation. TwospecialfilescontainingPhysicianRegistrydatawerecreatedtoassistHCFA, Registrypersonnel,carrierpersonnelandresearchersinusingthedata. Onefile-UPIN Integrityfile-containsunedited,originalRegistrydataandspecialvariables(i.e.,"flags")that indicatedataqualityforeachproviderpracticesetting. Theotherfile-Multiple-UPINfile- containsrecordsofprovidersthatmayhavemorethanoneUPIN. Thesefilesweredeveloped byHealthEconomicsResearch,Inc.(HER)basedonitsanalysesofRegistrydata.l Theflagvariablescanbeusedbyoperationspersonneltoquicklyobtainfrequenciesof thedifferenttypesofnon-feasiblevaluesgivenadataelement. Researcherscansimilarlyuse theflagstoobtainaquickassessmentofdataqualitywithouthavingtosettheirowncriteria fordoingso. ThenextsectiondescribesRegistryfileandrecordformats. Itisfollowedbya descriptionofthedevelopmentoftheflagvariablesandtheIntegrityandMultiple-UPINfiles. Thenextsectiondescribesthechangesthatperiodicallyneedtobemadetotheprogramsthat createdtheIntegrityfile. Thelastsectiondescribesreportsthatwerecreatedtoassistthe RegistryandcarriersinmaintainingRegistrydata. 1UniquePhysicianIdentificationNumber(UPIN)ValidationStudies:CarrierAnalysis,HCFAMasterContractNo.500-92-0050, DriiveryOrderNo.5,August23,1994. -1- upin\super\text.doc\pwt 2.0 REGISTRYRECORDANDHCFARECORDLAYOUTS Inthissection,thefilesusedasbasicinputfilesincreatingtheIntegrityandMultiple- UPINfilesaredescribed. Eachquarter,TransamericaOccidentalLifeInsuranceCompany (TOLIC),theRegistrycontractor,sendsanupdatedcopyoftheRegistryfiletoHCFA. Foreach providerthereisonerecord. Aprovider'srecordintheRegistry'sfileconsistsofaheader section,containingdatathatshouldbeinvariantacrosspracticesettingsandapracticesetting section. Withinthepracticesettingsection,thereareasmanypracticesettingsegmentsasthe providerhaspracticesettings,bothactiveandinactive. Becausethenumberofpracticesetting segmentsvariesbyprovider,afilewiththistypeofrecordstructureisknownasavariable- lengthrecordfile. ThisstructureisillustratedinthetophalfofExhibit1. ThereareseveraldataelementsinTOLICsfilethathaveadifferentformatfromthe recordssubmittedbycarrierstotheRegistry(Exhibit2). Inparticular,severalofthedatefields intheTOLICfilehaveapackednumericformatandthecomponentsofthedatevariablesare transposed. AlsoincludedinExhibit2isthevaluecarrierswereinstructedtousetoindicate "missing"information. Uponreceiptofthefile,HCFA'sBureauofDataManagementandStrategy(BDMS) createsa515-byteflatfilewithfixed-lengthrecords(firstiteminPanelAinExhibit3). Foreach provider,BDMScreatesasmanyrecordsastherearepracticesettingsintheprovider'sTOLIC record. Eachproviderrecordconsistsofaheadersectionandapracticesettingsectionas illustratedinthebottomhalfofExhibit1. SelectedvariablescreatedbyBDMSfromtheTOLICfilearelistedinExhibit4. Only thosevariablesintheBDMSfilethatareusedinthecreationoftheIntegrityandMultiple-UPIN filesarelisted. ThefirstcolumninExhibit4containsthenamesofdataelementssubmittedto TOLIConcarrierrecords. Thesecondcolumncontainsanexpandeddefinitionofcarrierdata elements. Thethirdcolumncontainsacodethatindicateswhetherthevariableisaheader -2- upin\super\text.doc\pwt variable(code=H),orwhetheritisapracticesettingvariable(code=S)ontheBDMSfile. The fourthcolumnisthe"fieldname"usedinHCFA'sdocumentationoftheflatfile. FromtheflatfilecreatedbyBDMS,HERhascreatedanSASdatasetthathasthesame structureastheBDMSfile. Foritsdevelopmentalwork,HERusedtheApril1994flatfile. The SASvariablenamesassignedbyHERarelistedinthefifthcolumnofExhibit4. Theprogram usedbyHERtocreatetheSASdatasetisavailablefromHCFA(item2inPanelAofExhibit3). IntheSAShie,datesarestoredasnumbersratherthaninaSASdateformat. Allbutoneofthe SASprogramsdescribedinSections3.2and3.3usesthisSASdatasetasitsinputfile. (The exceptionistheOUTSUPERprogramwhichisthelaststepincreatingtheIntegrityfile-see PanelBofExhibit3.) Thereareseveraldataelementsthatarecommontoboththeheaderandpracticesetting segmentsoftheproviderrecord. Forinstance,theSASnamefortheheaderversionofthedate ofbirthisDOBwhilethenameforthepracticesettingversionisSETDOB. Note,however,that thevaluesofthetwoversionscoulddiffer,becausetheyarederivedfromtheirrespective sectionsintheTOLICproviderrecord. TOLICdoesnotforcethetwovaluestoequaleach other. Thefollowingvariableshavebothheaderandpracticesettingversions: • providername, • dateofbirth, • schoolcode, • graduationyear, • sanctioninformation: • sanctioncode, • sanctiondate,and • sanctionlength. -3- upin\super\text.doc\pwt Thepracticesettingversionsofthesevariablesarethesameasthoseusedinthecarrierrecords transmittedtoTOLIC. 3.0 DEVELOPMENTOFTHEINTEGRITYANDMULTIPLE-UPINFILES 3.1 IntegrityFileFlags TheuseoftheIntegrityfileiscenteredontheflagvariablescreatedduringits construction. Therearetwotypesofflagvariables. Theflagvariablesforindividualvariables indicatewhetherthevalueofavariableisfeasibleornon-feasibleand,ifnon-feasible,itsnature (e.g.,retiredcodepresent). Thesecondtypeindicateswhetherthecodingoftwovariables beingcomparedisconsistent. Thebasiccategoriesforeachtypeofflagvariablearedescribed inthefoursectionsthatfollow. 3.1.1 IndividualDataElements Flagvariablesforindividualvariablesindicatewhetherthevalueofavariableisfeasible ornon-feasible,and,ifnon-feasible,itsnature(e.g.,missing). Forexample,adateofbirth equaltoJanuary2,1952isfeasible;butadateequaltoJanuary32,1952isnot. Inthesecond case,thedateofbirthiserroneous. Whilethisexampleisobvious,the"dubious"categorycalls formoreexplanation. Consider,forinstance,aproviderthathasagraduationdateof1935. Assumingthathegraduatedfrommedicalschoolatage25,thismakeshim84yearsoldin 1994. Whiletheremightbeafewprovidersthatarestillpracticingmedicineatthatage,itis unlikely. Therefore,thegraduationdateisclassifiedas"dubious." Thefivebasicflagvaluesare: F-Feasible M-Missing -A- upin\super\text.doc\pwt E-Erroneous D-Dubious U-Unknown Specialflagvalueswerecreatedtomeetspecificcircumstances,e.g.,statelicensenumberisnot rightjustifiedperRegistryspecifications. Thecriteriausedtodefinefeasibleandnon-feasible valuesforeachvariablearepresentedinExhibit5. TheflagsforindividualpracticesettingvariablesarecreatedintheSASprogram OUTINTS(seePanelBinExhibit3).2Theflagsforindividualheadervariablesarecreatedin theSASprogramOUTINTH. ThenamesoftheflagvariablesintheIntegrityfilehavean"I" prefix. Iftherearebothheaderandpracticesettingversionsofadataelement(e.g.,dateof birth),an"H"suffixindicatesaheaderflagandaSsuffixindicatesapracticesettingflag. 3.1.2 LogicalConsistency Logicalconsistencyflagsarebasedonthecomparisonofrelatedvariables,e.g., specialtycodeandcredentials. Ifthespecialtycodeindicatesapodiatryspecialtyandthe credentialsindicatesthattheproviderisachiropractor,thenthereisalogicalinconsistency betweenthetwo. Therearefourgeneralvaluesforthelogicalconsistencyflagvariables: • K-bothvariablesarefeasibleandarelogicallyconsistentwitheachother • I-bothvariablesarefeasiblebutarelogicallyinconsistent • M-bothvariablesaremissing • N-anyothercombination Unlessotherwiseindicated,SASprogramsreferencedinSection3.1and3.2arelistedinPanelBofExhibit3. -5- upin\super\text.doc\pwt Theoneexceptiontotheabovelistisforcomparisonsbetweengraduationyeuiandtheopen andclosedatesofmedicalschools. Thereasonisthatclosuredatesareonlyavailablefor medicalschoolsandnotfortheothertypesofprofessionalschool. Inthosecasesinwhicha providergraduatedfromaprofessionalschoolotherthanamedicalschool,theflagvalueisset toablank. Theflagsforlogicalconsistencycomparisonsbetweenpracticesettingvariablesare createdintheSASprogramOUTLCFS. Theflagsforthelogicalconsistencycomparisons betweenheadervariablesarecreatedintheSASprogramOUTLCFH. Thenamesoflogical consistencyflagvariablesintheIntegrityfilehavea"LCF"prefix. 3.1.3 ConsistencyofHeaderandPracticeSettingValues Consistencyflagsforthecomparisonofheaderandpracticesettingversionsofadata elementwerecreated. Thevaluesofthesevariablesshouldbeidentical. Therearefourgeneral valuesfortheheader/practicesettingconsistencyflagvariables: • K-bothvariablesarefeasibleandhavethesamevalue • I-bothvariabl sarefeasiblebuthavedifferentvalues • M-bothvariablesaremissing • N-anyothercombination Theflagsfortheconsistencybetweenheaderandpracticesettingvariablesarecreated intheSASprogramOUTHDSET. ThenameoftheflagvariablesintheIntegrityfilehavea "HDSET"prefix. -6- upin\super\text.doc\pwt