MEPRS and EASIV “all you didn’t want to know and then some” LTC Robert L. Nace Lab Manager 1LT Chih Huang OIC, Anato

1. 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

2. 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”

3. 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”

4. Medical Expense & Performance Reporting System • MEPRS is the standardized cost accounting system for the Military Health System (MHS), containing Tri-Servicefinancial, 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 manpowerresources • In January 1985, the two systems were combined and MEPRS was born Dwight D. Eisenhower Army Medical Center “Caring from the Heart”

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

6. 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”

7. MEPRS Source 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”

8. MEPRS Data Flow **M2(an extract from MDR) **MDR(an extract from EAS IV) Workload (CHCS) *EAS IV Repository (Full MEPRS dataset) Financial (STANFINS, STARS/FL, CRIS) EASi Personnel (DMHRSi --UCAPERS, SPMS, EAS) **MEWACS (an extract from EAS IV; includes a small extract from M2) * Updated nightly ** Updated monthly NOTE: The MDR & M2 updates refer to MEPRS data only

9. 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”

10. Financial Data

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

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

13. Personnel Data

14. Personnel Data • Full Time Equivalent (FTE) • 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”

15. Personnel Data Total FTEs (Assigned / Available) PersonnelCategory 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 TypeSuffix P – Physicians D – Dentist N – Intern F – Fellow R – Resident V - Veterinarians

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

17. Workload Data

18. 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”

19. Account Structure

20. 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: • 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”

21. 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”

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

23. 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”

24. Other FCCs of Lab Interest • FAA = Area Reference Lab • Brooke Army Medical Center, Fort Sam Houston, TX • Dwight David Eisenhower Army Medical Center,FortGordon, 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”

25. Expense Allocation

26. 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”

27. 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”

28. 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”

29. AInpatientCare First, Support Services(“E” accounts) expensesare allocated BAmb.Care CDentalServices ESupport Services Other EAccnts DAncillary Services FSpecialProgs GMedReadiness Expense Allocation $ Each Support Services FCC is allocated until no expenses remain in “E” accounts

30. AInpatientCare Then, Ancillary Services(“D” accounts) expensesare allocated BAmb.Care DAncillary Services Other DAccnts CDentalServices FSpecialProgs GMedReadiness Expense Allocation $ Each Ancillary Services FCC is allocated until no expenses remain in “D” accounts

31. 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”

32. Data Quality

33. 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”

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

35. 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

36. Expense Assignment System IV(EAS IV)

37. 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”

38. Class 18 Ancillary CPT WorkloadObjects • 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”

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

40. 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

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

42. New Reports(Pivot Charts…YAY!)

43. 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”

44. Other Uses 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”

45. 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”

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

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

48. 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”

49. What’s the Point?

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