Preparing for an Audit: DMHRSi Time vs. Workload Reporting

1. Preparing for an Audit: DMHRSi Time vs. Workload Reporting Navy Resources Symposium4 June 2012 Herb EscobarEscobar Analytics and Services, Inc.hescobar@easincorporated.com

2. 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.

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

4. DMHRSi Data and Application

5. 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

6. 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

7. 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

8. 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

9. DMHRSi Data Quality Challenges

10. 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

11. DMHRSi = MEPRS Correct

12. DMHRSi > MEPRS Incomplete Timecards Pulled?

13. DMHRSi < MEPRS Edits in MEPRS Only?

14. 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

15. Tri-Service Labor Reporting vs. Workload Study

16. 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.

17. Context

18. 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

19. 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

20. 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

21. 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

23. 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

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

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

26. 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

27. 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

28. 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

29. 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

30. 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

31. Review of Objectives

32. 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.

33. Preparing for an Audit: DMHRSi Time vs. Workload Reporting Navy Resources Symposium4 June 2012 Herb EscobarEscobar Analytics and Services, Inc.hescobar@easincorporated.com