meprsandeasiv “all you didn’t want to know and then some” ltc robert l. nace lab manager 1lt...

MEPRSMEPRSand and

EASIVEASIV““all you didn’t want to know and then some”all you didn’t want to know and then some”

LTC Robert L. NaceLTC Robert L. NaceLab ManagerLab Manager

1LT Chih Huang1LT Chih HuangOIC, Anatomic PathologyOIC, Anatomic Pathology

Eisenhower Army Medical CenterEisenhower Army Medical CenterFort Gordon, GeorgiaFort Gordon, Georgia

Dwight D. Eisenhower Army Medical CenterDwight D. Eisenhower Army Medical Center“Caring from the Heart”

Agenda

• MEPRS• EASIV• MEPRS Source Data• MEPRS Account Structure (FCCs)• MEPRS Expense Allocation• MEPRS Data Quality• CHCS & WAM


Objectives• Gain a basic understanding of the MEPRS

workload reporting system, structure and processes and how these relate to the lab's bottom line for both productivity and costs

• Gain an understanding of the Expense Assignment System IV (EASIV)

• Review the various reports available in EASIV and other workload reporting applications/systems

• Review CHCS workload data quality processes and reports

Medical Expense & Performance Reporting System

• MEPRS is the standardized cost accounting system for the Military Health System (MHS), containing Tri-Service financial, personnel, and workload data from reporting medical and dental treatment facilities worldwide.

• Evolved from two historical systems – Uniform Chart of Accounts (UCA) – Uniform Staffing Methodologies (USM)

• The UCA focused on tracking expenses and the USM was concerned with manpower resources

• In January 1985, the two systems were combined and MEPRS was born


MEPRS Applications

Typical Uses include• Health Affairs / Services Performance

Contract “HA Instrument Panel”• Accrual Fund and TRICARE for Life (TFL)

rates, reconciliation and evaluation• Six Sigma MTF performance metrics

(S2M3)• Patient-level SIDR and SADR costs on

M2• Optimization and Continuous Process• Improvement implementation and

evaluation• Service Business Case Analyses and

MTF “make vs. buy” assessments• PB&E budgeting and execution

analyses

• Prospective Payment System (PPS) metrics and reconciliation

• UBO billing rates (ASAs, APVs, Tent-Care, MAC, Inter-Agency, Anesthesia, etc)

• MILCON / Capital Project justification• MTF care Valuation and Efficiency

metrics• Next-Generation TRICARE contracts

benefit development and evaluation• DoD/VA and internal/external

partnership program reporting and evaluation

• HPA&E evaluation and analyses initiatives


Expense Assignment System IV(EAS IV)

• The EAS IV Repository provides the ability to query MEPRS data via Business Objects (a web-based query tool) in order to access data in detailed and aggregated form and to formulate the data into a variety of reports


MEPRS Source Data • Service specific Financial Data

– Army: STANFINS (Standard Army Financial System)

– Navy: STARS/FL (Standard Accounting and Reporting System – Field Level)

– Air Force: CRIS PBAS (Commander’s Resource Integration System Program Budget Accounting System)

• Service Specific Personnel data– Army: UCAPERS (Uniform Chart of

Accounts Personnel Utilization System “Crazy Eight”)

– Navy: SPMS (Standard Personnel Management System)

– Air Force: AF Personnel Subsystem of EAS

• Workload – CHCS / WAM

MEPRS Data:DoD-Standardized,Aggregated by FCC

DMHRSi

GFEBS


MEPRS Data Flow

Workload(CHCS)

Financial(STANFINS, STARS/FL, CRIS)

Personnel(DMHRSi --UCAPERS,

SPMS, EAS)

EASiEASi

*EAS IV Repository(Full MEPRS dataset)

**MDR(an extract

from EAS IV)

**MEWACS(an extract from EAS IV; includes

a small extract from M2)

**M2(an extract from MDR)

* Updated nightly ** Updated monthly

NOTE: The MDR & M2 updates refer to MEPRS data only

Important Note!!

CHCS WAM EASIV M2

• Although source data is the same for the various systems the data you retrieve MAY NOT be the same!

• If the data doesn’t look right INVESTIGATE!Dwight D. Eisenhower Army Medical CenterDwight D. Eisenhower Army Medical Center

“Caring from the Heart”

Financial DataFinancial Data


• Kinds of Dollars (SEECs)•Pay Data

• Military• Civilian

•Contracts•Supplies•Equipment•Base Operations•Depreciation



• DoD-standardized financial data

DoD Air Force Army Navy

SEEC - Standard Expense Element Code

EEIC - Element of Expense Investment Code

EOR - Element of Resource

EE - Expense Element

PEC - Program Element Code

PEC - Program Element Code

AMSCO - Army Management Structure Code

SAG - Subactivity Group


Personnel DataPersonnel Data

Personnel DataPersonnel Data• Full Time Equivalent (FTE)

–Amount of labor available to the MTF work center if a person works 1 month–168 Man-Hours = 1 FTE

(Avg. 21 Days/Month x 8 Hours)–2080 Man-Hours/yr = 1 FTE??

• Assigned FTEs–Time reported by Personnel assigned to specific positions/work centers on

MTF manning documents• Available FTEs

–Time reported by any personnel in a given clinic for a given month. Includes those who are Assigned, attached, borrowed, contracted, volunteers

• Non-Available FTEs–Time reported by Assigned personnel in their Assigned work center that is

unrelated to the healthcare mission such as sick leave, disaster preparedness training, etc.


PersonnelPersonnelCategoryCategory

Skill TypeSkill Type


Total FTEs (Assigned / Available)Total FTEs (Assigned / Available)

Skill TypeSkill TypeSuffixSuffix

P – PhysiciansD – DentistN – InternF – FellowR – ResidentV - Veterinarians

1 – Clinician2 - Direct Care Professional3 - Registered Nurse4 - Direct Care Para Professional5 -Admin / Clerical

C – CivilianE – EnlistedW - Red CrossL - Local NationalO – OfficerT – OtherV – VolunteerX - Contractor


PhysicianDentistMedical ResidentMedical FellowMedical InternDental InternDental FellowDental ResidentVeterinarian

Physician AssistantNurse PractitionerNurse MidwifeNurse AnesthetistCommunity HealthOccupat. Health NurseClinical Laboratory OfficersMedical Technologists CIV CytotechsOther DC Professionals

LPN or LVNNursing AssistantMLT (CIV and MIL)MIL CytotechsHealth TechsOther

Registered NurseOther

LogisticsClericalAdministratorLab IT?Other

Workload DataWorkload Data

Workload DataWorkload Data

• The main source of MEPRS workload data is CHCS

• The Workload Assignment Module (WAM) of CHCS automates the interface with EAS and allows beneficiary category and Current Procedural Terminology (CPT) data


Account StructureAccount Structure

Account StructureAccount Structure• Functional Cost Codes (FCCs)

– 4-letter MTF-specific codes representing work centers or reporting facilities; used to track costs, workload and FTEs

–First 3 letters are DoD-standard–The first letter identifies the type of service

provided:A - Inpatient Care

C - Dental CareB - Ambulatory Care

D - Ancillary ServicesE - Support ServicesF - Special ProgramsG - Medical Readiness


• The second letter identifies Summary Accounts within MTF functional categories:• D = ANCILLARY SERVICE

• DA = Pharmacy• DB = Pathology• DC = Radiology• DD = Special Procedure Services• DE = Central Sterile Supply• DF = Surgical Services• DG = Ambulatory Nursing Services

Functional Cost Codes (FCCs)Account StructureAccount Structure


• The third letter identifies particular work centers within Summary Accounts:

• D = Ancillary Service• DB = Pathology

– DBA CLINICAL PATHOLOGY – DBB ANATOMICAL PATHOLOGY– DBD CYTOGENETIC LABORATORY– DBE MOLECULAR GENETIC LABORATORY– DBF BIOCHEMICAL GENETIC LABORATORY– DBX COST POOLS– DBZ PATHOLOGY NOT ELSEWHERE CLSFD



• The fourth letter is MTF-unique and used to identify specific types of costs and workload:• D = Ancillary Service

• DB = Pathology• DBA = Clinical Pathology

• DBAA = Clinical Pathology Main Lab• DBA”X” = Clinical Pathology TMC Lab

• DBB = Anatomic Pathology• DBAA = Anatomic Pathology Main Lab



Other FCCs of Lab Interest• FAA = Area Reference Lab

– Brooke Army Medical Center, Fort Sam Houston, TX– Dwight David Eisenhower Army Medical Center,Fort Gordon, GA – Fitzsimons Army Medical Center, Denver, CO– Madigan Army Medical Center, Tacoma, WA– Tripler Army Medical Center, APO San Francisco, CA– Walter Reed Army Medical Center, Washington, DC– William Beaumont Army Medical Center, El Paso, TX – National Naval Medical Center, Bethesda, MD– USA Hospital, Landstuhl, APO New York 09180

• FAD = DoD Military Blood Program• FCC = Support to Non-Federal External Providers (previously CHAMPUS

Beneficiary Support)• FCD = Support to Other Military Medical Activities (if you provide

reference lab support to other MTFs)• FCE = Support to Other Federal Agencies


Expense AllocationExpense Allocation

Expense AllocationExpense Allocation• Cost Pools

– Cost pools are identified with an “X” in the 3rd FCC position

– Used when time and expense cannot be specifically assigned because two or more work centers share space, personnel or supplies. For example, mixed wards.

– Expenses and FTEs in cost pools are reassigned (purified) on the basis of workload.

– Cost pools are purified in alphabetical order before allocation of support and ancillary expenses.


Expense Allocation• Intermediate (Stepdown) Accounts

– D - Ancillary Services (lab, rad, pharm)– E - Support Services (e.g., admin, logistics, facilities, med maintenance)

• Ancillary and Support expenses are allocated (stepped-down) across final accounts

• Final Operating Accounts– A - Inpatient Care– B - Ambulatory Care– C - Dental Care– F - Special Programs– G - Medical Readiness




• Costs are allocated based on performance factors established by DoD 6010.13M which can be different from workload–Weighted procedures performed–Hours / Minutes of Service performed–Square footage cleaned


31

Other E

Accnts

AInpatient

CareB

Amb.Care

CDental

Services

FSpecialProgsG

MedReadiness

DAncillary Services

ESupport Services

First, Support Services (“E” accounts) expensesare allocated

Each Support Services FCC is allocated until no expenses remain in “E” accounts


32

Other D

Accnts

AInpatient

CareB

Amb.Care

CDental

Services

FSpecialProgs

GMed

Readiness

DAncillary Services

Then, Ancillary Services (“D” accounts) expensesare allocated

Each Ancillary Services FCC is allocated until no expenses remain in “D” accounts

Expense Allocation

Total ExpensesTotal Expenses

Total Expenses Business Objects Formula

Direct Expense + Purified Expense + Stepdown Expense Contributed+ Stepdown Expense from D+ Stepdown Expense from E

= Total Expenses


Data QualityData Quality

Data QualityData Quality

• Data quality issues in MEPRS generally result from:• Insufficient vigilance or attention to data quality• Lack of effective education and training• Inconsistent implementation of policies,

guidelines and business rules• System-related issues - transmission or processing

errors


Policy & Business RulesPolicy & Business Rules• DoD 6010.13M (dated April 7, 2008)

– Provides Tri-Service MEPRS program policy and guidance to all MEPRS reporting MTFs / DTFs

– Download from/access Online: www.meprs.info

Chapter 1: General Information

Chapter 2: Chart of Functional Cost Codes

Chapter 3: Guidelines And Reporting Requirements

Chapter 4: Issue Process

Appendices Acronyms, Definitions, Guidelines for reporting FTEs


http://www.meprs.info/

MEWACS provides monthly MEPRS data quality feedback, systematically highlighting potential MTF data anomalies

Human Systems Interface (HSI) provides expert data quality and analysis assistance to field, serving as the link between MEPRS education and data quality surveillance initiatives.

The Six Sigma MEPRS Management Metrics (S2M3) workbook is an interactive tool containing seven key MEPRS-based performance metrics

Data SurveillanceData Surveillance

Expense Assignment System IVExpense Assignment System IV(EAS IV)(EAS IV)

• X’s in the matrix indicate compatible classes – your queries can contain objects from compatible classes only• Y’s identify principal classes – you must select objects from the principal class first, followed by other compatible classes

EAS Object Classes and CompatibilityEAS Object Classes and Compatibility


Class 18 Ancillary CPT WorkloadClass 18 Ancillary CPT WorkloadObjectsObjects

• Fiscal Year• Parent DMIS ID• Fiscal Month• Providing DMIS ID,• Providing 4th Level

Functional Cost• Beneficiary Category

Code• Beneficiary Category

Description• CPT Code

• CPT Modifier• CPT Code Type• CPT AMA Short Name• CPT DoD Name• CPT Weight• Raw Statistical Amount• Weighted Statistical

Amount• Cost Per Weighted• Unit Total Procedure Cost


Basic Query - Class 21Basic Query - Class 21


Basic Query with Standard CalculationsBasic Query with Standard Calculations

Cost Per Weighted = Total Expenses Ancillary Weighted Procedures

Cost Per Raw = Total Expenses Ancillary Procedures Count

Procedures Per FTE = Ancillary Procedures Count Available FTE

Old Reports


New Reports(Pivot Charts…YAY!)

Other Uses

– Business Case Analysis (Class 18)

• Pull for your Region by CPT, Modifier, Raw Count


Other Uses

• Staffing utilization (Class 7)– Available vs Non-available

(Aggregate and Detailed)– Other people coding to your

AO

1.15 FTE - 68K Respiratory Specialist coded to DBAA

More available than assigned??


Other Uses

• Detailed analysis to investigate data anomalies

• Doesn’t pass the reality check…this was a mid-size MEDDAC


Other Uses

• Show me the money…


Other UsesSurfing the web

Real work

Drinking Coffee Dwight D. Eisenhower Army Medical CenterDwight D. Eisenhower Army Medical Center“Caring from the Heart”

Other Uses

FY Parent RVUs Provider Cost Institutional Cost Prov Cost per RVU Inst Cost per RVU Total Cost per RVU2009 0124 794,142 1,922,723$ 30,975,665$ 2$ 39$ 41$

RVUs Provider Cost Institutional Cost Prov Cost per RVU Inst Cost per RVU Total Cost per RVU844,513 4,996,058$ 26,876,731$ 6$ 32$ 38$

Lab

Rad

• MHS/TMA reporting

• Scenario from a recent Quest/SRA workshop. Yes, someone is actually looking at this

Provider and Institutional Cost per RVU for Lab/Rad


What’s the Point?

The PointThe Point• MEPRS data in EAS are used at the MHS/TMA level in a

number of ways:

• Currently, EAS is the only central source for Tri-service Financial data.

• These data are used for:– Adjusted Standardized Amounts (ASAs)– Medicare Eligible Retiree Health Care Fund– MTF Valuation– Patient Level Cost Accounting (PLCA)– Congressional Inquiries– BRAC Analyses


The PointThe Point• Currently, EAS is the only central source for

Tri-service Personnel data.

• These data are used for:– Expense Allocation– Business Planning Tool– MHS Balanced Scorecard– Productivity Metrics– Congressional Inquiries– Readiness Analyses


The PointThe Point• Bottom line….

• People are looking at YOUR data and making assumptions and decisions about YOUR organization and laboratory

• This data will likely be briefed to your Command during your TARA visit


Performance-Based Adjustment Model Performance-Based Adjustment Model (PBAM)(PBAM)

• PBAM– a budget adjustment methodology designed to

modify Medical Treatment Facility (MTF) funding based on workload and/or outcomes generated as compared to a performance goal and adjusted for efficiency.

– Uses the red/amber/green targets on the Command Management System

– Funding adjusted based upon actual performance on specific indicators


PBAM Pathology??

•Formula will probably be comprised of a blend of purchased care costs, baseline historical workload data, etc

Performance-Based Adjustment Model Performance-Based Adjustment Model (PBAM)(PBAM)

Other Sources For DataOther Sources For Data

• Your RM and MEPRS folks• EASIV repository • S2M3• MEWACS


S2M3S2M3

• We are (were?) being tracked via S2M3 Initiative against the other services

• Six Sigma MEPRS Management Metrics (S2M3) is a blend of Direct Care and civilian industry benchmark metrics presented in an interactive Excel workbook containing seven key MEPRS-based performance metrics: Pharmacy Dispensing Costs

– FTEs per occupied bed day – Ratio of support personnel to providers – Pharmacy workload per pharmacy FTE – Laboratory workload per lab FTE – Inpatient costs per RWP – Ambulatory costs per APG


S2M3S2M3

• Lab productivity tracked via peer groups – Medical Centers– Large Hospitals– Small Hospitals– Large Clinics– Small Clinics– Large Hospital OCONUS– Small Hospital OCONUS– Clinics OCONUS


• MEWACS is an interactive data quality feedback tool developed by the MEPRS Management Improvement Group (MMIG) to proactively identify, investigate, and resolve MEPRS data anomalies in a timely, systematic manner. Updated monthly, MEWACS contains numerous Tri-Service MTF activity level metrics, including: EAS IV Repository data load status and compliance with 45-day reporting suspense

– MTF-specific summary data outliers – Interactive MTF MEPRS Data Profiles by

3rd level Functional Cost Code – WWR vs. EAS IV Repository total

ambulatory visit comparison – Ancillary and Support expense

allocation tests

MEWACSMEWACS


MEWACSMEWACS

• Limited functionality applicable to the lab right now– Personnel Statistics– Limited expense statistics– Data load status

• Working with SRA to add– Total Workload– Expenses – Cost Per Raw/Weighted– Procedures Per FTE


So now what?So now what?• How can you improve your performance?

– Know your data and it’s validity– Improve data quality

• MEC workload (e.g., Anatomic)• CHCS CPT Code reviews (proactive vs reactive)

– Correct CPT Code AND Modifier• DMHRSi Coding (Just say NO to Straight 8s)

• Increase workload– Recapture out-sourced labs if cost-effective– Expand partnerships (VA, other services, etc)

• Decrease costs– staffing, contracts, and supply


http://www.dmisid.com/cgi-dmis/defaulthttp://www.meprs.info/

Useful LinksUseful Links

http://www.dmisid.com/cgi-dmis/default

http://www.meprs.info/

CHCS Data QualityCHCS Data Quality

CHCS and WAMCHCS and WAM

• Comparing WAM with MEPRS summary report every month

• Make sure discrepancies are resolved before the monthly “deadline”

WAM Reporting OptionsWAM Reporting Options

• Other Reports to periodically check– Lab Test CPT Exception– Lab Method CPT

Exception– Lab Workload Exception

Report (WEX)

Workload Exception Report (WEX)Workload Exception Report (WEX)

• Displays workload not reported through WAM to EAS by data discrepancies category– CPT Code: Inactive CPT Code– Lab Section: No Lab Section

Defined for this test– Performing Location:

MEPRS/DMIS ID Mismatch or Inappropriate Code

– Requesting Location: Inactive or Invalid MEPRS codes

• Corrected via MEC option in CHCS

Workload Manual Entry (MEC)Workload Manual Entry (MEC)

• Three options– Edit Workload– Add New Workload– Resolve an exception

• What can you edit?– CPT Code– CPT Modifier– Requesting Location– Workload Type– Workload Counts

CPT Code ModifiersCPT Code Modifiers

90: For results obtained from outside reference labs (Send-outs tests) ie. Quest or CDD

32: When performing lab receives & performs tests for other submitting labs ie. Ft. Stewart sends Pap Smears to Eisenhower, Eisenhower will receive 32 modifiers/test

26: For Pathology Consult cases (in Lab File and Table Build, Pathology Consult = Yes)

00: In-house tests and for tests receives within the same group/division

Cascading order of how CHCS Cascading order of how CHCS Captures CPT Codes in CHCSCaptures CPT Codes in CHCS

1) Lab Method: Defined for specific Site/Specimen

2) Lab Work Element

3) MTF CPT Code (first page of Lab File & Table Build)

Note: It is highly recommended that CPT code(s) be build at only one place in order to avoid wrong CPT codes being capture by CHCS

MEC COPATH CPT Codes

Additional procedures performed for Anatomic Pathology tests

When do you MEC AP workload?

• Histology cases: Special stains, IHC, or any additional procedures done that is capturable under the CPT handbook

• Cytology cases: QC cases (10% random QC and high risk QC), abnormal cases reviewed by pathologist, or any additional procedures done that is capturable under the CPT handbook

Questions?

meprsandeasiv “all you didn’t want to know and then some” ltc robert l. nace lab manager 1lt...

Documents

military health system

starsfl standard accounting

heartmeprs applicationstypical

triservice financial

analyses initiativesdwight

business objects

basic understanding

aggregated form