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2010 UBO/UBU Conference
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Title: MEPRS and Laboratory Management
Session: R-4-1100
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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
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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.”
Financial Data – GFEBS
Personnel data– DMHRSi
Workload – CHCS/COPATH/DBSS/WAM
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Aggregated by FCC
Lab MEPRS Data
Financial Data
Kinds of DollarsPay Data
MilitaryCivilian
– Contracts – Supplies – Equipment
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GFEBS
Elements of Resource Material Group
Account Processing Code (APC) Cost Centers
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Personnel Data
Pathologists (61U) 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)
LogisticsClericalAdministrativeLab IT
OfficerEnlistedCivilian
ContractOther
CliniciansSkill Type 1
Direct Care ProfessionalsSkill Type 2
Direct Care Para ProfessionalsSkill Type 4
Admin/Clerical/Log
Skill Type 5
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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
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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
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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
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
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Why Care About Ancillary MEPRS Data?
BLUF: People are looking at your MTFs data and making assumptions, assessments, and decisions based on it
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Who Is Looking at Your Data?
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Technology Assessment & Requirements Analysis (TARA)
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Six Sigma MEPRS Management Metrics
Who Is Looking at Your Data?
FY Parent RVUs Provider Cost Institutional Cost Prov Cost per RVU Inst Cost per RVU Total Cost per RVU2009 0124 794,142 1,922,723$ 30,975,665$ 2$ 39$ 41$
RVUs Provider Cost Institutional Cost Prov Cost per RVU Inst Cost per RVU Total Cost per RVU844,513 4,996,058$ 26,876,731$ 6$ 32$ 38$
Lab
Rad
MHS/TMA
Scenario from a recent Quest Workshop
It’s beginning to look a lot like PBAM for ancillaries
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Provider and Institutional Cost per RVU for Lab/Rad
Who Is Looking at Your Data?
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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
Periodic Data Validation
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Performance Metrics
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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
Benchmarking Performance“Before”
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“Foundation for Strategic Plan”
• Improving performance on
metrics - Workload - Budget - Staffing - Data quality
Benchmarking Performance“After”
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• 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)
Old Reports
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• Periodically sent out through RMC Lab Managers - MEDCENS - MEDDACS - Health Centers
New Reports
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Staffing Assessments– Assigned vs. Available – Available vs. Non-available– Identify inappropriate coding
by internal and external staff
Data Validation – Staffing
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• Inappropiate coding:
- 68V Respiratory Specialist
- Pathology Tech (GS0646)
- 68KM2 Military Cytotech
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
Business Case Analysis
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11.70 READINESS LABOR
11.72 MILITARY PER-SONNEL COMPENSA-TION11.10 CIVILIAN PER-SONNEL COMP
26.20 OTHER SUPPLIES
31.15 MED/DENT EQUIP
31.20 OTHER EQUIPMENT
25.15 PURCHASE MAINT EQUIPMENT
25.30 EDUCATION & TRAINING
25.50 CONTRACT HEALTH CARE
25.65 OTHER MIS CONT
21.00 TRAVEL & TRANSPORT OF PER-SONS22.00 TRANSPORTATION OF THINGS
23.10 COMMUNICATION
43.00 INTEREST AND DIV-IDENDS
26.15 MED/DENT SUPPLIES
26.25 PHARM SUPPLIES
11.71 RESERVES PER-SONNEL COMPENSATION
Expenses
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CLINICAL LABO-RATORY OFC/LAB
MGR
LAB SCIENCE OFF MICROBIOLOGIST PATHOLOGIST0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
#N/A
SUPPORT TO RMC BRAC INTEGRATION OFF/TEAM
SUPPORT TO REGIONAL MEDICAL COMMAND (RMC)
SUPPORT TO OTHER MILITARY ACTIVITIES (REGION)
SUPPORT TO OTHER FEDERAL AGENCIES
READINESS TRAINING PEACETIME & WARTIME MEDICAL
READINESS PHYSICAL TRAINING
PCS/ETS RELATED FUNCTIONS
MEDICAL STAFF TRAINING
MEDICAL STAFF TEACHING
MEDICAL MILITARY ORGANIZATIONAL ACTIVITIES (MORA)
MEDDAC ONLY - TEACHING NON-GME STUDENTS ONLY
LOGISTICS DIVISION
DOD MILITARY BLOOD PROGRAM EAMC
COMMAND STAFF EAMC
CLINICAL PATHOLOGY MCPHERSON
CLINICAL PATHOLOGY EAMC
CLINICAL INVESTIGATION PROGRAM EAMC
AREA REFERENCE LABORATORY EAMC
ANATOMICAL PATHOLOGY EAMC
Staff Utilization
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The “Real” Work
Investigate data anomalies/outliers
Doesn’t pass the reality check…this was a small/mid-size MEDDAC
Other Uses
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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
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When was the last time you saw a “V” or a “W” status for an ancillary DSI?
Workload Management
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Monthly WAM / CHCS Reconciliation
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Monthly Data Quality Report
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Submitted to MEPRS and PAD monthly after WAM EOM initialization
Workload Exception Reports
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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
CHCS ad-hoc– Facilitates auditing of
errors to identify and correct the source
CHCS Error Correction Units Report
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Validation of Financial Information
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Cost Center / FE (Number) Valid From Valid To Name (Cost Center) Description (Cost Center)
MEPRS FDC (Functional Designator Code) APC1
74KK0188 10/1/2000 12/31/2099 CH PATH CH PATHOLOGY DBAA NHD0
74KK0189 10/1/2000 12/31/2099 ANATOMICAL PATHOLOGY ANATOM PATH DBBA NHJ0
74KK0190 10/1/2000 12/31/2099 CYTOLOGY SEC CYTOLOGY DBBA NHC0
74KK0191 10/1/2000 12/31/2099 HISTOLOGY SEC HISTOLOGY DBBA NHH0
74KK0192 10/1/2000 12/31/2099 MORGUE SEC MORGUE SEC DBBA NHK0
74KK0193 10/1/2000 12/31/2099 CLIN PATH BR CLIN PATH BR DBAA NHE0
74KK0194 10/1/2000 12/31/2099 CHEMISTRY SEC CHEMISTRY SEC DBAA NHF0
74KK0195 10/1/2000 12/31/2099 HEMATOLOGY SEC HEMATOLOGY SEC DBAA NHQ0
74KK0196 10/1/2000 12/31/2099 MICROBIOLOGY SEC MICROBIOLOGY SEC DBAA NHU0
74KK0197 10/1/2000 12/31/2099 TRANSFUSION SEC TRANSFUSION SEC DBAA NHV0
74KK0198 10/1/2000 12/31/2099 BIO SURETY PRGM SEC BIO SURETY PRGM SEC DBAA NHS0
74KK0199 10/1/2000 12/31/2099 PATH SUP BR PATHOLOGY SUPPORT BR BR DBAA NGR0
74KK0200 10/1/2000 12/31/2099 RCD/RPT SEC RCD/RPT SEC DBAA NGS0
74KK0201 10/1/2000 12/31/2099 POINT OF CARE BR POINT OF CARE BR DBAA NGT0
74KK0202 10/1/2000 12/31/2099 WFH CLINICAL PATHOLO WFH LAB SEC DBAW NDLA
74KK0203 10/1/2000 12/31/2099 MOORE PATH THOMAS MOORE LAB SEC DBAV NCWA
74KK0204 10/1/2000 12/31/2099 MONROE PATH MONROE LAB SEC DBAN NGY0
74KK0205 10/1/2000 12/31/2099 BENNETT PATH BENNETT LAB SEC DBAJ NDGA74KK0206 10/1/2000 12/31/2099 SMRC LAB
PHYSICAL EXAMINATION LAB(SMRC LAB SEC) DBAA NGM0
74KK0207 10/1/2000 12/31/2099 COPELAND LAB COPELAND LAB SEC DBAA NGN0
74KK0208 10/1/2000 12/31/2099 AVIATION MED LAB AVIATION MED LAB (TM #12 LAB) DBAP NGB0
Are these correct?
Pulled by timekeeper for DBA and DBB FCCs– Can be used to
investigate and identify “bad coders”
Potentially >150 hrs inappropriately coded to DBAA
DMHRSi Report
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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?
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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)
“Official” Sources for Lab MEPRS Data
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Old Army MEPRS Program Office (AMPO) Website has historical ancillary data from 2004–2007 (lab workload, financial, cost per weighted procedure)
MEDCOM Lab MEPRS Data
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Consolidated Cost and Workload Report is a tool to expedite data quality evaluation, expense, and workload validation (lab expense data only)
Minute MEPRS University (5M2U)
MADI/QUEST Workshops
Training
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http://www.meprs.info/index.cfm
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!”
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Q&A
Questions?
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