Update BFD HHA exporter to support PPS codes and improve HCPCS to rev…

…enue center mapping
synthetichealth · Jul 3, 2023 · 7313dd9 · 7313dd9
1 parent 15c8434
commit 7313dd9
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Showing 4 changed files with 64 additions and 12 deletions.
diff --git a/.gitignore b/.gitignore
@@ -31,6 +31,8 @@ src/main/resources/export/snf_pdpm_code_map.json
 src/main/resources/export/snf_pps_code_map.json
 src/main/resources/export/snf_rev_cntr_code_map.json
 src/main/resources/export/hha_rev_cntr_code_map.json
+src/main/resources/export/hha_pps_case_mix_codes.csv
+src/main/resources/export/hha_pps_pdgm_codes.csv
 src/main/resources/export/hospice_rev_cntr_code_map.json
 src/main/resources/export/inpatient_rev_cntr_code_map.json
 src/main/resources/export/outpatient_rev_cntr_code_map.json

diff --git a/src/main/java/org/mitre/synthea/export/rif/BB2RIFExporter.java b/src/main/java/org/mitre/synthea/export/rif/BB2RIFExporter.java
@@ -84,6 +84,8 @@ public class BB2RIFExporter {
   final CodeMapper inpatientRevCntrMapper;
   final CodeMapper outpatientRevCntrMapper;
   final Map<String, RandomCollection<String>> externalCodes;
+  final RandomCollection<String> hhaCaseMixCodes;
+  final RandomCollection<String> hhaPDGMCodes;
   final CMSStateCodeMapper locationMapper;
   final BeneficiaryExporter beneExp;
   final InpatientExporter inpatientExp;
@@ -115,6 +117,8 @@ private BB2RIFExporter() {
     outpatientRevCntrMapper = new CodeMapper("export/outpatient_rev_cntr_code_map.json");
     locationMapper = new CMSStateCodeMapper();
     externalCodes = loadExternalCodes();
+    hhaCaseMixCodes = loadPPSCodes("export/hha_pps_case_mix_codes.csv");
+    hhaPDGMCodes = loadPPSCodes("export/hha_pps_pdgm_codes.csv");
     try {
       staticFieldConfig = new StaticFieldConfig();
       rifWriters = prepareOutputFiles();
@@ -166,6 +170,30 @@ private static Map<String, RandomCollection<String>> loadExternalCodes() {
     return data;
   }
 
+  private static RandomCollection<String> loadPPSCodes(String resourcePath) {
+    RandomCollection<String> codes = new RandomCollection<>();
+    try {
+      String fileData = Utilities.readResourceAndStripBOM(resourcePath);
+      List<LinkedHashMap<String, String>> csv = SimpleCSV.parse(fileData);
+      for (LinkedHashMap<String, String> row : csv) {
+        String code = row.get("code");
+        long count = Long.parseLong(row.get("count"));
+        codes.add(count, code);
+      }
+    } catch (Exception e) {
+      if (Config.getAsBoolean("exporter.bfd.require_code_maps", true)) {
+        throw new MissingResourceException(
+            "Unable to read PPS code file",
+            "BB2RIFExporter", resourcePath);
+      } else {
+        // For testing, the external codes are not present.
+        System.out.printf("BB2RIFExporter is running without '%s'\n", resourcePath);
+      }
+      return null;
+    }
+    return codes;
+  }
+
   <E extends Enum<E>> void setExternalCode(Person person,
       Map<E,String> fieldValues, E diagnosisCodeKey,
       E externalCodeKey, E externalVersionKey,

diff --git a/src/main/java/org/mitre/synthea/export/rif/CodeMapper.java b/src/main/java/org/mitre/synthea/export/rif/CodeMapper.java
@@ -3,10 +3,8 @@
 import com.google.gson.Gson;
 import com.google.gson.JsonSyntaxException;
 import com.google.gson.reflect.TypeToken;
-import java.io.File;
 import java.io.IOException;
 import java.lang.reflect.Type;
-import java.nio.file.Files;
 import java.util.ArrayList;
 import java.util.Collections;
 import java.util.HashMap;
@@ -20,7 +18,6 @@
 import org.mitre.synthea.helpers.Config;
 import org.mitre.synthea.helpers.RandomCollection;
 import org.mitre.synthea.helpers.RandomNumberGenerator;
-import org.mitre.synthea.helpers.SimpleCSV;
 import org.mitre.synthea.helpers.Utilities;
 import org.mitre.synthea.world.concepts.HealthRecord.Code;
 

diff --git a/src/main/java/org/mitre/synthea/export/rif/HHAExporter.java b/src/main/java/org/mitre/synthea/export/rif/HHAExporter.java
@@ -19,6 +19,9 @@
  */
 public class HHAExporter extends RIFExporter {
 
+  private static final long HHA_PPS_CASE_MIX_START = parseSimpleDate("20080101");
+  private static final long HHA_PPS_PDGM_START = parseSimpleDate("20200101");
+
   /**
    * Construct an exporter for HHA claims.
    * @param exporter the exporter instance that will be used to access code mappers
@@ -87,23 +90,45 @@ long export(Person person, long startTime, long stopTime) throws IOException {
 
       final String HHA_TOTAL_CHARGE_REV_CNTR = "0001"; // Total charge
       final String HHA_GENERAL_REV_CNTR = "0270"; // General medical/surgical supplies
+      final String HHA_PPS_REV_CNTR = "0023"; // Prospective payment system
       final String HHA_MEDICATION_CODE = "T1502"; // Administration of medication
+
+      // Select a PPS code for this service period (if a PPS program was in place at the time).
+      // Only one PPS code per service period since the code is based on patient characteristics
+      // and care need.
+      // TODO: rather than pick a weighted random PPS code, pick a code based on current patient
+      // characteristics.
+      String ppsCode = null;
+      if (servicePeriod.getStart() > HHA_PPS_PDGM_START) {
+        ppsCode = exporter.hhaPDGMCodes.next(person);
+      } else if (servicePeriod.getStart() > HHA_PPS_CASE_MIX_START) {
+        ppsCode = exporter.hhaCaseMixCodes.next(person);
+      }
+      System.out.printf("Assigned PPS code: %s\n", ppsCode == null ? "NULL" : ppsCode);
+
       ConsolidatedClaimLines consolidatedClaimLines = new ConsolidatedClaimLines();
       for (HealthRecord.Encounter encounter : servicePeriod.getEncounters()) {
         for (Claim.ClaimEntry lineItem : encounter.claim.items) {
           String hcpcsCode = null;
           if (lineItem.entry instanceof HealthRecord.Procedure) {
-            for (HealthRecord.Code code : lineItem.entry.codes) {
-              if (exporter.hcpcsCodeMapper.canMap(code)) {
-                hcpcsCode = exporter.hcpcsCodeMapper.map(code, person, true);
-                if (exporter.hhaRevCntrMapper.canMap(code)) {
-                  revCenter = exporter.hhaRevCntrMapper.map(code, person);
+            // 10% of line items use a PPS code, use higher number here to account for
+            // every claim having a total charge line
+            if (ppsCode != null && person.rand() < 0.15) {
+              hcpcsCode = ppsCode;
+              revCenter = HHA_PPS_REV_CNTR;
+            } else {
+              for (HealthRecord.Code code : lineItem.entry.codes) {
+                if (exporter.hcpcsCodeMapper.canMap(code)) {
+                  hcpcsCode = exporter.hcpcsCodeMapper.map(code, person, true);
+                  if (exporter.hhaRevCntrMapper.canMap(hcpcsCode)) {
+                    revCenter = exporter.hhaRevCntrMapper.map(hcpcsCode, person);
+                  }
+                  break; // take the first mappable code for each procedure
                 }
-                break; // take the first mappable code for each procedure
               }
-            }
-            if (hcpcsCode == null) {
-              revCenter = HHA_GENERAL_REV_CNTR;
+              if (hcpcsCode == null) {
+                revCenter = HHA_GENERAL_REV_CNTR;
+              }
             }
             consolidatedClaimLines.addClaimLine(hcpcsCode, revCenter, lineItem, encounter);
           } else if (lineItem.entry instanceof HealthRecord.Medication) {