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Medical Expense and Performance Reporting System (MEPRS) Program
Data Quality ToolsType Brief: Information
April 30, 2014
DHA MEPRS Program Office
““Medically Ready Force…Ready Medical Force”Medically Ready Force…Ready Medical Force”
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DHA Vision
“A joint, integrated, premier system of health, supporting those who serve in
the defense of our country.”
““Medically Ready Force…Ready Medical Force”Medically Ready Force…Ready Medical Force”
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Agenda∎ MEPRS Policy and Business Rules
IntroductionAccount StructureData (Financial, Personnel, & Workload)Policy and Business Rules
∎ Data Quality Management Control Review ListEducationMEPRS Early Warning and Control System (MEWACS)
Data Load Status Summary Outliers Allocation Test
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Introduction to MEPRS
4““Medically Ready Force…Ready Medical Force”Medically Ready Force…Ready Medical Force”
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14 December 2011 Pre-decisional FOUO 5
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Introduction
14 December 2011 Pre-decisional FOUO 6
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Introduction
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∎ DoD 6010.13M (April 7, 2008; Change 2 April 15, 2014). Authority DoDD 6000.12E, “Health Services Operations
and Readiness” A uniform expense and labor reporting system shall be maintained in all fixed
MTFs and dental treatment facilities to provide standardized expense and
manpower data for management of health care resources.Standards for the Federal government Statement of
Federal Financial Accounting Standards (SFFAS) 4 MEPRS supports MTFs and all entities within the MHS in approximating and
reporting full cost of resources used to produce output by responsibility segments/functional cost centers. The full cost data derived from MEPRS may be used by the department in developing actuarial liability estimates for the Military Retirement Health Benefits Liability in the Other Defense Organization General Funds. This information is included in the department’s annual agency wide audited financial statements.”
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∎ Purpose: Provide uniform reporting by Functional Cost Code (FCC) of expense, labor, & workload for DoD Military Treatment Facility (MTF) affording management a basic framework for cost and work center accounting.
∎ MEPRS refers to the expense, labor, and workload data.
∎ Expense Assignment System (EAS) is the Web-based hardware and software in which the data is created and the information resides.
Introduction
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• Business Planning• Medicare-Eligible Retiree HealthCare Fund (MERHCF)• Manpower Standards • Data Quality Statement
Multiple MEPRS Inputs
• Base Realignment and Closure (BRAC) Analysis Workload & Expenses
• Audit Agency • DHA Development of Per Member Per Month (PMPM)
Calculation• Billing Rates• MHS Balanced Scorecard Instrument Panel
Metrics Scorecard – Comparison of Service Productivity
Introduction
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RVUsb
“E” – Support
“D” – Ancillary
“A” – Inpatient
“B” – Outpatient
“C” – Dental
“F” – Special
Programs
“G” – Readiness
EAS IVExpenses
Labor
Workload
RECONCILE
Direct Care “Step Down”
Defense Health Program Managerial Cost Accounting
OUTPUT
TotalCost
RVUs RWPs
ICD/E&M/CPTDRGsSIDR
CAPERCHCS/AHLTA
Introduction
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MEPRS Data:DoD-Standardized,Aggregated by FCC
Service-specific FinancialdataArmy: STANFINS/GFEBS
(Standard Army Finance System/General Fund Enterprise System)
Navy: STARS-FL (Standard Accounting and Reporting System/Field level)Air Force: GAFS – R/ DEAMS
(General Accounting Finance System Rehost/Defense Enterprise Accounting and Management System)
Personnel DMHRSi
(Defense Medical Human Resource System - internet)
Workload
CHCS/WAM(Composite Health Care System / Workload Assignment Module)
Introduction
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Note: The DHA National Capital Region Medical Directorate (NCR-MD) currently uses GFEBS for Fort Belvoir and STARS/FL for Walter Reed National Military Medical Center
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Functional Cost Codes (FCCs) are 4-character MTF-specific codes representing work centers or reporting facilities; used to track costs, workload and FTEs. The first 3 letters are DoD-standard.
The fourth letter is MTF-unique and used to identify specific types of costs and workload:
B = AMBULATORY CARE (DoD standard)BH = PRIMARY MEDICAL CARE (DoD standard)
BHA = OUTPT PRIMARY CARE CLINICS (DoD standard)
BHAA = Outpt Primary Care Clinic – Parent Facility (MTF
specific) BHAM = Outpt Primary Care Clinic - TMC-
1 (MTF specific) BHAW = Outpt Primary Care Clinic - TMC-
5 (MTF specific)
Note: use of 4th Level MEPRS FCC for Patient Centered Medical Home
Chart of AccountsAccount Structure
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Account Structure
14 December 2011 Pre-decisional FOUO 13
∎ Cost pools are identified with an “X” in the 3rd FCC position. They are used when time and expense cannot be specifically assigned because two or more work centers share space, personnel or supplies. For example, most inpatient wards.
∎ Expenses and FTEs in cost pools are reassigned (purified) on the basis of workload.
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Expense Allocation
Account Structure
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$- $(10) $10 EFA
$- $(12) $2 $10 DBA
$- $(20) - $20 ABX
$33 - $8 $5 $15 $5 ABA
Total Expenses
Expenses Contributed
Ancillary Services
D
Support Services
E
Purified Cost Pools
Direct Expenses
3rd Level FCC
$3 $5 $5 ABI $4 $17 -
- -
- - N/A
Expense Allocation “ Step Down”
MEPRS Policy & Business Rules
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Financial
Service specific codes that categorize expenses into Pay Data (Military & Civilian),Contracts, Supplies, Equipment, Base Operations, etc. are mapped to DoD standard codes in EAS.
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DoD Air Force Army Navy
SEEC - Standard Expense Element Code
EEIC - Element of Expense Investment Code
EOR - Element of Resource EE - Expense
Element
PEC - Program Element Code
PEC - Program Element Code
AMSCO - Army Management Structure Code
SAG - Subactivity Group
CI – Commit. Item
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Personnel
Full Time Equivalent (FTE)Amount of labor available to the MTF work center if a person works fulltime for 1 month.
Assigned FTEsTime reported by personnel assigned to specific positions/work centers on MTF manning documents.1 FTE = number of assigned days / the number of days in a month
Available FTEsTime reported by any personnel in a given clinic for a given month. Includes those who are Assigned, attached, borrowed, contracted, volunteers, etc.1 FTE = 168 man-hours in 1 month(1FTE is calculated as an average of 21 work days per month x 8 hours per day)
Non-Available FTEsTime reported by Assigned personnel in their Assigned work center that is unrelated to the healthcare mission such as sick leave, personal leave, etc.
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Personnel
PersonnelPersonnelCategoryCategory
Skill TypeSkill Type
Total FTEs (Assigned / Available)Total FTEs (Assigned / Available)
Skill TypeSkill TypeSuffixSuffix
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Personnel
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Workload
The main function of workload data in EAS is to provide a basis to allocate expenses among work centers; therefore, workload is collected in relationship to costing. Historically, MEPRS workload in EAS with its limited focus has been used for analysis, but today the MHS Data Mart (M2) is the official source of workload data because it serves an analysis mission.
Inpatient Services Admissions
DispositionsOccupied Bed DaysBassinet Days
Ambulatory ServicesVisits
Ancillary Services (D)Procedures (Raw and Weighted)
Minutes of Service (Surgical)
Hours of Service (ICU)
Special Programs (F)ImmunizationsVisits
Associated Workload
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Policy and Business Rules
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∎ DoD 6010. 13-M, dated 7 April 2008, Change 2, April 15, 2014: Provides Tri-Service MEPRS program policy and guidance to all MEPRS
reporting (fixed) MTFs/DTFs. Administrative Change published which alters only non-substantive
portions of the issuance due to the establishment of the Defense Health Agency (DHA).
Researching more timely method of update to link to annual update of EAS IV System Tables.
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MEPRS Management Improvement Group (MMIG)The MMIG was established in 1999 to provide functional and
automated information system oversight for MEPRS, EAS, and the source systems. Current charter is dated 14 Dec 2009 and is currently under revision. It is an entity with a mission of uniformity, data integration, standardization, and compliance that operates under he auspices of the Resource Management Steering Committee. Meeting Minutes and Information on www.meprs.info .
HA / DHA Directorates
DH
A P
rogr
am
Offi
ces
(DH
IMS
/ DH
SS) Chartered W
orkgroups
(DQM
CP/UBU/UBO/CCAW
G)
Policy and Business Rules
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EASi
DMHRSi
•Manpower data•MILPERS
EAS IV Repository Access via Business Objects
EAS IV Repository-- DoD- Standardized MEPRS Data
EAS IV
•O&M Expense•Civilian Salary•Obligation data•PEC data
Service FinancialSystem
Composite Health CareSystem (CHCS)
•Admissions/Discharges•Bed Days•Visits•Ancillary Workload
WAM
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Policy and Business Rules
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∎ EASIV System Updates:EAS IV includes Service-unique and DoD/DHA tables that
contain multiple data elements which must be maintained and which must be in compliance with all current policy, regulations, etc.
The Table Update process in EAS IV also includes mapping the Service-unique data elements to a corresponding DoD/DHA data elements for consistent MHS MEPRS reporting.
Some of the EAS IV tables can be updated monthly, but all Service and DHA tables must be updated at least once a year. This monthly and annual process is referred to as the EAS IV Table Update Process.
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MEPRS Data Quality Management Control Review List
25““Medically Ready Force…Ready Medical Force”Medically Ready Force…Ready Medical Force”
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MEPRS DQMC Review List Questions
∎Education 5M2U (MADI)
∎MEWACSData Load StatusOutliersAllocation
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MEPRS Education
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Question A.7.c) “Have the members of the DQ Assurance Team been
trained in their area of responsibility?”Note: A.7.c is to be used locally to ensure that team members have training in their functions and responsibilities. (E.g., Analysis: WISDOM; Medical Expense and Performance Reporting System (MEPRS): MADI, QUEST; Uniform Business Office (UBO): webinars; Patient Administration (PAD): Service PAD Course.)
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WWW.MEPRS.INFO/5M2U
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5 Minute MEPRS University (5M2U)
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A web-based distance learning vehicle that offers animated tutorials that illustrate MEPRS concepts and processes.
Each tutorial contains targeted learning content and is approximately five minutes in length.
Consists of the five core modules that make up the MEPRS Application and Data Improvement (MADI) course as well as modules to guide the repository user through common data extraction scenarios.
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Data Load Status
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Question C.1.c) “Were the data load status, outlier and allocation
tabs in the MEWACS document reviewed and explanations provided in the comments section for flagged data anomalies?”
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Data Load StatusWW.MEPRS.INFO/MEWACS
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Data Load Status
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Review Item 1. “EAS IV Repository MEPRS data load
status and compliance with the 45-day reporting suspense or Service Guidance whichever is earlier. If the facility has a pattern (2 or more) of flagged cells on this tab, has it corrected it or developed a plan to correct it? Provide an explanation in the Comments Section.”
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Data Load Status
14 December 2011 Pre-decisional FOUO33
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Data Load Status
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Data Load Status
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DQMC Review List
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Review Item 2. “MTF-specific summary data outliers.
If the facility has any Prior Fiscal Year or Current Fiscal Year flagged cells on this tab, provide an explanation in the Comments Section.”
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Summary Outliers
14 December 2011 Pre-decisional FOUO 37
Clicking on the outlier month will take you to MTF
Data Profiles
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Summary Outliers
14 December 2011 Pre-decisional FOUO 38
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Summary Outliers
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Summary Outliers
14 December 2011 Pre-decisional FOUO
Multiple selection is available on many of
the fields
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Allocation
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Review Item 3. “Ancillary and Support expense
allocation tests. If the facility is flagged in the Prior Fiscal Year or Current Fiscal Year due to incomplete allocation of ancillary or support expenses, provide an explanation in the Comments Section, including projected date for submitting corrected data.”
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Allocation
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Allocation
Fourth level FCC drilldown
available.
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Allocation
Fourth level FCC drilldown
available.
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THANK YOU FOR YOUR INTEREST IN MEPRS !QUESTIONS?
MEPRS PROGRAM OVERVIEW
45““Medically Ready Force…Ready Medical Force”Medically Ready Force…Ready Medical Force”
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MHS Objectives
∎ Promote more effective and efficient health operations through enhanced enterprise-wide shared services
∎ Deliver more comprehensive primary care and integrated health services using advanced patient-centered medical homes
∎ Coordinate care over time and across treatment settings to improve outcomes in the management of chronic illness, particularly for patients with complex medical and social problems
∎ Match personnel, infrastructure, and funding to current missions, future missions, and population demand
∎ Establish more inter-service standards/metrics, and standard process to promote learning and continuous improvement
∎ Create enhanced value in military medical markets using an integrated approach in 5-year business plans
∎ Align incentives with health and readiness outcomes to reward value creation∎ Improve the health of the population by addressing determinants of health
““Medically Ready Force…Ready Medical Force”Medically Ready Force…Ready Medical Force”