MEPRS and EASIV “all you didn’t want to know and then some” LTC Robert L. Nace Lab Manager 1LT Chih Huang OIC, Anatomic Pathology Eisenhower Army Medical Center Fort Gordon, Georgia

Agenda MEPRS EASIV MEPRS Source Data MEPRS Account Structure (FCCs) MEPRS Expense Allocation MEPRS Data Quality CHCS & WAM Dwight D. Eisenhower Army Medical Center “Caring from the Heart”

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

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 is the ONLY MHS cost accounting system containing uniform Tri-Service financial, workload, and personnel information. MEPRS data are routinely used by TMA, the Services and MTFs for critical policy and management decisions, as well as program evaluation Dwight D. Eisenhower Army Medical Center “Caring from the Heart”

MEPRS Applications Typical Uses include “Caring from the Heart” 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 Dwight D. Eisenhower Army Medical Center “Caring from the Heart”

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

MEPRS Source Data GFEBS DMHRSi MEPRS 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 GFEBS MEPRS Data: DoD-Standardized, Aggregated by FCC DMHRSi Dwight D. Eisenhower Army Medical Center “Caring from the Heart”

EASi MEPRS Data Flow *EAS IV Repository **M2 (an extract from MDR) (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) Workload (CHCS) Financial (STANFINS, STARS/FL, CRIS) Personnel (DMHRSi --UCAPERS, SPMS, EAS) * 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 Center “Caring from the Heart”

Financial Data

Financial Data Kinds of Dollars (SEECs) Pay Data Contracts Supplies Military Civilian Contracts Supplies Equipment Base Operations Depreciation Dwight D. Eisenhower Army Medical Center “Caring from the Heart”

Financial Data Pay Source Differences Military Pay Civilian Pay Service-specific Composite Military Pay Tables Special Pays not medical-unique Civilian Pay Army / Navy use actual pay from Service financial system Air Force uses Composite Civilian Pay Tables Dwight D. Eisenhower Army Medical Center “Caring from the Heart”

Financial Data DoD-standardized financial data “Caring from the Heart” Dwight D. Eisenhower Army Medical Center “Caring from the Heart”

Personnel Data

Personnel Data Full Time Equivalent (FTE) Assigned FTEs Available FTEs 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. Dwight D. Eisenhower Army Medical Center “Caring from the Heart”

Personnel Data Total FTEs (Assigned / Available) Personnel Category C – Civilian E – Enlisted W - Red Cross L - Local National O – Officer T – Other V – Volunteer X - Contractor 1 – Clinician 2 - Direct Care Professional 3 - Registered Nurse 4 - Direct Care Para Professional 5 -Admin / Clerical Skill Type Skill Type Suffix P – Physicians D – Dentist N – Intern F – Fellow R – Resident V - Veterinarians

Personnel Data Physician Assistant Nurse Practitioner Nurse Midwife Nurse Anesthetist Community Health Occupat. Health Nurse Clinical Laboratory Officers Medical Technologists CIV Cytotechs Other DC Professionals Registered Nurse Other LPN or LVN Nursing Assistant MLT (CIV and MIL) MIL Cytotechs Health Techs Other Logistics Clerical Administrator Lab IT? Other Physician Dentist Medical Resident Medical Fellow Medical Intern Dental Intern Dental Fellow Dental Resident Veterinarian

Workload Data

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

Workload Data Today, the principal purpose for Workload data collection in EAS is expense allocation. CHCS and M2 are seen as the official MHS workload systems. EAS workload data is “count” workload only Dwight D. Eisenhower Army Medical Center “Caring from the Heart”

Account Structure

Account 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: F AND G ARE SOMEWHAT UNIQUE TO THE MILITARY. WE KEEP THEM SOMEWHAT SEPARATE TO ENSURE THAT WHEN WE USE THE OTHER DATA FOR COMPARISONS TO THE CIVILIAN SECTOR, WE ARE COMPARING APPLES TO APPLES. A - Inpatient Care D - Ancillary Services B - Ambulatory Care E - Support Services F - Special Programs C - Dental Care G - Medical Readiness Dwight D. Eisenhower Army Medical Center “Caring from the Heart”

Account Structure Functional Cost Codes (FCCs) 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 Dwight D. Eisenhower Army Medical Center “Caring from the Heart”

Account Structure Functional Cost Codes (FCCs) 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 NOTE: See DoD 6010.13-M, April 7, 2008 for guidance on appropriate use Dwight D. Eisenhower Army Medical Center “Caring from the Heart”

Account Structure Functional Cost Codes (FCCs) 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 Dwight D. Eisenhower Army Medical Center “Caring from the Heart”

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

Expense Allocation

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

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

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

Expense Allocation A Inpatient Care B Amb. Care C Dental Services F Special Progs G Med Readiness D Ancillary Services $ E Support Services First, Support Services (“E” accounts) expenses are allocated Other E Accnts EXAMPLE: COMMANDER’S COST IS DISTRIBUTED ACROSS ALL ACCOUNTS. THE BASIS FOR ALLOCATION IS FTEs; i.e., COSTS ARE DISTRIBUTED BASED ON HOW MANY FTEs YOU HAVE WITH THE THEORY BEING THAT THE MORE FTEs YOU HAVE, THE MORE ATTENTION THE COMMANDER HAS TO PAY TO YOUR AREA. YOU PAY FOR HIS OR HER TIME. COULD DO THIS BY SQUARE FOOTAGE OR SOME OTHER MEASURE AS WELL. THE COMMANDER’S COSTS ARE FIRST DISTRIBUTED TO OTHER E ACCOUNTS, AND THEN TO OTHER SUPPORT ACCOUNTS – E.G., ANCILLARY SERVICE SUPPORT ACCOUNTS BENEFIT FROM THE COMMANDER’S TIME AS WELL. AT THE END OF THIS PROCESS, ALL E ACCOUNTS SHOULD BE AT $0.00. Each Support Services FCC is allocated until no expenses remain in “E” accounts

Expense Allocation A Inpatient Care B Amb. Care C Dental Services F Special Progs G Med Readiness $ D Ancillary Services Then, Ancillary Services (“D” accounts) expenses are allocated Other D Accnts Each Ancillary Services FCC is allocated until no expenses remain in “D” accounts

Total Expenses = Total Expenses Total Expenses Business Objects Formula Direct Expense + Purified Expense + Stepdown Expense Contributed + Stepdown Expense from D + Stepdown Expense from E = Total Expenses Dwight D. Eisenhower Army Medical Center “Caring from the Heart”

Data Quality

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

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

Data Surveillance 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

Expense Assignment System IV (EAS IV)

EAS Object Classes and Compatibility 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 Dwight D. Eisenhower Army Medical Center “Caring from the Heart”

Class 18 Ancillary CPT Workload Objects 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 Dwight D. Eisenhower Army Medical Center “Caring from the Heart”

Basic Query - Class 21 “Caring from the Heart” Dwight D. Eisenhower Army Medical Center “Caring from the Heart”

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

New Reports (Pivot Charts…YAY!)

Other Uses Business Case Analysis (Class 18) Pull for your Region by CPT, Modifier, Raw Count Dwight D. Eisenhower Army Medical Center “Caring from the Heart”

Other Uses Staffing utilization (Class 7) More available than assigned?? 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 Dwight D. Eisenhower Army Medical Center “Caring from the Heart”

Other Uses Detailed analysis to investigate data anomalies Doesn’t pass the reality check…this was a mid-size MEDDAC Dwight D. Eisenhower Army Medical Center “Caring from the Heart”

Other Uses “Caring from the Heart” Show me the money… Dwight D. Eisenhower Army Medical Center “Caring from the Heart”

Other Uses “Caring from the Heart” Surfing the web Real work Drinking Coffee Dwight D. Eisenhower Army Medical Center “Caring from the Heart”

Provider and Institutional Cost per RVU for Lab/Rad Other Uses 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 Dwight D. Eisenhower Army Medical Center “Caring from the Heart”

What’s the Point?

The 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 TRYING TO CAPUTRE COSTS AND MANAGE COSTS WE’RE SHOWING HOW THAT DATA GOES IN WE’LL TALK ABOUT WHAT WE’RE DOING TO OVERCOME PROBLEMS WITH THE DATA Dwight D. Eisenhower Army Medical Center “Caring from the Heart”

The 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 TRYING TO CAPUTRE COSTS AND MANAGE COSTS WE’RE SHOWING HOW THAT DATA GOES IN WE’LL TALK ABOUT WHAT WE’RE DOING TO OVERCOME PROBLEMS WITH THE DATA Dwight D. Eisenhower Army Medical Center “Caring from the Heart”

The 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 TRYING TO CAPUTRE COSTS AND MANAGE COSTS WE’RE SHOWING HOW THAT DATA GOES IN WE’LL TALK ABOUT WHAT WE’RE DOING TO OVERCOME PROBLEMS WITH THE DATA Dwight D. Eisenhower Army Medical Center “Caring from the Heart”

Performance-Based Adjustment Model (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 Dwight D. Eisenhower Army Medical Center “Caring from the Heart”

Performance-Based Adjustment Model (PBAM) PBAM Pathology?? Formula will probably be comprised of a blend of purchased care costs, baseline historical workload data, etc

Other Sources For Data Your RM and MEPRS folks EASIV repository S2M3 MEWACS Dwight D. Eisenhower Army Medical Center “Caring from the Heart”

S2M3 “Caring from the Heart” 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 Dwight D. Eisenhower Army Medical Center “Caring from the Heart”

S2M3 Lab productivity tracked via peer groups Medical Centers Large Hospitals Small Hospitals Large Clinics Small Clinics Large Hospital OCONUS Small Hospital OCONUS Clinics OCONUS Dwight D. Eisenhower Army Medical Center “Caring from the Heart”

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

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

So now what? How can you improve your performance? Increase workload 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 Dwight D. Eisenhower Army Medical Center “Caring from the Heart”

Useful Links http://www.meprs.info/ http://www.dmisid.com/cgi-dmis/default

CHCS Data Quality

CHCS and WAM Comparing WAM with MEPRS summary report every month Make sure discrepancies are resolved before the monthly “deadline”

WAM Reporting Options Other Reports to periodically check Lab Test CPT Exception Lab Method CPT Exception Lab 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) 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 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 Captures CPT Codes in CHCS Lab Method: Defined for specific Site/Specimen Lab Work Element 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

Additional procedures performed for Anatomic Pathology tests 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?