IDES Process Redesign Project

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  • RESEARCH POSTER PRESENTATION DESIGN 2011

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    Integrated Disability Evaluation System Process Redesign

    PROGRAM BACKGROUND AND INTRODUCTION

    NAVY MEDICINE WEST PATIENT CATCHMENT AREA

    PROGRAM OBJECTIVES, CHALLENGES, AND ACTIONS

    PATIENT ADMINISTRATION AND VA MSC TEAM IDES TIMELINE PROGRESS

    IDES PROCESS REDESIGN RESULTS

    CONTINUOUS PROCESS IMPROVEMENT

    NMCSD is leveraging technology to meet the MEB Stage goal. NMCSD

    conducted a multi-disciplinary Lean Six-Sigma Rapid Improvement

    Event (RIE) in December 2011, resulting in an e-routing solution using

    the IDES Tracker. The e-routing function electronically transmits:

    IDES Referral form from Referring Physician to PAD

    C&P Exam from PAD to Referring Physician

    NARSUM from Referring Physician to Jr. Physician, CA, and to PAD

    Addendums and Rebuttals from PAD to Physician and back to PAD

    Case documents are immediately e-routed upon completion of action,

    generating an automatic e-mail alert to the appropriate staff. CAC-

    enabled signature and digital signature pads ensure secure, encrypted

    data transfer resulting in 100% tracking and accountability for every

    IDES case. All of NMCSD will be using e-routing by April 2012.

    LT Ryan Shiek, LT Meg Potter, LTJG Sean Oehrlein, LT Johnny Oliva

    Metric

    (Tracking System)

    Before

    (JUL/AUG 2011)

    After

    (FEB 2012)

    Reduction

    Referral Stage

    (VTA)

    46 Days (USN)

    39 Days (USMC)

    8 Days (USN)

    7 Days (USMC)

    38 Days

    32 Days

    MEB Stage (VTA) 106 Days (USN)

    114 Days (USMC)

    63 Days (USN)

    57 Days (USMC)

    43 Days

    57 Days

    MEB Average Open

    Case (IDES Tracker)

    115 Days 39 Days 76 Days

    % MEB Cases > 35

    Days (IDES Tracker)

    80% 38% 42%

    Open Cases (IDES

    Tracker)

    524 Cases 308 Cases 216 Cases

    Average Days to Complete Referral (10 day) and MEB Stages (35 day)

    Navy Medicine West (NMW)

    provides medical care to more

    than 675,000 beneficiaries. The

    NMW patient catchment area

    includes Navy Military Treatment

    Facilities on the West Coast as well

    as Hawaii, Japan, and Guam.

    NMCSD is the regional Echelon III

    command and processes more than

    1,200 MEB cases annually.

    Complicated cases are referred to

    NMCSD for MEB processing. NMCSD

    is a main recovery site for

    Wounded, Ill, and Injured in

    conjunction with the Combat and

    Complex Casualty Care (C5)

    program.

    PAD leadership critically evaluated the NMCSD IDES process and found

    the following issues were causing delays:

    - IDES team understaffed

    - No detailed method to track IDES case progress

    - IDES referral no shows

    - IDES staff difficulty balancing different stage processes

    - Addendums found necessary at end of the process

    - Redundant signatures required on multiple documents

    PAD Leadership used the Continuous Process Improvement (CPI)

    methodologies Just-Do-It and Lean to make these sustainable

    improvements:

    - Increased IDES staffing by 11

    - Increased IDES supervision by 4

    - Developed the IDES Tracker

    - Created IDES escort to eliminate no-shows

    - Specialized IDES staff in Referral Stage or MEB Stage

    - Pre-screened files for Addendums

    - Provided IDES Physician signature authority

    NMCSD now meets the Referral Stage goal and reduced the MEB Stage

    average. The result will save the military an estimated $11.9 million

    in 2012 compensation (Pay, Subsistence, Housing).

    - Referral Stage: $4.9M (((35 days x 1200 cases)/365 days)*$42,418.08**)

    - MEB Stage: $7.0M (((50 days x 1200 cases)/365 days)*$42,418.08) **Compensation calculated for E-4, 4 years of service, CONUS average, 0 dependents

    The Integrated Disability Evaluation System (IDES) process involves

    multiple government entities, electronic tracking systems, and hand-

    offs between stages within phases to complete a single IDES case for

    our Wounded, Ill, and Injured patient population. The result of the

    IDES process is a determination of fitness for duty; and if found unfit,

    a disability rating percentage from the Veterans Administration.

    The goal of this project was to align the processing times for Naval

    Medical Center San Diego (NMCSD) IDES cases with the processing

    times defined in SECNAVINST 1850. Specifically PAD leadership was

    tasked to complete the following objectives in a sustainable manner:

    - Reduce the Referral Stage average to 10 days

    - Reduce the MEB Stage average to 35 days

    0

    20

    40

    60

    80

    100

    120

    JUL AUG SEP OCT NOV DEC JAN FEB

    USMC MEB

    USN MEB

    USMC Ref.

    USN Ref.

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