Adding or editing a direct to encounter definition

To use direct to encounter (D2E), you configure a D2E definition with the following criteria:

• Identify the patient population - Specify the encounters or cost details that qualify for a cost item.

• Configure the data tabulation - Specify how you want Axiom to tabulate and derive the data. For example, sum of total or a "use of" scenario, i.e. ten days length of stay.

  • Volume, such as case count, length of stay, or visits

  • Data aggregation, such as averages, maximum or minimum count, or sum

  • The service date or post date to use

• Identify where to put the D2E cost item - Define the department(s) in which to place the cost item, which becomes the target of the outbound data of a D2E. The item is then added to the selected departments.

After you create a D2E definition, Axiom then automatically creates a pseudo cost item to the cost item table in the database. It is referred to as "pseudo" because it technically does not exist in the cost item table and is only used to charge for items that are non-chargeable. For more information, see About pseudo cost items and D2E.

To use the D2E method, in the RVU maintenance page you must also add the pseudo cost item to the department and enter the RVU values. During the costing process, the cost for the pseudo cost item comes from the RVU values for the department(s) identified in the D2E definition. This means that if you have not set up an RVU value, pseudo cost items will cost at zero. During the costing process, the assignment of the pseudo cost items will use the RVU value. Anything else will default to an RCC and will then cost through the process.

IMPORTANT: If a department changes or closes, make sure to make the appropriate adjustment to the D2E definition for that department.

To add or edit a direct to encounter definition:

1. From the Enterprise Decision Support home page, in the Cost accounting section, click Modify a cost model or Create a cost model.

2. The last cost model selected is shown at the top of the page. To change cost models, select another one from the Select cost model drop-down.

3. Under the Methods section, click Define direct to encounter.

4. If there is not an existing D2E definition table version assigned to this cost model, the table will be empty.

   1. Click the link in the "Create or select a version here" text within the table.

   2. In the Modify a cost model dialog, from the Direct to encounter drop-down, do one of the following and click Save:

      • To create a new version of the D2E definition table, select Create new version.

      • To assign an existing version of the D2E definition table, select the version from the list.

5. If there is an existing D2E definition table version assigned to this cost model and you would like to modify it:

   1. Click the link in the cost model's name in the table's header.

   2. In the Modify a cost model dialog, from the Direct to encounter drop-down, do one of the following and click Save:

      • To create a new version of the D2E definition table, select Create new version.

      • To assign an existing version of the D2E definition table, select the version from the list.

   NOTE: Steps 4-5 are optional. As part of the initial set up of the cost model, the version has likely already been created or selected. This step simply provides you a quick and easy way to select another version to use or create a new one from scratch, if needed.

6. In the Manage direct to encounter cost definitions page, do one of the following:
   • To add a definition, click + Add definition.

   • To edit a definition, click its edit icon in the Actions column.

7. In the Add/Edit cost definition dialog, complete the following, and click Save:

   Field	Steps
   Name	Enter a unique name for the pseudo cost item. TIP: We recommend that you use a name that you can visually recognize as a D2E type of cost item in reporting. For example: D2E Item 12345 Medical Records.
   Description	Enter a description of the definition.
   Table to filter	Select the table that best suits the allocation (cost detail or encounter). NOTE: The table you choose affects the choices in the remaining drop-downs in the dialog. For example, if you select cost detail, you need to select the correct selection from the Volume filter field and the Service date proxy field. The dialog will prompt you to make the correct selections.
   1 CostDetail filter	Create or select an existing filter using the Filter Wizard to specify the cost details that qualify for a pseudo cost item. IMPORTANT: When creating or using filters for D2E definitions, the utility defaults to filtering the data in the encounter or cost detail table. You can filter on another table type, such as a custom table, but in order for the system to process the D2E correctly, the table must look up to either one of these tables.
   2 Aggregation settings
   Volume filter	Select the best fit for the allocation. The volume field allows you to select a numerical field on which to generate the volume for each patient’s D2E cost item. This volume will determine what proportion of cost that each patient receives, so take care that you select a volume proxy that is meaningful for the distribution of the costs in the department. Example 1: The volume for allocating the costs of the patient registration department to patients may use a simple case count on the encounter table for the volume, each patient getting an equal registration share. Example 2: The volume for allocating the costs of a piece of equipment from the IT department that is used over the period of a patient stay may use the length of stay as the volume. Note that there are more selections in this field when using the encounter table. This is because there are more useful numeric value fields in this table. The charge detail table only includes two meaningful volume fields.
   Aggregation method	Select one of the following: To allocate costs based on an average calculation of the volume method, select Average. To allocate costs based on a count of the volume method, select Count. To allocate costs based on a one time count of the volume method, select Distinct count. To allocate costs based on the maximum value in the volume method, select Maximum. To allocate costs based on the minimum value in the volume method, select Minimum. To allocate costs based on the sum of the volume in the volume method, select Sum.
   Service date proxy	Because you are creating service dates that do not actually exist, you need to select a date field to copy to generate meaningful service dates to match the actual periods of stay for the patients and to align with the period of costs you are wanting to allocate to those patients. Do one of the following: For the encounter table filter, for the date range of data to be utilized to allocate the expenses to the encounter level, select Admit date or Discharge date. For the cost detail table filter, for the date range of data to be utilized to allocate the expenses to the encounter level, select Post date or Service date.
   3 To departments	Create or select an existing filter using the Filter Wizard to identify the department(s) in which to add the pseudo cost item. If you select more than one department, each one will receive a pseudo cost item with the same value.

8. In the RVU maintenance page, add the new pseudo cost item to the appropriate department(s), and enter the RVU value.

   IMPORTANT: Without an RVU value, D2E items will cost at zero.

9. If you are creating a new model, the next step is to define your cost method exclusions. Click Next in the bottom right corner of the page or click the Cost method exclusions tab at the top of the page.
10. If you are modifying an existing cost model, you can continue making changes to other parts of the model or go directly to processing the cost model if this is your only change.

    IMPORTANT: When making any changes to an existing cost model, you must reprocess it in order for the results to reflect the changes.