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Orientation to MEPRS Structure and Processes Tri-Service 2007 Medical Expense and Performance Reporting System Orientation to MEPRS Structure and Processes Tri-Service 2007 Medical Expense and Performance Reporting System (MEPRS) Conference Charlee Wunderlin SRA International, Inc

Unit Objectives After completing this module, workshop participants will be able to: üDescribe the Unit Objectives After completing this module, workshop participants will be able to: üDescribe the primary purpose the Medical Expense and Performance Reporting System (MEPRS) satisfies in the Military Health System (MHS). üList the three different types of data contained in MEPRS. üList and define at least the 1 st-level Functional Cost Code (FCC) values used in MEPRS. üDistinguish between the purification and allocation (stepdown) processes conducted in MEPRS. üDescribe the general cost components that make up “Total Expenses” in MEPRS. 2

Outline w Introduction w MEPRS Account Structure w MEPRS Data Financial Personnel Workload w Outline w Introduction w MEPRS Account Structure w MEPRS Data Financial Personnel Workload w Allocation Process w Total Expenses 3

Introduction w MEPRS: Medical Expense and Performance Reporting System w Origin: MEPRS evolved from Introduction w MEPRS: Medical Expense and Performance Reporting System w Origin: MEPRS evolved from two historical systems – the Uniform Chart of Accounts (UCA) and the Uniform Staffing Methodologies (USM). The UCA focused on tracking expenses and the USM was concerned with manpower resources In January 1985, the two systems were combined and the “MEPRS System” was born. 4

Introduction w Purpose: Provide uniform reporting of expense, manpower, & workload for Do. D Introduction w Purpose: Provide uniform reporting of expense, manpower, & workload for Do. D Medical Treatment Facilities (MTFs) MEPRS is a system of manpower, cost distribution and expense reporting that provides management with a basic framework for cost and work center accounting. Standardized reporting by Functional Cost Code (FCC) w MEPRS = Information w EAS = the hardware and software in which the information resides. 5

Introduction MEPRS Data: Do. DStandardized, aggregated by FCC w Service-specific Financial data § Army: Introduction MEPRS Data: Do. DStandardized, aggregated by FCC w Service-specific Financial data § Army: STANFINS (Standard Army Financial System) § Navy: STARS/FL (Standard Accounting and Reporting System-Field Level § Air Force: CRIS PBAS (Commander’s Resource Integration System) (Program Budget Accounting System) w Service-specific Personnel data § Army: UCAPERS (UNIFORM CHART OF ACCOUNTS PERSONNEL UTILIZATION SYSTEM. § Navy: SPMS (Standard Personnel Management System § Air Force: AF Personnel Sub-System of EAS w Workload § CHCS / WAM (Composite Health Care System / Workload Assignment Module) 6

Introduction w Workload - CHCS Source System: The Composite Health Care system, is installed Introduction w Workload - CHCS Source System: The Composite Health Care system, is installed in more than 700 Do. D hospitals and clinics. CHCS is an automated medical information system supporting all Do. D MTFs in providing comprehensive, quality health care to uniformed service personnel, retirees and dependents. Sample Functions: Patient Registration, admission, disposition, radiology, and pharmacy 7

Introduction w MEQS III: Is a menu-driven Business Objects overlay to an Informix database Introduction w MEQS III: Is a menu-driven Business Objects overlay to an Informix database of MEPRS extracted data. It is the only source of detailed FY 95 -FY 00 MTF financial, FTE, and FCC workload data. It has been archived and therefore is no longer maintained. w EAS IV Repository: Replaces MEQS III as the source of central MEPRS Data. It has significantly greater detail than MEQS III, to include: MTF source financial data, BENCATs, CPT Codes and more detailed FTE Costs. 8

Local Management Analyst conducts ad hoc queries Expense Assignment System (EAS IV) at MTF Local Management Analyst conducts ad hoc queries Expense Assignment System (EAS IV) at MTF merges data files Composite Health Care System (CHCS) • Admissions/Discharges • Bed Days • Visits • Ancillary Workload Central Systems Feed “MEPRS Data” Service Financial System • O&M Expense • Civilian Salary • Obligation data • PEC data Service Personnel System • Manpower data • MILPERS 6 9

MEPRS Account Structure (Functional Cost Codes) MEPRS Account Structure (Functional Cost Codes)

Functional Cost Codes w 4 -letter MTF-specific codes representing work centers and used to Functional Cost Codes w 4 -letter MTF-specific codes representing work centers and used to track costs, workload and FTEs w First 3 letters are Do. D-standard w The first letter identifies the type of service provided: A - Inpatient Care B - Ambulatory Care C - Dental Care D - Ancillary Services E - Support Services F - Special Programs G - Medical Readiness 11

Functional Cost Codes w The second letter identifies summary accounts within MTF functional categories: Functional Cost Codes w The second letter identifies summary accounts within MTF functional categories: A = INPATIENT CARE § AA = Medical Care § AB = Surgical Care § AC = Obstetrical//Gynecological Care w The third letter identifies particular work centers within summary accounts: A = INPATIENT CARE § AA = MEDICAL CARE – AAA = Internal Medicine – AAB = Cardiology – AAD = Dermatology 12

Functional Cost Codes w The fourth letter is MTF-unique and used to identify specific Functional Cost Codes w The fourth letter is MTF-unique and used to identify specific location or type of costs and workload: B = AMBULATORY CARE § BH = PRIMARY MEDICAL CARE – BHA = Primary Care Clinics » BHAM = Primary Care Clinic - TMC-1 » BHAW = Primary Care Clinic - TMC-5 w A value of “ 5” in the 4 th FCC position is reserved for Ambulatory Procedure Visits (APV) costs and workload 13

Functional Cost Codes w Sample Inpatient accounts: A = INPATIENT CARE § AA = Functional Cost Codes w Sample Inpatient accounts: A = INPATIENT CARE § AA = Medical Care § AB = Surgical Care § AC = Obstetrical//Gynecological Care § AD = Pediatric Care § AE = Orthopedic Care § AF = Psychiatric Care § AG = Family Practice Care § AZ = Extended Care Services § ABZ = Surgical Care, NEC 14

Functional Cost Codes w Sample Ambulatory accounts: B = OUTPATIENT CARE § BA = Functional Cost Codes w Sample Ambulatory accounts: B = OUTPATIENT CARE § BA = Medical Care § BB = Surgical Care § BC = Obstetrical//Gynecological Care § BD = Pediatric Care § BH = Primary Medical Care § BI = Emergency Medical Care § BJ = Flight Medicine Care § BK = Underseas Medicine Care § BBJ = Pediatric Surgery Clinic § BBZ = Surgical Care, NEC § BHAR = Troop Medical Clinic #1 15

Functional Cost Codes w Sample Dental accounts: C = DENTAL CARE § CA = Functional Cost Codes w Sample Dental accounts: C = DENTAL CARE § CA = Dental Services § CB = Dental Prosthetics § CBA = Dental Laboratory § CBZ = Dental Prosthetics, NEC 16

Functional Cost Codes w Sample Ancillary accounts: D = ANCILLARY SERVICES § DG = Functional Cost Codes w Sample Ancillary accounts: D = ANCILLARY SERVICES § DG = SAME DAY SERVICES § DGA = Ambulatory/Same Day Surgery § DGB = Hemodialysis § DGD = Peritoneal Dialysis § DGX = Same Day Services Cost Pools § DGZ = Same Day Service, NEC 17

Functional Cost Codes w Sample Support Services accounts: E = SUPPORT SERVICES § EA Functional Cost Codes w Sample Support Services accounts: E = SUPPORT SERVICES § EA = Depreciation § EAA = Inpatient Depreciation § EAB = Outpatient Depreciation § EAC = Dental Depreciation § EBA = Command § EBB = Special Staff § EBC = Administration § EBD = Clinical Management § EBE = Graduate Medical Education Support 18

Functional Cost Codes w Sample Special Programs accounts: F = SPECIAL PROGRAMS § FAF Functional Cost Codes w Sample Special Programs accounts: F = SPECIAL PROGRAMS § FAF = Screening and Testing Program § FAI = Physiological Training/Support Program § FAK = Student Expenses / Work-hour § FAL = Continuing Health Education § FAZ = Health Programs Not Elsewhere Clsfd § FBB = Preventive Medicine § FBC = Industrial Hygiene Program 19

Functional Cost Codes w Sample Medical Readiness accounts: G = MEDICAL READINESS § GAA Functional Cost Codes w Sample Medical Readiness accounts: G = MEDICAL READINESS § GAA = Deployment Planning & Administration § GAB = Other Readiness Planning & Admin § GBB = Other Readiness Exercises § GCA = Readiness Training Conducted Locally § GCB = Other Readiness § GDA = Unit Or Personnel Deployment § GEA = Pre-positioned War Reserve 20

MEPRS Data MEPRS Data

Financial Data w. Kinds of Dollars Pay Data §Military §Civilian Contracts Supplies Equipment Base Financial Data w. Kinds of Dollars Pay Data §Military §Civilian Contracts Supplies Equipment Base Operations Depreciation 22

Financial Data w Pay Source Differences Military Pay §Service-specific Composite Military Pay Tables §Special Financial Data w Pay Source Differences Military Pay §Service-specific Composite Military Pay Tables §Special Pays not medical-unique Civilian Pay §Army / Navy use actual pay from Service financial system §Air Force uses Composite Civilian Pay Tables 23

Financial Data w Do. D-standardized financial data Service-specific pure financial data are also available Financial Data w Do. D-standardized financial data Service-specific pure financial data are also available in the EAS IV Repository 24

Personnel Data w. Full Time Equivalent (FTE) Amount of labor available to the MTF Personnel Data w. Full Time Equivalent (FTE) Amount of labor available to the MTF work center if a person works 1 month 168 Man-Hours = 1 FTE (Avg. 21 Days/Month x 8 Hours) w. Assigned FTEs Listed on facility manning documents w. Available FTEs Includes assigned, attached, borrowed, contracted, volunteers w. Non-Available FTEs Leave, loaned 25

Personnel Data Total Assigned / Available FTEs Personnel Category Skill Type Suffix 26 Personnel Data Total Assigned / Available FTEs Personnel Category Skill Type Suffix 26

Personnel Data Physician Dentist Medical Resident Medical Fellow Medical Intern Dental Resident Veterinarian Physician Personnel Data Physician Dentist Medical Resident Medical Fellow Medical Intern Dental Resident Veterinarian Physician Assistant Registered Nurse Practitioner Other Nurse Midwife Nurse Anesthetist Community Health Occupat. Health Nurse Clinical Nurse Specialist Other DC Professionals LPN or LVN Nursing Assistant Other Logistics Clerical Administrator Other 27

Workload Data w With few exceptions (e. g. , biomedical equipment repair), the source Workload Data w With few exceptions (e. g. , biomedical equipment repair), the source of MEPRS workload data is CHCS w The Workload Assignment Module (WAM) of CHCS automates the interface with EAS and includes beneficiary category and Current Procedural Terminology (CPT) data 28

Workload Data w Inpatient Services (A) Admissions Dispositions Occupied Bed Days Bassinet Days w Workload Data w Inpatient Services (A) Admissions Dispositions Occupied Bed Days Bassinet Days w Ambulatory Services (B) Ambulatory Visits Evaluation & Management (E&M) Codes CPT Codes 29

Workload Data w Dental Services (C) American Dental Assn. Weighted Values American Dental Assn. Workload Data w Dental Services (C) American Dental Assn. Weighted Values American Dental Assn. Lab Weighted Values w Ancillary Services (D) Raw and Weighted Procedures Minutes of Service (Surgical Services) Hours of Service (ICU) CPT-4 Codes (EAS IV) w Special Programs (F) Immunizations Visits 30

Expense Allocation Expense Allocation

Expense Allocation w Cost Pools Cost pools are identified with an “X” in the Expense Allocation w Cost Pools Cost pools are identified with an “X” in the 3 rd FCC position. Used when time and expense cannot be specifically assigned because two or more work centers share space, personnel or supplies. For example, mixed wards. Expenses and FTEs in cost pools are reassigned (purified) on the basis of workload. Cost pools are purified in alphabetical order before allocation of support and ancillary expenses. 32

Expense Allocation w Ward 3 E has a several nurses assigned to the cost Expense Allocation w Ward 3 E has a several nurses assigned to the cost pool (nursing salary dollars) shared by three specialties -- Cost Pool ABX ($10, 000) ABA - General Surgery (2500 MOS) ABI - Plastic Surgery (2500 MOS) ABK - Urology (5000 MOS) w Nursing Salary dollars accumulated in ABX ($10, 000) are purified based on each specialty’s proportional Ward 3 E minutes of service (MOS) ABX $10, 000 $0 ABK $5, 000 ABA $2, 500 ABI $2, 500 33

Expense Allocation Parent DMIS ID 4 th Level FCC Direct Expenses 0109 AAAA $ Expense Allocation Parent DMIS ID 4 th Level FCC Direct Expenses 0109 AAAA $ 1, 044, 639 0109 AABA $ 244, 757 0109 AADA $ 658 0109 AAEA $ 1, 767 0109 AAXE $ 2, 329, 272 0109 AAXF $ 2, 333, 061 0109 ABAA $ 379, 421 0109 BAM 5 $ 12, 028 0109 BAO 9 $ 213, 957 0109 BAXF $ 41, 604 0109 BAXH $ 213, 906 0109 CAAE $ 1, 258, 181 0109 DAAA $ 3, 006, 612 0109 DAXA $ 44, 159, 937 0109 DDBA $ 85, 373 0109 EAAA $ 2, 014, 889 0109 FFCB $ 41, 131 0109 GAAA $ 54, 538 This spreadsheet visually depicts different types of 4 th Level Functional Cost Codes. Highlighted in green are the COST POOLS. 34

Expense Allocation w Final Operating Accounts A - Inpatient Care B - Ambulatory Care Expense Allocation w Final Operating Accounts A - Inpatient Care B - Ambulatory Care C - Dental Care F - Special Programs G - Medical Readiness w Intermediate (Stepdown) Accounts D - Ancillary Services E - Support Services 35

Expense Allocation w Allocation (stepdown) of Support Services and Ancillary Services costs across final Expense Allocation w Allocation (stepdown) of Support Services and Ancillary Services costs across final operating accounts w Costs are allocated based on performance factors established by Do. D 6010. 13 M Weighted procedures performed Hours / Minutes of Service performed Square footage cleaned 36

Expense Allocation First, Support Services expenses are allocated E Support Services A Inpatient Care Expense Allocation First, Support Services expenses are allocated E Support Services A Inpatient Care C Dental Services Other E Accnts Each Support Services FCC is allocated until no expenses remain in “E” accounts B Amb. Care D Ancillary Services G Med F Special Progs Readiness 37

Expense Allocation Then, Ancillary Services expenses are allocated D Ancillary Services A Inpatient Care Expense Allocation Then, Ancillary Services expenses are allocated D Ancillary Services A Inpatient Care Other D Accnts Each Ancillary Services FCC is allocated until no expenses remain in “D” accounts B Amb. Care C Dental Services F Special Progs G Med Readiness 38

Total Expenses Total Expenses

Total Expenses w Total Expenses: Direct Expenses § Supplies § Labor § Etc. Expenses Total Expenses w Total Expenses: Direct Expenses § Supplies § Labor § Etc. Expenses from Cost Pools Expenses Contributed Expenses from Ancillary (D) accounts Expenses from Support (E) accounts 40

Total Expenses After Purification of Cost Pools and Allocation of D & E Accounts Total Expenses After Purification of Cost Pools and Allocation of D & E Accounts Direct Expenses A, B, C, D, E, F, G = Total Expenses A, B, C, F, G 41

Total Expenses Business Objects Formula + + Direct Expense Purified Expense Stepdown Expense Contributed Total Expenses Business Objects Formula + + Direct Expense Purified Expense Stepdown Expense Contributed Stepdown Expense from D Stepdown Expense from E = Total Expenses 42

Total Expenses 3 rd Level FCC Direct Expenses Purified Cost Pools ABA $5 $15 Total Expenses 3 rd Level FCC Direct Expenses Purified Cost Pools ABA $5 $15 $5 $8 - $33 ABI $5 $5 $3 $4 - $17 ABX $20 - $(20) $- DBA $10 - $2 - $(12) $- EFA $10 - - N/A $(10) $- Support Services E Ancillary Expenses Total Services Contributed Expenses D 43

Cost Drivers Proportion of dollars within each FCC Direct (Supply) Direct (Personnel) From Ancillary Cost Drivers Proportion of dollars within each FCC Direct (Supply) Direct (Personnel) From Ancillary From Support A 5% 21% 49% 25% B 8% 33% 37% 22% C 13% 55% 4% 28% F 30% 28% 24% 18% G 13% 68% 1% 18% 44

Functional Guidance Functional Guidance

Functional Guidance w Do. D 6010. 13 M Provides Tri-Service guidance to all MEPRS Functional Guidance w Do. D 6010. 13 M Provides Tri-Service guidance to all MEPRS reporting MTFs / DTFs Contains policy and guidance for implementation of MEPRS program Download from/access Online: www. meprs. info Chapter 1: Background Chapter 2: Chart of Functional Cost Codes Chapter 3: Manpower & Expense Assignment Chapter 4: Reporting Requirements Chapter 5: MEPRS Issue Process Appendices Acronyms, Definitions, Guidelines for reporting FTE 46

TMA MEPRS Oversight w MEPRS Management Improvement Group (MMIG) Established in 1999 Provides Functional TMA MEPRS Oversight w MEPRS Management Improvement Group (MMIG) Established in 1999 Provides Functional Oversight Tri-Service Integration, Standardization and Compliance Automated Information System Oversight Coordinates Policy / Action with Resource Management Steering Committee (RMSC) Meeting Minutes and Information on www. meprs. info 47

Functional MEPRS POCs Army Ms. Romona Bacon, MEDCOM (210) 295 -3370 Mona. Bacon@amedd. army. Functional MEPRS POCs Army Ms. Romona Bacon, MEDCOM (210) 295 -3370 Mona. Bacon@amedd. army. mil Navy Ms. Jane Cunningham, BUMED (202) 762 -0551 jmcunningham@us. med. navy. mil Ms. Nicole Myers, BUMED (202) 762 -0550 nmeyers@changearchitect. net Air Force Mr. Darrell D. Dorrian (703)681 -6356 Darrell. Dorrian@Pentagon. af. mil TMA Mr. Patrick Wesley, MMIG Chairman (703) 681 -8910 Patrick. Wesley@tma. osd. mil Ms. Deirdre Baker (210) 832 -5216 Deirdre_Baker@sra. com 48

MEPRS Website w TMA MEPRS website www. meprs. info w Navy MEPRS website http: MEPRS Website w TMA MEPRS website www. meprs. info w Navy MEPRS website http: //navymedicine. med. navy. mil/ w Army MEPRS website www. ampo. amedd. army. mil/ w Air Force MEPRS website www. afms. mil/sgmc/ w MHS Help Desk www. mhs-helpdesk. com 49

Review of Objectives Review of Objectives

Unit Objectives After completing this module, workshop participants will be able to: üDescribe the Unit Objectives After completing this module, workshop participants will be able to: üDescribe the primary purpose the Medical Expense and Performance Reporting System (MEPRS) satisfies in the Military Health System (MHS). üList the three different types of data contained in MEPRS. üList and define at least the 1 st-level Functional Cost Code (FCC) values used in MEPRS. üDistinguish between the purification and allocation (stepdown) processes conducted in MEPRS. üDescribe the general cost components that make up “Total Expenses” in MEPRS. 51

Orientation to MEPRS Structure and Processes Questions? Comments? Orientation to MEPRS Structure and Processes Questions? Comments?