Navy Medicine Leadership Symposium January 2011 Resource Discussion

1. Navy Medicine Leadership Symposium • January 2011 • Resource Discussion Managing the workforce

2. Resource Outlook Budget & PPS Contract planning & deobligations Where Can I Find Money? Coding - Data Quality Feedback Patient-Centered Process Improvement Internal Control & SOPs Outline

3. Budget FY 11: Budget (CR until 4 March) $3.6B • Includes WII, TBI/PH, PDHRA • Medical Home—major push • FY 12 Plan: delayed until after 14 Feb$3.6B • Gates initiatives (contracts & medical supply optimization) • Better BAG alignment • POM13: underway • Continuing impact of Gates initiatives • Ongoing: OPNAV discussion about medical mission • FY11 CR ‘process' may be used to hold spending to FY10 levels. • Expect pressure to prioritize and justify, especially contracts.

4. PPS Performance RWP Production is above FY09 Baseline 54.6K RWP Baseline RVU Production is above FY09 Baseline 18.2M RVU Baseline Total workload is up over the baseline!!

5. Acquisition Contract Planning & Forecasting Last year -- first M4 - M8 letter to Regions / Activities -- still maturing…needs CO’s engagement. Deadlines: 15 Feb: validate existing & continuing contracts and submit funding (or expected date of funding) 1 April: submit contractor performance reports & finalize funding 1 June: submit new requirements and associated funding Results: better contract responsiveness from NMLC De-obligations from previous year: inefficient use of resources Improved! FY09: $33M de-obligated by Jan 2010 FY10: $ 3M de-obligated by Jan 2011 FISC moving away from medical… Goal: improved $$ & total force planning 5 Better alignment between comptrollers and logisticians

6. Where Can a C-O Find Money? Government Purchase Cards Have MATMAN analyze what you buy; purchase cards = spot market Large $$ and quantities  contracts (strategic sourcing) Pharmacy & Inventory Levels Administrative & Overhead contracts What services are you buying and why? When was the last line-by-line review? Where are you setting the limits? Workload How much work are you doing vs. how much are you investing (contracts, GS, military)? Coding Poor coding  work not reported lost PPS earnings …soon to be PMPM? If the C-O doesn’t push on these, who will? 6

7. Top DQ CO “Explanations” • “Coding accuracy for outpatient E&M, ICD-9, & CPT codes has decreased. We are reviewing our POAM's.” • “Coding Auditor is constantly training the coders on the proper codes to use.” • “One year vacancy of the coding auditor/trainer will be filled in July.” • “Audit performed by (my boss).” • “20 of 29 E&M were correct.” • “AHLTA disposition defaults to an incorrect E&M code.” Need C-O help on better explanations

8. CNI Coordination Bethesda, Portsmouth, Beaufort, Balboa, Bremerton, Guam. • Transfer base-type functions to CNI: • Done! FY12 & out for 6 “stand-alones” • Hospitals remain with BUMED under Maintenance UICs • Building maintenance & special projects remain with BUMED / DHP • Any residual items  POM13/14 • No impact to hospitals on USMC bases / Cairo / Lima. • Regions / Activities: coordinate / communicate on specific resource questions • CNI & BUMED HQ working an integrated shift via site-specific ISSA to CNI responsibility • Do not transfer additional resources to CNI Key for BUMED is historic funding levels

9. Process Improvement • Industrial Engineering: scientific approach to process improvement that relies on current data, systemic analysis of solutions, and metrics to measure improvement / quality • Partnership with Johns Hopkins • Similar to efforts by Intermountain Health et al • Projects owned by MTF / Region • Enterprise-wide application of lessons under study by M3 • 9 projects completed; 10 projects underway. • Goal: best processes for patient & family centered care • POC: Tim Ward 202-762-1639 Maximizing our return on existing investments 3-year working plan in place

10. Completed: NMC San Diego -- Inpatient OB, Orthopedic supply chain NMC Portsmouth -- Orthopedic Patient Flow, Pharmacy NH Camp Lejeune -- Medical Evaluation Boards; Outpatient OB NH Camp Pendleton -- Outpatient OB NNMC Bethesda – OR Replenishment and Central Sterile operations In Process: NNMC Bethesda -- OR performance, CDD & WR Integration tasks NMC San Diego -- Ambulatory Procedure Visits NH Camp Pendleton -- Orthopedic outpatient, Medical Evaluation Boards Multiple locations -- Pharmacy operations and Automation procurement NHC Cherry Point, NH Camp Lejeune, NH Bremerton, NMC San Diego NH Camp Lejeune -- Inpatient OB (starts Jan 11) Summary of IE Projects to Date OB, Ortho, Pharmacy consistent areas of concern 10

11. 1. Overall Process: (Federal Managers’ Financial Integrity Act (FMFIA)) 2. Financial Reporting:(FMFIA)no new weaknesses/accomplishments for FY10 Previously reported weaknesses that remain in work: OverallAnti Fraud, Command Evaluation Program, Medical Coding, Personnel Security Financial MERCHF, Accounts Payable, Accounts Receivable, Funds Balance w/ Treasury CNO SECNAV Annual Statement of Assurance BUMED Accomplishments Weaknesses Navy-wide issues

12. SOPs Are Mandatory Since 1 Oct 09