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Title: MEPRS and Laboratory Management Session: R-4-1100. 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

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Presentation Transcript
objectives
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

clinical laboratory
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.”
slide4

Lab MEPRS Data

Aggregated by FCC

  • Financial Data
    • GFEBS
  • Personnel data
    • DMHRSi
  • Workload
    • CHCS/COPATH/DBSS/WAM
financial data
Financial Data

GFEBS

Elements of Resource 

Material Group

Account Processing Code (APC) Cost Centers

  • Kinds of Dollars
  • Pay Data
      • Military
      • Civilian
    • Contracts
    • Supplies
    • Equipment
personnel data
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)
workload
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
workload8
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
laboratory fcc accounts
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
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
why care about ancillary meprs data
Why Care About Ancillary MEPRS Data?

BLUF: People are looking at your MTFs data and making assumptions, assessments, and decisions based on it

who is looking at your data
Who Is Looking at Your Data?

Technology Assessment & Requirements Analysis (TARA)

who is looking at your data13
Who Is Looking at Your Data?

Six Sigma MEPRS Management Metrics

who is looking at your data14
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

why care about ancillary meprs data15
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
performance metrics
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

benchmarking performance before
Benchmarking Performance“Before”
  • “Foundation for Strategic Plan”
  • Improving performance on
  • metrics
  • - Workload
  • - Budget
  • - Staffing
  • - Data quality
benchmarking performance after
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)
old reports
Old Reports
  • Periodically sent out through RMC Lab Managers
  • - MEDCENS
  • - MEDDACS
  • - Health Centers
data validation staffing
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
business case analysis
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
staff utilization
Staff Utilization

The “Real” Work

other uses
Other Uses
  • Investigate data anomalies/outliers
  • Doesn’t pass the reality check…this was a small/mid-size MEDDAC
so now what
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
workload management
Workload Management
  • When was the last time you saw a “V” or a “W” status for an ancillary DSI?
monthly data quality report
Monthly Data Quality Report
  • Submitted to MEPRS and PAD monthly after WAM EOM initialization
workload exception reports

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
chcs error correction units report
CHCS Error Correction Units Report
  • CHCS ad-hoc
    • Facilitates auditing of errors to identify and correct the source
dmhrs i report
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
point of care testing
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?
slide36

“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)

slide37

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)

training
Training
  • Minute MEPRS University (5M2U)
  • MADI/QUEST Workshops

http://www.meprs.info/index.cfm

summary
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!”

slide40
Q&A

Questions?