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Navy Medicine Leadership SymposiumJanuary 2011

Resource Discussion

Managing the workforce

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Outline

• Resource Outlook― Budget & PPS― Contract planning & deobligations

• Where Can I Find Money?

• Coding - Data Quality Feedback

• Patient-Centered Process Improvement

• Internal Control & SOPs

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Budget

FY 11: Budget (CR until 4 March) $3.6B - Includes WII, TBI/PH, PDHRA- Medical Home—major push

FY 12 Plan: delayed until after 14 Feb

$3.6B― Gates initiatives (contracts & medical supply

optimization)― Better BAG alignment

POM13: underway- Continuing impact of Gates initiatives - Ongoing: OPNAV discussion about medical mission 1. FY11 CR ‘process' may be used to hold spending to FY10 levels.

2. Expect pressure to prioritize and justify, especially contracts.

PPS PerformanceFY10 NAVY PPS PRODUCTION - RWPs

54.2

54.4

54.6

54.8

55.0

55.2

55.4

Jan Apr May Jun Jul Sep

RW

Ps

(000

's)

AS STATED ON MONTHLY RECONCILIATION REPORTS

FY10 NAVY PPS PRODUCTION - RVUs

17.5

18.0

18.5

19.0

Jan Apr May Jun Jul Sep

RV

Us

(M's

)

AS STATED ON MONTHLY RECONCILIATION REPORTS

RWP Production is above FY09 Baseline

RVU Production is above FY09 Baseline

18.2M RVU Baseline

54.6K RWP Baseline

Total workload is up over the baseline!!

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Acquisition Contract Planning & Forecasting• Last year -- first M4 - M8 letter to Regions /

Activities -- still maturing…needs CO’s engagement.

• Deadlines: ― 15 Feb: validate existing & continuing contracts and submit

funding (or expected date of funding)― 1 April: submit contractor performance reports & finalize funding― 1 June: submit new requirements and associated funding

• Results: better contract responsiveness from NMLC

De-obligations from previous year: inefficient use of resources

• Improved! FY09: $33M de-obligated by Jan 2010 FY10: $ 3M de-obligated by Jan 2011Better alignment between comptrollers and logisticians

Goal: improved $$ & total force planning

FISC moving away from medical…

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Where Can a C-O Find Money? • Government Purchase Cards

― Have MATMAN analyze what you buy; purchase cards = spot market

― Large $$ and quantities contracts (strategic sourcing)• Pharmacy & Inventory Levels• Administrative & Overhead contracts

― What services are you buying and why?― When was the last line-by-line review? ― Where are you setting the limits?

• Workload― How much work are you doing vs. how much are you

investing (contracts, GS, military)?• Coding

― Poor coding work not reported lost PPS earnings

If the C-O doesn’t push on these, who will?

…soon to be PMPM?

Top DQ CO “Explanations”

– “Coding accuracy for outpatient E&M, ICD-9, & CPT codes has decreased. We are reviewing our POAM's.”

– “Coding Auditor is constantly training the coders on the proper codes to use.”

– “One year vacancy of the coding auditor/trainer will be filled in July.”

– “Audit performed by (my boss).”

– “20 of 29 E&M were correct.”

– “AHLTA disposition defaults to an incorrect E&M code.”

Need C-O help on better explanations

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CNI Coordination

• Transfer base-type functions to CNI: Done! FY12 & out for 6 “stand-alones”― Hospitals remain with BUMED under Maintenance UICs― Building maintenance & special projects remain with

BUMED / DHP― Any residual items POM13/14― No impact to hospitals on USMC bases / Cairo / Lima.

• Regions / Activities: coordinate / communicate on specific resource questions

― CNI & BUMED HQ working an integrated shift via site-specific ISSA to CNI responsibility

― Do not transfer additional resources to CNIKey for BUMED is historic funding levels

Bethesda, Portsmouth,

Beaufort, Balboa, Bremerton, Guam.

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Process Improvement • Industrial Engineering: scientific approach

to process improvement that relies on current data, systemic analysis of solutions, and metrics to measure improvement / quality

― Partnership with Johns Hopkins― Similar to efforts by Intermountain Health et al― Projects owned by MTF / Region― Enterprise-wide application of lessons under study by M3

• 9 projects completed; 10 projects underway.

• Goal: best processes for patient & family centered care

• POC: Tim Ward 202-762-16393-year working plan in place

Maximizing our return on existing

investments

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Completed:NMC San Diego -- Inpatient OB, Orthopedic supply chainNMC Portsmouth -- Orthopedic Patient Flow, PharmacyNH Camp Lejeune -- Medical Evaluation Boards; Outpatient OBNH Camp Pendleton -- Outpatient OBNNMC Bethesda – OR Replenishment and Central Sterile operations

In Process:NNMC Bethesda -- OR performance, CDD & WR Integration tasksNMC San Diego -- Ambulatory Procedure Visits NH Camp Pendleton -- Orthopedic outpatient, Medical Evaluation BoardsMultiple locations -- Pharmacy operations and Automation procurement

NHC Cherry Point, NH Camp Lejeune, NH Bremerton, NMC San Diego

NH Camp Lejeune -- Inpatient OB (starts Jan 11)

Summary of IE Projects to Date

OB, Ortho, Pharmacy consistent areas of concern

1. Overall Process: (Federal Managers’ Financial Integrity Act (FMFIA))

2. Financial Reporting: (FMFIA) no new weaknesses/accomplishments for FY10

Previously reported weaknesses that remain in work:

OverallAnti Fraud, Command Evaluation Program, Medical Coding, Personnel Security

Financial MERCHF, Accounts Payable, Accounts Receivable, Funds Balance w/ Treasury

Annual Statement of Assurance

Accomplishments

Weaknesses

SECNAVCNOBUMED

Navy-wide issues

SOPs Are Mandatory Since 1 Oct 09

Comptroller AOR DFA AORNEW! Equipment Contract Establishment NEW! Equipment Contract Establishment

Contract Closeout Contract Closeout

Purchase Card Purchase Card

NEW! Inter-Agency Billing for Medical Services (IAB)

Medical/Surgical Prime Vendor Management (Med/Surg)

NEW! Outpatient Third Party Collections (TPC) Billing Personal Property

Defense Travel System (DTS) Electronic Catalog (ECAT)

Daily Accounting Real Property

Non-Daily Accounting Coming Soon! Personal Services Contract Establishment

Support Agreements: Receiver-Side Coming Soon! Contracting Officer’s Representative (COR)

Coming Soon! Budget Formulation Clinical Support ServicesComing Soon! Budget Execution Pharmacy Inventory Management