Preparing for an Audit: DMHRSi Time vs. Workload Reporting Navy Resources Symposium 4 June 2012 Herb Escobar Escobar Analytics and Services, Inc. hescobar@easincorporated.com

Objectives After completing this session the attendee can: Describe the Defense Medical Human Resources Reporting System internet (DMHRSi). Characterize data that can be analyzed with DMHRSi not available in MEPRS. Characterize the extent to which workload and timesheet reporting differs at MTF and MEPRS Code level in Navy Medicine. Describe methods that can be used to test the extent to which timesheet and workload reporting differ.

Outline DMHRSi Data and Application DMHRSi Data Quality Challenges Tri-Service Labor Reporting vs. Workload Study Questions

DMHRSi Data and Application

DMHRSi Overview Defense Medical Human Resources System - internet (DMHRSi) Repository for MHS human capital and labor cost assignment data Source for tri-Service medical human capital information Source of FTE data and personnel expenses in MEPRS and M2 Self-reported labor hours across Functional Cost Codes (4th-level MEPRS Codes) Labor hours across MEPRS Codes lead to personnel costs Actual salary for Civilians Uniform composite pay tables for Military No personnel costs for Contractors

DMHRSi Data Sources “DMHRSi Discoverer-Plus” is the integrated reporting tool Interactive Corporate Reports Ad-hoc queries Performance and documentation challenges SMART receives regular DMHRSi extracts

DMHRSi Data Sources (Cont.) Monthly DMHRSi HR extract available in MDR Person-level assignment data from 1 Oct 2008 – Present /mdr/pub/dmhrsi/hr/dmhrsi.sas7bdat EDIPN/NPI/SSN Name/Rank/Grade Person Category/Skill Type/Suffix Occupation Code/Taxonomy/Job/Position Assignment MTF/Organization/People Group Labor Reporting MTF/Organization/People Group Assignment Start/End Dates

Analytic Applications of DMHRSi data Richness of DMHRSi data facilitates analyses not possible with MEPRS or M2 personnel data alone Workload and cost metrics by Facility/Service of assignment – Army or Air Force providers in Navy facilities Assigned/Available MEPRS codes by person – where are people actually working National Practitioner Identifier (NPI) and Electronic Data Interchange Person Number (EDIPN) facilitates linking workload from CAPER/SIDR to specific provider characteristics Labor reporting vs. workload across Functional Cost Codes

DMHRSi Data Quality Challenges

DMHRSi Data Quality Common of DQ issues observed – some easy to spot Manual data entry errors: UIC “KV!MFV9P" vs. "KV1MFV9P” Inconsistent data entry: “TMA” vs. “TRICARE MGT”, “PHS” vs. “Public Health” Caps vs. Lower Case: “Navy” vs. “NAVY” More serious DQ issues affect reconciliation of data transmitted to downstream systems

DMHRSi = MEPRS Correct

Incomplete Timecards Pulled? DMHRSi > MEPRS Incomplete Timecards Pulled?

DMHRSi < MEPRS Edits in MEPRS Only?

Intercepted DMHRSi to EASIV Raw File EASIV output file is sometimes intercepted and edited due to DMHRSi system performance challenges Easy to make mistakes & makes traceability of data impossible

Tri-Service Labor Reporting vs. Workload Study

Background Labor costs account for about 70% of MHS facility expenses. Accurate reporting of labor hours across facility work centers is critical for valid healthcare cost and productivity analysis. DoD 6010.13M provides detailed labor reporting policy and instructions. First-of-its-kind study sponsored by the Methods, Measures and Analyses Directorate at TMA/DHCAPE through Axiom – Resource Management examined reported labor and associated workload across clinics.

Context

Method Darnall AMC - Ft. Hood, NH Pensacola, and the 60th Medical Group –Travis AFB Fiscal Year 2011 data were analyzed Person-specific Available hours by facility, fiscal month, and cost center were obtained from DMHRSi Labor Cost Assignment (LCA) module via Discoverer CAPER and SIDR workload records by facility, fiscal month, and cost center were extracted from the MHS Data Repository (MDR) EDIPN and NPI data were added to the LCA extract to facilitate provider-level matching to CAPER/SIDR workload datasets LCA data matched to CAPER/SIDR by facility, fiscal month, and 4th-level Functional Cost Code

Method (Cont.) All skill types were included in the LCA analysis dataset (i.e., providers, nurses, techs, etc.) Only MEPRS-B CAPERs were included Provider 1 – 5 Work RVUs and individual providers in CAPERs were included (only 1 – 3 were populated) CAPER/LCA match on EDIPN then NPI SIDR analyses included Attending, Admitting, and procedure-specific providers; Total RWPs retained SIDR/LCA match on NPI

Matching CAPER/LCA by Child DMISID Aggregate Provider Work RVUs used Match by Fiscal Year, Fiscal Month, Parent DMISID, Child DMISID, and 4th-Level Cost Center per MEPRS labor reporting policy Variance noted across aggregated by Child MTFs Color coding criteria is not per policy; no prior quantitative assessments have been performed

Matching CAPER/LCA by Summary Cost Center Aggregate Provider Work RVUs used Match by Fiscal Year, Fiscal Month, Parent DMISID, Child DMISID, and 4th-Level Cost Center per MEPRS labor reporting policy Variance noted across clinical services

Matching SIDR/LCA by Summary Cost Center Attending Provider Total RWPs shown (Admitting Provider also analyzed with poorer results) Match by Fiscal Year, Fiscal Month, Parent DMISID, Child DMISID, and 4th-Level Cost Center per MEPRS labor reporting policy Variance noted across clinical services, poor match overall

Matching CAPER/LCA – MTF Aggregate Aggregate Provider Work RVUs reported Match by Fiscal Year, MEPRS-B, and Parent DMISID Provider Salary data from MEPRS

Matching SIDR/LCA – MTF Aggregate Aggregate Total RWPs reported Match by Fiscal Year, MEPRS-A, and Parent DMISID Provider Salary data from MEPRS

Matching LCA MEPRS-B FTEs in CAPER Comparison of Providers with labor hours reported in MEPRS-B Cost Centers vs. CAPER workload Match by Parent DMISID, MEPRS-B, EDIPN, and NPI Participating in Readiness or supporting non-clinical administrative services? Per DoD6010-13M APP3, non-clinical administration hours should be recorded in overhead (E) Cost Centers

Matching LCA MEPRS-A FTEs in SIDR Comparison of Providers with labor hours reported in MEPRS-A Cost Centers vs. SIDR workload Match by Parent DMISID, Fiscal Month, 3rd-Level FCC, NPI, EDIPN Participating in Readiness or supporting non-clinical administrative services? ICU workload in SIDR in A-FCCs vs. DJ* in LCA Per DoD6010-13M APP3, non-clinical administration hours should be recorded in overhead (E) Cost Centers

Matching LCA MEPRS-A FTEs in SIDR Comparison of Providers with labor hours reported in MEPRS-A Cost Centers vs. SIDR workload Match by Parent DMISID, NPI, EDIPN Significant improvement over 3rd-Level FCC comparison Almost all MEPRS-A Provider FTEs in LCA report some SIDR workload

Clinic-Level vs. Aggregate Analysis MHS policy prescribes workload, labor, and expense data reporting by functional cost center (clinic-level) However, some analytical applications rely on inpatient and outpatient aggregates Clinic-Level MHS Cost Data Applications “Make vs. Buy” Analysis Program Evaluation (i.e., PCMH) Product-line Performance Metrics Patient-Level Costs for M2/MDR Business Planning Inpatient / Outpatient Aggregate Cost Data Applications Annual MERCHF Reconciliation Third Party Collection ASAs PMPM Calculations PPS Analysis

Study Conclusions Study demonstrates ability to link reported labor hours by provider to specific workload production Unquestionable problem dictating further attention and examination Next Steps Follow-on study will seek to validate initial results and expand analyses Explore centrally developed metrics to monitor: DMHRSi Labor vs. workload match DMHRSi Available FTE vs. EASIV Available FTE

Review of Objectives

Objectives Review After completing this session the attendee can: Describe the Defense Medical Human Resources Reporting System internet (DMHRSi). Characterize data that can be analyzed with DMHRSi not available in MEPRS. Characterize the extent to which workload and timesheet reporting differs at MTF and MEPRS Code level in Navy Medicine. Describe methods that can be used to test the extent to which timesheet and workload reporting differ.

Preparing for an Audit: DMHRSi Time vs. Workload Reporting Navy Resources Symposium 4 June 2012 Herb Escobar Escobar Analytics and Services, Inc. hescobar@easincorporated.com