Why MEPRS Matters More Than Ever

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Why MEPRS Matters More Than Ever
Mike Dinneen, MD, PhD Director, Office of
Strategy Managment Office of the Assistant
Secretary of Defense for Health Affairs
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Transformational Change

• Most ailing organizations have developed a
  functional blindness to their own defects. They
  are not suffering because they cannot resolve
  their problems, but because they cannot see their
  problems.
• John Gardner
• The significant problems we face cannot be
  solved at the same level of thinking we were at
  when we created them.
• Albert Einstein
• There is nothing so powerful as an idea whose
  time has come.
• Victor Hugo

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Objectives

• Understand Department of Defense Strategic
  Direction and how expense reporting fits in.
• Understand the MHS Strategic Plan and how MEPRS
  fits in.
• Understand the critical importance of MEPRS Time
  allocation in achieving performance based
  management.
• Understand how MEPRS accounting will be modified
  to enable collection of cost and workload data in
  a manner that resembles best civilian practices.

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MHS Vision A world-class health system that
supports the military mission by fostering,
protecting, sustaining and restoring health.
MHS Mission To enhance DoD and our Nations
security by providing health support for the full
range of military operations and sustaining the
health of all those entrusted to our care.
Promote Protect Health of the Force and
Communities
Deploy to Support the Combatant Commanders
Patient Care, Sustain Skills and Training
to
and
Deployable Medical Capability
Medically Ready and Protected Force
Manage and Deliver Beneficiary Care
Support Homeland Defense Provide Humanitarian Aid
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Create Value for our External Stakeholders What
are the key outcomes?

• A fit, healthy and protected force
• Reduced death, injuries and diseases during and
  after military operations
• Satisfied beneficiaries
• Creation of healthy communities
• Effective management of healthcare costs

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MHS Mission To enhance DoD and our Nations
security by providing health support for the full
range of military operations and sustaining the
health of all those entrusted to our care.
Stakeholder Perspective
Financial Perspective
S2 Warrior Care Before, during and after
operations
S4 Healthy communities
S1 Force medical readiness and community
protection
S3 Beneficiary satisfaction
F1 Manage health care costs
Customer Perspective
Commanders and Service Members
DoD Beneficiaries
Total Customer Solution
Product Leadership
C1 Health Partnerships
C3 Care anytime, anywhere
C4 Readiness partnership
C2 Convenience and accessibility
Internal Process Perspective
Mission Centered Care
Patient Centered Care
Deployable Medical Capability and Homeland
Defense for Communities
Manage and Deliver the Health Benefit
Medically Ready and Protected Force
IP2 Partnerships with beneficiaries
IP3 Patient centered, effective processes
IP7 Humanitarian missions and homeland defense
IP10 Individual medical readiness
IP5 Joint processes deliver care anytime,
anywhere
IP8 New product and service development
IP1 Evidence based medicine
IP9 Health and environmental monitoring
IP6 Globally accessible health and performance
information
Learning Growth Perspective
Learning Growth Perspective
Organization Culture
Science and Technology
Human Capital
Organization Culture
L1 Customer focus
L3 Culture of jointness and interagency
cooperation
L7 IM/IT optimally leveraged
L6 Coordinated Biomedical RD
L5 Total force development
L2 Performance based management
L4 Authority and accountability are aligned
Resource Perspective
R2 Infrastructure management
R1 Transparent and reliably available resources
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Performance Based Organization

• A high performance organization is
• Employer of choice (staff)
• Provider of choice (customers)
• Best value for investors (stakeholders)
• What is required to create a high performance
  organization
• A strategic plan that describes how value is
  created for each of the three groups above
• Business plans for each business unit that link
  with the strategic plan
• Well understood objective measures of success
• A workforce provided with incentives and tools to
  innovate

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The Burning Platform What is the Problem that
We Are trying to Solve

• We do not know for sure that our medical
  professional workforce has the experience to
  excel in operational settings.
• We appear to be less efficient that civilian
  counterparts in part because we are not valuing
  non-clinical but, mission essential activites.
• We cant accurately compare performance across
  MTFs because we count differently
• Our data systems have not been designed to
  specifically support our business model

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What is the Cause of the Problem

• Current policy does not specify use of a specific
  business model
• Current organizational structure is widely
  variable
• Training does not adequately address performance
  based management in healthcare
• Our systems were not designed to monitor costs,
  outputs and outcomes in a manner consistent with
  commercial practices
• Leadership accountability for system performance
  is not been aligned with incentives and measures.
• We are not developing business managers and group
  practice managers as a strategic job family.

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What is the Solution?

• Group Practice and Clinical Work Centers
• managed separately
• supports optimal performance while adapting to
  some variation in organizational structure
• Supports business plans and financing in
  Multi-Service Markets to be Market based
• Promotes monitoring and management of clinical
  currency for all medical professionals

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The Civilian Model of Institutional vs.
Professional Charges a key enabler

• Institutional Charges
• Pays for hospital and some clinic expenses
• Linked to DRG/RWP for IP care
• Pays for ER and APV facility expenses
• Professional Charges
• Pays for group practice expenses
• Linked to RVUs earned by providers in all
  clinical settings (IP, OP and APV)

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How will this affect you?

• Standard Application of MEPRS across all Services
• Standard triservice business processes for the
  collection of labor expenses
• Full transparency of performance data, including
  MEPRS labor cost allocation
• You must identify your customers and answer the
  so-what question.

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Keys to Success

• Simplify data capture for individuals
• Lump, dont split work centers
• Standard naming of work centers
• Standard time allocation rules
• Simplified data entry
• Show people their data
• Align accountability with authority the golden
  rule

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Hypothetical Example of Group Practice and
Clinical Work Center Monthly Financial Reports
Monthly Group Practice Profit and Loss Statement (Professional)  
Total "Revenue" 3000RVU40/RVU 120,000
Support Staff Salary Expense (MEPRS ) (45,000)
Supply Expense (5,000)
Travel Expense (4,000)
Overhead Expense (E Stepdown) (20,000)
Net Earnings 46,000
Provider Salaries (56,000)
Profit (or loss) (10,000)


Monthly Hospital Ward Profit and Loss (Institutional)  
Total "Revenue" 150RVU6000/RWP 900,000
Support Staff Salary Expense (MEPRS ) (325,000)
Supply Expense (145,000)
Travel Expense (10,000)
Overhead Expense (E Stepdown) (300,000)
Profit (or loss) 120,000
Note Q Where does the group practice revenue
come from? A All of the work done by the
providers in the group practice regardless of
where it is done!
Note Q Where does the ward revenue come
from? A All of the work done by the ward only,
(not the work that the physicians receive RVU
value for).
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What do you think?
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Synopsis

• I will show how success in strategic
  transformation in the Department of Defense and
  the Military Health System depends on accurate
  and reliable expense data.
• I will then explain how minor changes and
  improvements in the methods for capturing and
  displaying MEPRS data will allow us to compare
  performance across MTFs and benchmark with
  civilian healthcare facilities. This section of
  the brief will include an overview of the concept
  of professional and institutional charges.
• Finally, I will try to show how success in
  simplifying and standardizing MEPRS 3rd and 4th
  level names and definitions will make the
  transition to DMHRSi much easier.

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Strategic Goal Enhance deployable medical
capability, force medical readiness and homeland
defense including humanitarian missions

• Tactical Focus
• Partner with VA to improve case management and
  share medical information
• Improve care for traumatic brain injury (TBI) and
  post traumatic stress disorder (PTSD)
• Conduct TBI and PTSD research within the MHS and
  in partnerships
• Improve the medical surveillance program
• Codify and expand humanitarian mission support
• Improve the Medical Logistics System

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Strategic Goal Sustain the Military health
benefit through top quality patient-centered care
and long-term patient partnerships with a focus
on prevention

• Tactical Focus
• Improve provider-patient communication and
  partnering ensure that our patients are in
  control of their health
• Expand tobacco, alcohol and weight management
  programs
• Implement focused disease management in MTFs and
  the purchased care system
• Target CPI projects to improve access to care,
  referral management and pharmacy management

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Strategic Goal Provide globally accessible, real
time, health information that enables medical
surveillance and evidence based healthcare

• Tactical Focus
• Implement AHLTA and TMIP and ensure seamless
  patient tracking
• Develop joint DoD and VA IP electronic health
  record
• Improve the speed and reliability of AHLTA
• Develop real time prevention, disease management
  and medical surveillance capabilities within
  AHLTA
• Deploy the personal health record

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Strategic Goal Provide incentives to achieve
quality in everything we do

• Tactical Focus
• Implement Continuous Process Improvement
  throughout the MHS
• Make clinical quality data transparent and widely
  available
• Focus MTF business plans on the entire MHS
  mission, not just production of health services
• Develop alternative RVU scale to incentivize
  prevention and readiness activities
• Implement joint governance to improve mission
  effectiveness
• Implement true market management especially in
  large multi-Service markets

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Strategic Goal Develop our most valuable
assetour people

• Tactical Focus
• Improve joint leadership training
• Develop common curricula and a tri-Service
  educational campus
• Implement coordinated programs to improve
  recruiting and retention
• Fully implement the Defense Medical Human
  Resource System (DMHRSi)

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Strategic Goal Build and sustain the best
hospitals and clinics nurture a caring
environment

• Tactical Focus
• Implement BRAC
• Use evidence-based design to create healing
  environments
• Remove barriers to effective management of
  facilities