Title: MEPRS and Laboratory Management Speaker: LTC Robert Nace Session: R-4-1100

1. Title: MEPRS and Laboratory ManagementSpeaker: LTC Robert Nace Session: R-4-1100

2. Objectives Review role of the clinical laboratory Review structure of laboratory MEPRS data Discuss use of MEPRS/EAS data in the laboratory Review some basic methods for ensuring Data Quality Discuss Point-of-Care Testing Review “official” sources of Lab MEPRS data

3. Clinical Laboratory • Defined by Code of Federal Regulations (42 CFR Part 493) • “any facility that does laboratory testing on specimens derived from humans to give information for the diagnosis, prevention, treatment of disease, or impairment of, or assessment of health.” • AFIP PAM 40-24 • “a facility for the biological, microbiological, serological, chemical, immunohematological, hematological, biophysical, cytological, pathological, or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, or the assessment of the health of, human beings.”

4. Lab MEPRS Data Aggregated by FCC • Financial Data • GFEBS • Personnel data • DMHRSi • Workload • CHCS/COPATH/DBSS/WAM

5. Financial Data GFEBS Elements of Resource  Material Group Account Processing Code (APC) Cost Centers • Kinds of Dollars • Pay Data • Military • Civilian • Contracts • Supplies • Equipment

6. Personnel Data Officer Enlisted Civilian Contract Other Clinicians Skill Type 1 Direct Care Professionals Skill Type 2 Direct Care Para Professionals Skill Type 4 Admin/Clerical/ Log Skill Type 5 • Logistics • Clerical • Administrative • Lab IT • Clinical Lab Officers (71A, 71B, 71E) • Medical Technologists • (GS-0644) • Cytotechnologist (GS-0601) • Histotechnologist (GS-0646) • MLT (GS-0645) • MLT (68K) • Cytology Specialist (68KM2) • Pathology Technician (GS-0646) • Health Technician (GS-0640) • Pathologists (61U)

7. Workload • Laboratory test procedures are defined using Current Procedural Terminology (CPT) Codes • Maintained by American Medical Association • Five-digit codes ranging from 80047-89398 for lab • Each CPT code is assigned a weighted value and reported in accordance with the EAS IV CPT Table • CPT codes are expanded using modifiers (00,26,32, and 90) • Modifier 00: Requested and performed in-house • Modifier 26: Pathologist consult/interpretation • Modifier 32: Test requested from external location outside the group of the performing lab (‘referral’ testing) • Modifier 90: Test sent out to be performed at a different lab

8. Workload • The main source of MEPRS workload data is CHCS • Majority of Clinical Pathology workload captured automatically in CHCS • Transfusion Service workload captured in Defense Blood Standard System (DBSS) MAY need to be manually entered in CHCS, depending on your local procedures • Anatomic Pathology workload captured in COPATH and MUST be manually entered into CHCS • The Workload Assignment Module (WAM) captures workload and facilitates the transfer of data to EAS repository

9. Laboratory FCC Accounts • Medical Expense and Performance Reporting System Manual DoD 6010.13-M (C2.4.10.8 – C2.4.10.15.1) • Pathology: DB • Clinical Pathology: DBA • Operates the clinical laboratories and conducts studies, investigations, analyses, and examinations, including diagnostic and routine tests and systems • Anatomic Pathology: DBB • Conducts the histopathology and cytopathology laboratories; directs studies, examinations, and evaluations, including diagnostic and routine procedures; provides referrals and consultations; performs postmortem examinations; and operates the morgue • Cytogenetic Laboratory: DBD • Molecular Genetic Laboratory: DBE • Pathology Not Elsewhere Classified: DBZ

10. Other FCC Accounts of Lab Interest • FAA = Area Reference Lab • Brooke Army Medical Center, Fort Sam Houston, TX • Dwight David Eisenhower Army Medical Center, Fort Gordon, 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

11. Why Care About Ancillary MEPRS Data? BLUF: People are looking at your MTFs data and making assumptions, assessments, and decisions based on it

12. Who Is Looking at Your Data? Technology Assessment & Requirements Analysis (TARA)

13. Who Is Looking at Your Data? Six Sigma MEPRS Management Metrics

14. Who Is Looking at Your Data? • MHS/TMA • Scenario from a recent Quest Workshop • It’s beginning to look a lot like PBAM for ancillaries Provider and Institutional Cost per RVU for Lab/Rad

15. Why Care About Ancillary MEPRS Data? • More than just a cost accounting tool for RM or administrative staff • EAS can actually be a useful ancillary management tool • Strategic Planning • Benchmarking • Assessing efficiency and productivity • Business Case Analysis

16. Periodic Data Validation

17. Performance Metrics Cost Per Raw/Weighted = Total Expenses or Total Expenses Weighted Procedures Procedures Count Procedures Per FTE = Weighted Procedures or Procedures Count Available FTE Available FTE

18. Benchmarking Performance“Before” • “Foundation for Strategic Plan” • Improving performance on • metrics • - Workload • - Budget • - Staffing • - Data quality

19. Benchmarking Performance“After” • Realigned performance with • MEDCEN peer group • - Significant increases in • workload in both DBA/DBB • - Expanded services while • maintaining costs • - Improved data quality • (DMHRSi and workload)

20. Old Reports • Periodically sent out through RMC Lab Managers • - MEDCENS • - MEDDACS • - Health Centers

21. New Reports

22. Data Validation – Staffing • Staffing Assessments • Assigned vs. Available • Available vs. Non-available • Identify inappropriate coding by internal and external staff • Inappropiate coding: • - 68V Respiratory Specialist • - Pathology Tech (GS0646) • - 68KM2 Military Cytotech

23. Business Case Analysis • Recapturing referral testing • Regional Business Case Analysis • Pulled workload by Facility (DMIS ID), CPT Code, Modifier (90), Raw Count • MEDCOM Advances in Medical Practice (AMP) proposals

24. Expenses

25. Staff Utilization The “Real” Work

26. Other Uses • Investigate data anomalies/outliers • Doesn’t pass the reality check…this was a small/mid-size MEDDAC

27. So Now What? • How can we improve our performance? • More emphasis/visibility on ancillary metrics • Get the users to take “ownership” of their data • Improved communication and partnering between ancillaries, MEPRS, and RM staff • Consistent guidance from MEPRS and RM • Improving data quality • CHCS CPT Code reviews (proactive vs reactive) • DMHRSi Coding (Just say NO to Straight 8s) • Run the recommended reports (SAIC D/SIDDOMS Doc D2-NWDQ-5000A 28 SEP 2007) • Validation of WAM workload data prior to monthly EAS transmission

28. Workload Management • When was the last time you saw a “V” or a “W” status for an ancillary DSI?

29. Monthly WAM / CHCS Reconciliation

30. Monthly Data Quality Report • Submitted to MEPRS and PAD monthly after WAM EOM initialization

31. Displays workload not reported through WAM to EAS by data discrepancies category CPT Code: Inactive CPT Code Lab Section: No Lab Section Defined for this test Performing Location: MEPRS/DMIS ID Mismatch or Inappropriate Code Requesting Location: Inactive or Invalid MEPRS codes Corrected via MEC option in CHCS Workload Exception Reports

32. CHCS Error Correction Units Report • CHCS ad-hoc • Facilitates auditing of errors to identify and correct the source

33. Validation of Financial Information Are these correct?

34. DMHRSi Report • Pulled by timekeeper for DBA and DBB FCCs • Can be used to investigate and identify “bad coders” • Potentially >150 hrs inappropriately coded to DBAA

35. Point-of-Care Testing • “Laboratory” testing by “Non-Laboratory” personnel • Traditionally CLIA waived testing • Performed by medics, nurses, providers, etc., outside of the lab • Urinalysis, Rapid Antigen Testing (e.g., Influenza), fingerstick glucose, Provider Performed Microscopy, PT/INR, etc. • Proliferating rapidly due to technology and ease of use • No standardized way to capture MEPRS data (Workload, Financial and Personnel) • Some sites are capturing CPT workload data in CHCS • No sites are capturing Financial and/or Personnel data • How do you determine costs or assess performance?

36. “Official” Sources for Lab MEPRS Data MEWACS provides monthly MEPRS data quality feedback, systematically highlighting potential MTF data anomalies (only lab FTE data available) The Six Sigma MEPRS Management Metrics (S2M3) workbook is an interactive tool containing seven key MEPRS-based performance metrics (Weighted Procedures, Ave Monthly Avail FTE, Weighted Procedures per FTE)

37. MEDCOM Lab MEPRS Data Consolidated Cost and Workload Report is a tool to expedite data quality evaluation, expense, and workload validation (lab expense data only) Old Army MEPRS Program Office (AMPO) Website has historical ancillary data from 2004–2007 (lab workload, financial, cost per weighted procedure)

38. Training • Minute MEPRS University (5M2U) • MADI/QUEST Workshops http://www.meprs.info/index.cfm

39. Summary Reviewed function/role of the clinical laboratory Discussed structure of laboratory MEPRS data Reviewed use of MEPRS/EAS data in the laboratory Reviewed basic methods for quality of laboratory data Reviewed “official” sources of Lab MEPRS data Discussed Point of Care Testing and MEPRS implications Some of us “get it,” and we do “feel your pain!”

40. Q&A Questions?