mike dinneen, md, phd director, office of strategy managment office of the assistant secretary of...
TRANSCRIPT
Mike Dinneen, MD, PhDDirector, Office of Strategy ManagmentOffice of the Assistant Secretary of Defense for Health Affairs
Why MEPRS Matters More Than Ever
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
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.
Patient Care, Sustain Skillsand Training
Promote & Protect Health of the Force and Communities
Deploy toSupport the CombatantCommanders
to and
MHS Mission: To enhance DoD and our Nation’s security by providing health support for the full range of military operations and sustaining the health of all those entrusted to our care.
Manage and Deliver Beneficiary Care
Medically Ready and Protected Force
Deployable Medical Capability
Support Homeland DefenseProvide Humanitarian Aid
MHS Vision: A world-class health system that supports the military mission by fostering, protecting, sustaining and restoring health.
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
MHS MissionMHS MissionTo enhance DoD and our Nation’s 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
Customer Perspective
Internal Process Perspective
Learning & Growth Perspective
Medically Ready and Protected Force
F1 Manage health care
costs
Mission Centered Care
IP9 Health and environmental
monitoring
S2 Warrior Care – Before, during
and after operations
S3 Beneficiary satisfaction
R1 Transparent and reliably available resources
Patient Centered Care
C2 Convenience and accessibility
C1 Health Partnerships
S4 Healthy communitie
s
DoD Beneficiaries Commanders and Service Members
Resource Perspective
C3 Care anytime, anywhere
IP10 Individual medical
readiness
C4 Readiness partnership
S1 Force medical readiness and community protection
“Total Customer Solution” “Product Leadership”
Manage and Deliver the Health Benefit
IP1 Evidence based
medicine
IP3 Patient
centered, effective processes
IP2 Partnerships
with beneficiaries
Deployable Medical Capability and Homeland Defense for Communities
IP8 New product and service development
IP6 Globally accessible health and performance information
IP5 Joint processes
deliver care anytime, anywhere
L5 Total force
development
R2 Infrastructure management
Human CapitalOrganization & Culture
Financial Perspective
IP7 Humanitarian missions and homeland defense
L6 Coordinated Biomedical
R&D
L7 IM/IT optimall
y leverage
d
Science and Technology
Learning & Growth Perspective
L4 Authority and accountability are aligned
L3 Culture of jointness and interagency cooperation
L2 Performance based management
L1 Customer focus
Organization & Culture
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
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 can’t accurately compare performance across MTFs because we count differently
• Our data systems have not been designed to specifically support our business model
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.
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
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)
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.
Keys to Success
• Simplify data capture for individuals– Lump, don’t 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
Monthly Group Practice Profit and Loss Statement (Professional)
Total "Revenue" 3000RVU*$40/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" 150RVU*$6000/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
Hypothetical Example of Group Practice and Clinical Work Center Monthly Financial Reports
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).
What do you think?
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.
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
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
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
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
Strategic Goal: Develop our most valuable asset—our 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)
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