1 Medical Expense and Performance Reporting System (MEPRS) Program Data Quality Tools Type Brief: Information April 30, 2014 DHA MEPRS Program Office “Medically Ready Force…Ready Medical Force”

2 DHA Vision “A joint, integrated, premier system of health, supporting those who serve in the defense of our country.” “Medically Ready Force…Ready Medical Force”

Agenda ∎ MEPRS Policy and Business Rules  Introduction  Account Structure  Data (Financial, Personnel, & Workload)  Policy and Business Rules ∎ Data Quality Management Control Review List  Education  MEPRS Early Warning and Control System (MEWACS)  Data Load Status  Summary Outliers  Allocation Test 3

Introduction to MEPRS 4 “Medically Ready Force…Ready Medical Force”

14 December 2011 Pre-decisional FOUO 5

Introduction 14 December 2011 Pre-decisional FOUO6

Introduction 7 ∎ DoD M (April 7, 2008; Change 2 April 15, 2014).  Authority DoDD E, “Health Services Operations and Readiness”  A uniform expense and labor reporting system shall be maintained in all fixed MTFs and dental treatment facilities to provide standardized expense and manpower data for management of health care resources.  Standards for the Federal government Statement of Federal Financial Accounting Standards (SFFAS) 4  MEPRS supports MTFs and all entities within the MHS in approximating and reporting full cost of resources used to produce output by responsibility segments/functional cost centers. The full cost data derived from MEPRS may be used by the department in developing actuarial liability estimates for the Military Retirement Health Benefits Liability in the Other Defense Organization General Funds. This information is included in the department’s annual agency wide audited financial statements.”

∎ Purpose: Provide uniform reporting by Functional Cost Code (FCC) of expense, labor, & workload for DoD Military Treatment Facility (MTF) affording management a basic framework for cost and work center accounting. ∎ MEPRS refers to the expense, labor, and workload data. ∎ Expense Assignment System (EAS) is the Web-based hardware and software in which the data is created and the information resides. Introduction 8

Business Planning Medicare-Eligible Retiree HealthCare Fund (MERHCF) Manpower Standards Data Quality Statement  Multiple MEPRS Inputs Base Realignment and Closure (BRAC) Analysis  Workload & Expenses Audit Agency DHA Development of Per Member Per Month (PMPM) Calculation Billing Rates MHS Balanced Scorecard Instrument Panel  Metrics Scorecard – Comparison of Service Productivity Introduction 9

RVUsb “E” – Support “D” – Ancillary “A” – Inpatient “B” – Outpatient “C” – Dental “F” – Special Programs “G” – Readiness EAS IV Expenses Labor Workload RECONCILERECONCILE Direct Care “Step Down” Defense Health Program Managerial Cost Accounting OUTPUTOUTPUT Total Cost RVUs RWPs ICD/E&M/CPT DRGs SIDR CAPER CHCS/ AHLTA Introduction 10

MEPRS Data: DoD-Standardized, Aggregated by FCC  Service-specificFinancialdata  Army: STANFINS/GFEBS (Standard Army Finance System/General Fund Enterprise System)  Navy: STARS-FL (Standard Accounting and Reporting System/Field level)  Air Force: GAFS – R/ DEAMS (General Accounting Finance System Rehost/ Defense Enterprise Accounting and Management System)  Personnel  DMHRSi (Defense Medical Human Resource System - internet)  Workload  CHCS/WAM (Composite Health Care System / Workload Assignment Module) Introduction 11 Note: The DHA National Capital Region Medical Directorate (NCR-MD) currently uses GFEBS for Fort Belvoir and STARS/FL for Walter Reed National Military Medical Center

Functional Cost Codes (FCCs) are 4-character MTF-specific codes representing work centers or reporting facilities; used to track costs, workload and FTEs. The first 3 letters are DoD-standard. The fourth letter is MTF-unique and used to identify specific types of costs and workload: B = AMBULATORY CARE (DoD standard) BH = PRIMARY MEDICAL CARE (DoD standard) BHA = OUTPT PRIMARY CARE CLINICS (DoD standard) BHAA = Outpt Primary Care Clinic – Parent Facility (MTF specific) BHAM = Outpt Primary Care Clinic - TMC-1 (MTF specific) BHAW = Outpt Primary Care Clinic - TMC-5 (MTF specific) Note: use of 4 th Level MEPRS FCC for Patient Centered Medical Home Chart of Accounts Account Structure 12

Account Structure 14 December 2011 Pre-decisional FOUO13 ∎ Cost pools are identified with an “X” in the 3 rd FCC position. They are used when time and expense cannot be specifically assigned because two or more work centers share space, personnel or supplies. For example, most inpatient wards. ∎ Expenses and FTEs in cost pools are reassigned (purified) on the basis of workload.

Expense Allocation Account Structure 14

$- $(10) $10 EFA $- $(12) $2 $10 DBA $- $(20) - $20 ABX $33 - $8 $5 $15 $5 ABA Total Expenses Expenses Contributed Ancillary Services D Support Services E Purified Cost Pools Direct Expenses 3rd Level FCC $3 $5 ABI $4 $ N/A Expense Allocation “ Step Down” MEPRS Policy & Business Rules 15

Financial Service specific codes that categorize expenses into Pay Data (Military & Civilian),Contracts, Supplies, Equipment, Base Operations, etc. are mapped to DoD standard codes in EAS. 16 DoDAir ForceArmyNavy 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 CI – Commit. Item

Personnel Full Time Equivalent (FTE) Amount of labor available to the MTF work center if a person works fulltime for 1 month. Assigned FTEs Time reported by personnel assigned to specific positions/work centers on MTF manning documents. 1 FTE = number of assigned days / the number of days in a month Available FTEs Time reported by any personnel in a given clinic for a given month. Includes those who are Assigned, attached, borrowed, contracted, volunteers, etc. 1 FTE = 168 man-hours in 1 month (1FTE is calculated as an average of 21 work days per month x 8 hours per day) Non-Available FTEs Time reported by Assigned personnel in their Assigned work center that is unrelated to the healthcare mission such as sick leave, personal leave, etc. 17

Personnel Personnel Category Skill Type Total FTEs (Assigned / Available) Skill Type Suffix 18

Personnel 19

Workload The main function of workload data in EAS is to provide a basis to allocate expenses among work centers; therefore, workload is collected in relationship to costing. Historically, MEPRS workload in EAS with its limited focus has been used for analysis, but today the MHS Data Mart (M2) is the official source of workload data because it serves an analysis mission. Inpatient Services Admissions Dispositions Occupied Bed Days Bassinet Days Ambulatory Services Visits Ancillary Services (D) Procedures (Raw and Weighted) Minutes of Service (Surgical) Hours of Service (ICU) Special Programs (F) Immunizations Visits Associated Workload 20

Policy and Business Rules 21 ∎ DoD M, dated 7 April 2008, Change 2, April 15, 2014:  Provides Tri-Service MEPRS program policy and guidance to all MEPRS reporting (fixed) MTFs/DTFs.  Administrative Change published which alters only non-substantive portions of the issuance due to the establishment of the Defense Health Agency (DHA).  Researching more timely method of update to link to annual update of EAS IV System Tables.

MEPRS Management Improvement Group (MMIG) The MMIG was established in 1999 to provide functional and automated information system oversight for MEPRS, EAS, and the source systems. Current charter is dated 14 Dec 2009 and is currently under revision. It is an entity with a mission of uniformity, data integration, standardization, and compliance that operates under he auspices of the Resource Management Steering Committee. Meeting Minutes and Information on HA / DHA Directorates DHA Program Offices (DHIMS / DHSS) Chartered Workgroups (DQMCP/UBU/UBO/CCAWG) Policy and Business Rules 22

EASi DMHRSi Manpower data MILPERS EAS IV Repository Access via Business Objects EAS IV Repository-- DoD- Standardized MEPRS Data EAS IV O&M Expense Civilian Salary Obligation data PEC data Service Financial System Composite Health Care System (CHCS) Admissions/Discharges Bed Days Visits Ancillary Workload WAM 23

Policy and Business Rules 24 ∎ EASIV System Updates:  EAS IV includes Service-unique and DoD/DHA tables that contain multiple data elements which must be maintained and which must be in compliance with all current policy, regulations, etc.  The Table Update process in EAS IV also includes mapping the Service-unique data elements to a corresponding DoD/DHA data elements for consistent MHS MEPRS reporting.  Some of the EAS IV tables can be updated monthly, but all Service and DHA tables must be updated at least once a year. This monthly and annual process is referred to as the EAS IV Table Update Process.

MEPRS Data Quality Management Control Review List 25 “Medically Ready Force…Ready Medical Force”

MEPRS DQMC Review List Questions ∎ Education  5M2U (MADI) ∎ MEWACS  Data Load Status  Outliers  Allocation 26

MEPRS Education 27 Question A.7.c) “Have the members of the DQ Assurance Team been trained in their area of responsibility?” Note: A.7.c is to be used locally to ensure that team members have training in their functions and responsibilities. (E.g., Analysis: WISDOM; Medical Expense and Performance Reporting System (MEPRS): MADI, QUEST; Uniform Business Office (UBO): webinars; Patient Administration (PAD): Service PAD Course.)

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5 Minute MEPRS University (5M2U) 29  A web-based distance learning vehicle that offers animated tutorials that illustrate MEPRS concepts and processes.  Each tutorial contains targeted learning content and is approximately five minutes in length.  Consists of the five core modules that make up the MEPRS Application and Data Improvement (MADI) course as well as modules to guide the repository user through common data extraction scenarios.

Data Load Status 30 Question C.1.c) “Were the data load status, outlier and allocation tabs in the MEWACS document reviewed and explanations provided in the comments section for flagged data anomalies?”

Data Load Status WW.MEPRS.INFO/MEWACS 31

Data Load Status 32 Review Item 1. “EAS IV Repository MEPRS data load status and compliance with the 45-day reporting suspense or Service Guidance whichever is earlier. If the facility has a pattern (2 or more) of flagged cells on this tab, has it corrected it or developed a plan to correct it? Provide an explanation in the Comments Section.”

Data Load Status 14 December 2011 Pre-decisional FOUO 33

Data Load Status 34

Data Load Status 35

DQMC Review List 36 Review Item 2. “MTF-specific summary data outliers. If the facility has any Prior Fiscal Year or Current Fiscal Year flagged cells on this tab, provide an explanation in the Comments Section.”

Summary Outliers 14 December 2011 Pre-decisional FOUO 37 Clicking on the outlier month will take you to MTF Data Profiles

Summary Outliers 14 December 2011 Pre-decisional FOUO38

Summary Outliers 39

Summary Outliers 14 December 2011 Pre-decisional FOUO Multiple selection is available on many of the fields 40

Allocation 41 Review Item 3. “Ancillary and Support expense allocation tests. If the facility is flagged in the Prior Fiscal Year or Current Fiscal Year due to incomplete allocation of ancillary or support expenses, provide an explanation in the Comments Section, including projected date for submitting corrected data.”

Allocation 42

Allocation Fourth level FCC drilldown available. 43

44 Allocation Fourth level FCC drilldown available.

THANK YOU FOR YOUR INTEREST IN MEPRS ! QUESTIONS? MEPRS PROGRAM OVERVIEW 45 “Medically Ready Force…Ready Medical Force”

46 MHS Objectives ∎ Promote more effective and efficient health operations through enhanced enterprise- wide shared services ∎ Deliver more comprehensive primary care and integrated health services using advanced patient-centered medical homes ∎ Coordinate care over time and across treatment settings to improve outcomes in the management of chronic illness, particularly for patients with complex medical and social problems ∎ Match personnel, infrastructure, and funding to current missions, future missions, and population demand ∎ Establish more inter-service standards/metrics, and standard process to promote learning and continuous improvement ∎ Create enhanced value in military medical markets using an integrated approach in 5- year business plans ∎ Align incentives with health and readiness outcomes to reward value creation ∎ Improve the health of the population by addressing determinants of health “Medically Ready Force…Ready Medical Force”