Labor Mapping Basics

1. Labor Mapping Basics VHA Homeless Programs VHA Office of Finance – Managerial Cost Accounting Office

2. Objectives • Managerial Cost Accounting (MCA) • What it is and why we have it • Understand basics of the Decision Support System (DSS) • Labor Mapping • Concepts • Business rules • “Types” of time • Clinical (Direct patient care) • Administrative • Education • Research • Labor mapping scenarios • Mapping impacts • Costs • Productivity VHA Office of Finance – Managerial Cost Accounting Office

3. What are MCA and DSS? • Managerial Cost Accounting – MCA • Observes and calculates the actual costs of operations • Determines where the money goes • Decision Support System – DSS • Official managerial cost accounting system for VA • A software system and secondary database • Accepts and matches data from other sources • Does not create data, this is your data • Requires input from managers • A reporting system • Cost • Workload • Patient Demographics • Productivity VHA Office of Finance – Managerial Cost Accounting Office

4. Where does the data come from? VHA Office of Finance – Managerial Cost Accounting Office

5. DSS Database Structure • DSS Production Units describe the labor activity • L1 = Emergency Department (ED) • MM = Patient Aligned Care Team (PACT) • DSS Cost Centers (ALBCCs) hold dollars and hours • 204L1* = Emergency Department (ED) ALBCC • 204MM* or 201MM* = Patient Aligned Care Team (PACT) ALBCCs • DSS Departments hold workload • Each cost center has a DSS department • Intermediate products = workload • 30 minute Clinic Visit • Intermediate products are costed • Patient encounter records show cost and workload VHA Office of Finance – Managerial Cost Accounting Office

6. Major Categories of Data • Costs • Examples • Equipment • Supplies • Labor Hours • Examples • Physician • Nursing staff • Clerical Staff • Products and services used for patient care • Examples • 15 minute clinic visit • 30 minute emergency department visit • 60 minute radiology procedure • Data about the patient • Examples • Diagnoses • Demographics • Treatment VHA Office of Finance – Managerial Cost Accounting Office

7. Products and services supplied to patients From VistA SchedulingorEvent Capture System (ECS) Mapped to department that produces work Workload VHA Office of Finance – Managerial Cost Accounting Office

8. Costs Labor Supplies Equipment FTE: Costs and hours From financial sources Mapped to areas where they are used Resources VHA Office of Finance – Managerial Cost Accounting Office

9. Labor Mapping – what is it? • A process of assigning labor resources to the workareas where they belong • Labor hours are mapped to the areas where the employees work and are paid • Assigns labor costs to the Account Level Budgeter Cost Center (ALBCC) where the work occurred. Services are asked to distribute their employees’ labor time (based on percentages) to the various ALBCCs where they work. 18

10. Labor Mapping affects… • In order for all of these to be accurate, service leaders need to ensure that labor mapping is reviewed and adjusted monthly. Department and Product Costs Effect 1 Labor Mapping Department Productivity Effect 2 Effect 3 Patient/Encounter Costs 18

11. Resource data flow ALB Cost Centers HUD/VASH Clinic 203PL1 HCHV/HCMI 203QZ1 Grant and Per Diem 203PG1 Financial Extracts VHA Office of Finance – Managerial Cost Accounting Office

12. The Golden Rule of MCA • Workload and cost must be kept together. • All employees must be labor mapped to the department where their workload is produced. VHA Office of Finance – Managerial Cost Accounting Office

13. MCA site team members perform technical steps to do mapping Local managers need to tell MCA staff how and where to map employee labor Knowledge of MCA/DSS IPDs Worksheets Access database interface Who does mapping? VHA Office of Finance – Managerial Cost Accounting Office

14. Cost distribution –Inpatient & Outpatient VHA Office of Finance – Managerial Cost Accounting Office

15. Cost per Clinic Stop Code Report – FY16 (Feb) VHA Office of Finance – Managerial Cost Accounting Office

16. Labor Variable Labor (VL) Fixed Direct Labor (FDL) Time Direct Patient Care Time Administration Time Education Time Research Time Types of Labor and Time VHA Office of Finance – Managerial Cost Accounting Office

17. Time to prepare, to provide for, and follow-up on the clinical care needs of patients including: Time spent in reviewing patient data. Consulting about patient care with colleagues. Reviewing medical literature. Contacting the patient or caregivers to discuss their needs. The labor hours provided by a physician or dentist who is supervising house staff residents providing care in a clinical setting. Allocated (mapped) to direct care ALBCCs/departments in proportion (%) to the time spent in each of these activities Variable Labor (VL) Direct Patient Care Time VHA Office of Finance – Managerial Cost Accounting Office

18. Administration Time includes time spent on managerial or administrative duties, generally at the level of the department, service, medical facility, VISN, or nationally, both within and outside VA including: In support of service-wide administrative activities, such as completing performance reviews, and medical center and VA Central Office reporting requirements. Managing a program within a clinical department, service, or hospital. Working on service or hospital-wide committees. Serving on state and national committees, advisory boards, or professional societies. Allocated (mapped) to the indirect service Administrative ALBCC (xxx00*) in proportion (%) to the time spent in each of these activities Fixed Direct Labor (FDL) Administration Time VHA Office of Finance – Managerial Cost Accounting Office

19. FDL/VL Splits for Administrative Time • Not for physicians and dentists • Used to reflect time clinical employees spend on purely administrative duties (FDL) and direct patient care (VL) within a Direct care ALBCC/department • FDL/VL Split – map as percentage • FDL (Fixed Direct Labor) = Administrative time; mapped to the place where the employee works • VL (Variable Labor) = Clinical time; mapped where the employee works VHA Office of Finance – Managerial Cost Accounting Office

20. Time spent providing formal training (didactic education). This includes preparation as well as actual classroom or lecture time for educators or presenters. Giving conferences in the community or nationally. In a classroom teaching medical school curriculum. In a classroom teaching residents and fellows. In managing a resident, fellow, or other type of student teaching program. Working on medical school committees. Allocated (mapped) to the indirect service Education/Support ALBCC (xxx02*) in proportion (%) to the time spent in each of these activities Fixed Direct Labor (FDL) Education Time NOTE: Time spent receiving training is considered a cost of direct patient care. VHA Office of Finance – Managerial Cost Accounting Office

21. Defined as time spent performing formal, approved health care research, or in activities in direct support of approved research. Working on research projects that have been approved by the local VA medical center Research and Development Committee which does not produce recorded patient care encounter workload in VistA. Working in an actual research laboratory or in a controlled setting that involves no direct patient care or treatment. Serving on hospital or affiliate research committees. Supervising a student’s, resident’s, or fellow’s non-clinical research. Writing for publications or grants. Attending meetings explicitly related to research activities. Presenting papers at research meetings. Sitting on a national study section or grant approving board. Allocated (mapped) to the indirectresearch support ALBCC (xxx01*) in proportion (%) to the time spent in these activities Fixed Direct Labor (FDL) Research Time VHA Office of Finance – Managerial Cost Accounting Office

22. Drive time…where is it included? • Clinical professional (Not a physician) • FDL/VL Split • Travel time mapped as FDL to the Direct ALBCC • DO NOT map FDL to administrative ALBCCs • Results in overstated indirect (overhead) cost • VL RVU • An average travel time may be added to the Labor RVU for the visit • Example: 30 minute drive time & 30 minute visit : RVU = 60 • Physician • VL RVU • An average travel time may be added to the Labor RVU for the visit • Example: 30 minute drive time & 30 minute visit : RVU = 60 • No FDL/VL splits allowed • If FDL, must be mapped to Clinical Administrative ALBCC (i.e. 203001) VHA Office of Finance – Managerial Cost Accounting Office

23. Labor Mapping Reports VHA Office of Finance – Managerial Cost Accounting Office

24. Labor Mapping Reports (2) VHA Office of Finance – Managerial Cost Accounting Office

25. Common Labor Mapping Questions: How do we map…? • Extended leave • Continue to map the employee to their “regular” assigned ALBCC/department unless there is an official SF-52 changing their assignment • Workers Compensation • To ensure standardization, the following Workers Compensation BOCs should be mapped to the Directors Office (40100*): • BOC 1094 Employee Compensation (FDO) • BOC 1095 Employee Salary Continuation (FDL) • BOC 1096 Employee on Sick Leave Pending Disability Retirement (FDL) • Maternity leave • Continue to map the employee to their “regular” assigned ALBCC/department unless there is an official SF-52 changing their assignment VHA Office of Finance – Managerial Cost Accounting Office

26. Common Labor Mapping Questions (2): How do we map…? • Non-physician, non-dentist employees supervising students/trainees • Continue to map the employee to the clinic, ward or service (direct ALBCC) where the student or trainee is performing patient care work • Paid trainees/students • Map the trainee/student to the clinic, ward or service (direct ALBCC) where they are performing patient care work VHA Office of Finance – Managerial Cost Accounting Office

27. Common Labor Mapping Questions (3): How do we map…? • Clinical Supervision • Map the employee to the clinic, ward or service (direct ALBCC) where they are performing patient care work • A VL/FDL split may be necessary if the employee performs any administrative supervisory duties such as conducting performance appraisals or approving time VHA Office of Finance – Managerial Cost Accounting Office

28. Questions? VHA Office of Finance – Managerial Cost Accounting Office

29. VHA Directive 2011-009, Physician and Dentist Labor Mapping VHA Directive 1161-Productivity and Staffing in Outpatient Clinical Encounters for Mental Health Providers Administrative Labor and FDL Mapping Education Support Mapping Research Support Mapping Resident Supervision Mapping MCA Financial Lexicon Mapping References VHA Office of Finance – Managerial Cost Accounting Office

30. To Learn More • MCA Learning Community • Contact the MCAO Training Team • VHAMCAOTraining@va.gov VHA Office of Finance – Managerial Cost Accounting Office