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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