Going back to Basic with Cost Accounting - .2.10.2015 · Going back to Basic with Cost Accounting

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  • Going back to Basic with Cost Accounting

    Presented by Terrin LandsDirector-Cost Reporting and RVU Development

  • ASCENSION HEALTH FOOTPRINTASCENSION HEALTH FOOTPRINT

    Ascension is the largest Catholic health system, the largest private nonprofit system and the second largest system (based on revenues) in the U it d St t ti i 23 t t d th Di t i t f C l biUnited States, operating in 23 states and the District of Columbia.

    2

  • FACILITIES AND STAFF (as of June 30 2014)FACILITIES AND STAFF (as of June 30, 2014)

    Locations 1,900,

    Acute Care Hospitals 101

    Rehabilitation Hospitals 4

    Psychiatric Hospitals 6

    Long-term Acute Care Hospitals 3

    Joint Venture Hospitals (

  • October 2, 20154

  • SymphonySymphony

    The Symphony Project is the Ascension Health name for the business transformation initiative enabled by afor the business transformation initiative enabled by a common PeopleSoft platform. Symphony is intended to facilitate efficiency, focus resources, and provide analytic capabilities that will improve operational and clinical outcomes.

    Since its beginning in 2009 we brought over 23Since it s beginning in 2009, we brought over 23 Ascension Health hospital systems and 4 supporting organizations live on one common platform for Human R P ll Fi d S l Ch i OResources, Payroll, Finance, and Supply Chain. Our project was delivered on-time, under-budget with significant ROI.

    October 2, 20155

  • Overview: Integrated Cost SolutionOverview: Integrated Cost Solution

    October 2, 20156

  • System Set-upSystem Set-up

    3310 GL

    Accounts

    6250 Depts.

    227 Cost Components

    Accounts

    Components

    13 Summary ComponentsOctober 2, 20157

    13 Summary Components for Reporting

  • Monthly Cost Accounting ProcessMonthly Cost Accounting Process

    Integrate Data

    Maintenance of Common

    Tables

    Receive Files from Source

    Systems

    Balance to source

    systems

    Department Cost

    Allocation

    Dept & Acct

    MappingOffsets & Remaps

    Supply Component Adjustment

    Overhead Allocations

    Recon to GL

    Service Item

    Allocation

    Price & Volume using Rev & Usage

    Create or Update RVUs

    Calculation of Unit Cost Reconciliation

    Patient Encounter

    CostingFile created in PM to MIC

    Applied to Patient Detail

    Reconciliation to PM & GL

    October 2, 20158

  • Keys to SuccessKeys to Success

    Service costingRealistic

    Clear d fi iti costing

    methodsRVU development

    Realisticdefinitions

    Naming conventions

    System tools

    Service costingDocument

    Feedbackcosting

    methodsDocument

    Defined process

    Data governance

    Leadership support Stakeholder

    expectations

    October 2, 20159

    expectations

  • Keys to SuccessKeys to Success

    Naming Conventions Clear DefinitionsNaming Conventions File names Datasets

    Clear Definitions Departments

    patient care vs overhead Datasets Components Remaps

    patient care vs overhead

    Accounts fixed vs variableRemaps

    Worksheets Batches

    direct vs indirect

    ComponentsBatches

    October 2, 201510

  • Key to Success Defined Process for AllKey to Success Defined Process for All

    Integrate Data

    Maintenance of Common

    Tables

    Receive Files from Source

    Systems

    Balance to source

    systems

    Department Cost

    Allocation

    Dept & Acct

    MappingOffsets & Remaps

    Supply Component Adjustment

    Overhead Allocations

    Recon to GL

    Service Item

    Allocation

    Price & Volume using Rev & Usage

    Create or Update RVUs

    Calculation of Unit Cost Reconciliation

    Patient Encounter

    CostingFile created in PM to MIC

    Applied to Patient Detail

    Reconciliation to PM & GL

    October 2, 201511

  • Keys to Success Service Costing MethodsKeys to Success Service Costing MethodsCDM Type Service Costing Allocation Method

    Acquisition cost (3 month weighted average) are usedSupply & Drug Items

    Acquisition cost (3 month weighted average) are used for Chargeable Supplies and Drugs

    Labor - ratio of cost to charges [RCC]

    R l ti V l U it t d t f i t l b Relative Value Units - expected costs of inputs- labor minutes, supplies (for supplies included in the procedure), equipment, other expenses [80/20]

    RVUs are utilized for Highest Volume and Highest Dollar

    Procedures

    RVUs are utilized for Highest Volume and Highest Dollar procedures

    Common RVUs are utilized wherever possible Established accepted practice RVUs are usedEstablished accepted practice RVUs are used

    Laboratory use Industry standard RVUs CHi Solutions

    Respiratory Therapy use Industry standard RVUs

    October 2, 201512

    p y py y AARC

    Physician Practices & Clinics use CMS RBRVS

  • Keys to Success RVU DevelopmentKeys to Success RVU Development

    Local RVU DevelopmentCommon - RVU DevelopmentEndoscopy & GI LabMammographySurgery

    Behavioral HealthCardiologyER & Trauma & Urgent Care g y

    Woman's Services

    Item Cost - 3 Month AvgCC

    ER & Trauma & Urgent CareHeart [Cath & EP Labs]Imaging Services

    Labor RCCPharmacyCentral Supply

    Interventional Rad & Spec ProcNeurology & Sleep MedOncology & Infusion

    RCCResidential Care

    gyOutpatient ServicesRehab Therapy

    W d C

    October 2, 201513

    Nursing UnitsWound Care

  • Keys to SuccessKeys to Success

    Documentation Data GovernanceDocumentation Master Configuration

    Workbook

    Data Governance

    Leadership SupportWorkbook Facility Specific

    Configuration Workbook Understand St k h ld Process Documentation

    Checklist

    Stakeholder Expectations

    Feedback Loop with users

    October 2, 201514

  • Keys to SuccessKeys to Success

    Use System Tools Be RealisticUse System Tools Saved Data Selections Linked SDS

    Be Realistic Understand Resources

    Staff (team) Linked SDS Automate with stops at

    audit points

    Staff (team) System

    Continuous Quality p Batches Shell Scripts

    Improvement

    Custom Interfaces

    October 2, 201515

  • Final NotesFinal Notes

    Our Team is able to:- Process 69 facilities monthly

    4 hours per facility 4 hours per facility- Build a New facility in 1 to 4 days

    With a team of

    October 2, 201516

  • Success MeasuresSuccess Measures

    Initiative Measure OutcomeInitiative Measure Outcome

    CostCentralizing the costing function and improve the quality of the data

    Elimination of consultants andCost and improve the quality of the data

    for 23 Health Ministries consultants and

    partial FTEs

    Quality Future plans for clinical outcome i iti ti To followQuality initiatives To follow

    UtilizationComparable reporting across Ascension Health with standard

    Leverage best practice amongstUtilization data definitions and cost process

    while using facility data

    practice amongstall facilities

    C ti f t f t ith lMonthly for 69

    Efficiency Creation of cost factors with lean staffy

    facilities with staff of 4

  • Questions?Questions?

    Terrin LandsAscension Health

    October 2, 201518

    Terrin.Lands@ascensionhealth.org