Data Warehouse User Group
March 10, 2011

Provider CFTE Metrics

Lower Levels of Detail in Future
Monthly Dashboards
FPSC Clinical Full-Time Equivalent
(CFTE) Metrics

Primary reason that UCSF participates in United Healthcare Consortium
is to have access to provider benchmarks

Providers are compared to, and have their work benchmarked against,
other providers in the same specialty in other university medical groups

AAMC (FPSC) benchmarks are preferable to MGMA benchmarks, since
academic staff practice patterns can vary greatly from private practice

Two separate CFTE figures in FPSC online reports
 Imputed CFTE: calculated by them. Actual Work RVUs billed by physician
are divided by the benchmark Work RVUs for all provider in the same
specialty
 Reported CFTE: provided by us and defaulted to 1.0 when no separate
value is reported to FPSC
FPSC CFTE Metrics
In the past (prior to 2009), the Medical Group:

Used FPSC’s Imputed CFTE to estimate how many full-timeequivalent physicians make up a given department or practice

Did not encourage departments to supply their own estimates (i.e.
Reported CFTE)

Default was 1.0, for every provider



If some departments reported percentages, but others didn’t, the results for
the overall group would be skewed
Assumed we were really only interested in the resulting Imputed FTEs
If departments wanted to, they could gauge their providers’ productivity
themselves

You can export Benchmark and Actual Work RVUs for a given physician from
the FPSC Productivity Report, then multiply the benchmark by the known
percent of clinical work for that provider
…that was then…
FPSC CFTE Metrics
…but this is now!

There’s a strong push to leverage the FPSC tool and make it
truly interactive


New Feedback Loop: instead of being just (passive) recipients of
Imputed CFTE data, department users can (actively) provide
targets (Reported CFTEs) that affect what the tool will return
Allows department administrators and other users to view expected
productivity against actual per physician per billing period



No further export and outside calculations would be needed
Results can be viewed directly via the FPSC online reports
These numbers are being reported and discussed in financial
and operational meetings, where people assume they are
accurate
Reported CFTE Calculation –
where we stand today

Reported CFTEs are grossly overstated


Most providers defaulted to 1 CFTE
“Once you’re in, you’re in” rule
 if a provider shows billing in a department, even if
it’s only one time or in one month, FPSC assumes
he/she is a permanent member of that department
 Future months will report a 1.0 CFTE for that
provider unless instructed not to
What the
dashboards
reflect
Reported CFTE Calculation –
where we stand today

Reported CFTEs are grossly overstated
(cont.)



Dirty charge records create phantom providers…who
hang around
 If a non-active or non-UCSF provider is accidentally
posted to a charge which is later sent to FPSC as
part of the quarterly submission, he/she is also
assumed to be a permanent member of that
department
 Note: you’ll sometimes see negative billing & RVUs,
which likely come from charge corrections.
Ironically, in these cases, the Imputed CFTE will be
negative, but the Reported will still be 1.0!
Providers billing out of more than one department are
counted multiple times
Providers associated with more than one specialty in the
past (i.e. first assignment later corrected) can appear in
the same department multiple times
Imputed CFTE Calculation –
where we stand today

On the other hand, Imputed CFTEs are probably
understated

Biggest Problem: Specialties with no RVU benchmarks


Imputed CFTE = [actual Work RVU]/[Work RVU Benchmark]
When the [Work RVU Benchmark] doesn’t exist, the formula defaults to
0.0. Examples include:






Neurology: Alzheimers / Dementia
Ophthalmology: Oculoplastic / Reconstructive Surgery
Orthopedic Surgery: Oncology
Pediatrics: Cardiology-Noninvasive
Pediatrics: Infectious Disease
What Shaifali calls the “chicken and the egg problem”

When a provider is assigned to one of these, the designation may
better reflect the provider’s niche service(s), but because the pool
of doctors is so limited, FPSC can’t issue a benchmark.

FPSC won’t discourage us from assigning providers to them in the
hopes that, someday soon, a big enough base of these providers
will allow them to compute a reliable benchmark
Imputed CFTE Calculation –
where we stand today

On the other hand, Imputed CFTEs are probably understated
(cont.)

Specialties that had benchmarks in previous years, but not anymore
(another version of “chicken and egg”) Examples include:


Pediatrics: Allergy / Immunology
Pediatrics: Pulmonology
Both of these had benchmarks in 2009, but they disappeared in 2010

Other Reasons:

Some departments (ex. Anesthesiology) don’t lend themselves to Work
RVU benchmarking

While it can’t be helped, and until an alternative benchmark can
is adopted, the seemingly low CFTE metric may be your
responsibility to explain

Physicians accidentally assigned to the wrong Department

Activity for a provider in your department may incorrectly be
attributed to another department – this makes your department
look artificially low
What happens now?

Mass Cleanup





We are working with Shaifali on a Master Provider List that removes all duplicates so
that every provider is assigned to only one Department and only one Specialty
Once the changes are made at FPSC, we need your help to validate the assignments.
The master list will be emailed to you after today’s webcast
Many providers on this list will have left the university already. Don’t worry about
deactivation just yet – the first step is to make sure we got them into the right
Department (or ex-Department) and Specialty
Next week, a Provider Update Template (next slide) will be sent to each department
containing only Providers in your department
Once the contact for your department receives it, he/she will be expected to





Specify an Avg CFTE (i.e. your “Reported CFTE” estimate) for each provider
Deactivate any providers who have left the practice by providing a Deactivation Date
Correct any Specialty assignments that are still inaccurate
Decide whether to move providers from Specialties with no benchmarks to Specialties with
benchmarks (I will specify those providers for you)
Call us with any questions!!
Completing the FPSC Provider
Update Template
Existing values – section is “read only”
Don’t want their activity
counted toward Imputed FTEs
in any of the “good” buckets,
so set their specialty to “00 –
Other Physician Specialty”
which has no benchmark
(Remember: when assigned
specialty has no benchmark,
Imputed FTE = 0.00 for that
provider)
Updated values go here
Don’t want these
counted in Reported
CFTE metric, so Avg
CFTE is set to 0.0
FPSC Provider Update Templates

New Process: all templates/updates now going through the Medical Group




We now log the assignments you make; if you go to the website and submit them
yourselves, we can’t tell if the assignments are new or old, intentional or just dirt
Doing this will prevent duplicate records from appearing again
Ensures we are completing the templates in a consistent manner across all dept’s
Your assignments and their associated benchmarks can be made available to you for
reporting

Your ability to make the changes directly at via the FPSC website has been disabled

In the future, we’ll be sending out a round of templates after each quarterly
submission

If you feel we have the wrong contact person, now is the time to educate us

In order to have the CFTE values updated prior to the Dean’s Office Budget
Meeting, we need your templates back to us by the first week of April!

Any questions? (additional slides at the end of this presentation)
Future Dashboard Reports –
more detail now possible



Current dashboards are
high level: Department
To make them more
meaningful, we’d like to
provider a greater level
of detail
This is *OPTIONAL* -department level reports
will continue to be
produced and made
available every month.
Future Dashboard Grouping
Levels

Some potential groupings are
“natural;” i.e. the logic is built into
our main production system(s)


On the other hand, several departments
have provided us Custom Grouping levels


Ex: Orthopedic Surgery has grouped their
providers into PODs
Low volume, mid-level providers or those
whose activity we’re not so concerned with
can be defaulted into a (Blank) or “All
Others” folder
Ex: Pediatrics could easily report by
“Campus Division”
Future Dashboard Grouping
Levels – maintenance is key

As with the FPSC Specialties, the assignment of Providers (or other
entities) into custom groups requires maintenance of these lists

The list needs to be kept current




If you do choose to provide custom lists, the custom groupings will
appear in the medical group’s cubes wherever possible


Notify us of new categories (ex. new providers in the case of Ortho)
Notify us of assignment changes
Work with us to insure your reports look the way you expect them to look
In most Cognos cubes, this is currently the “Div/CG1/CG2/Provider”
dimension
Save yourself some work(?)

Since you’ll already be maintaining the FPSC Specialty and CFTE estimate
for each provider in your department, you might want to consider having us
group your dashboard according to FPSC specialty
Future Dashboard Grouping
Levels – limitations


Dashboards have 3 main sections: Revenue, Visits
and Expenses
Revenue: SMS Revenue presents a challenge





Lowest level of SMS reimbursement data is GL Key
SMS cash cannot be allocated at the physician level.
If a dashboard is defined for a group of physicians without
considering the GL Key, there is no guarantee that their
revenue would be captured accurately.
Any grouping levels you define would have to divide
*cleanly* across GL Key
Expenses: even more limited

Lowest level of grouping is at the DBS (Cost Center) level
Future Dashboard Grouping
Levels – considerations


Bottom Line: Would a more detailed version of the
Dashboards help you understand or manage your
department’s activity?
If so, work with us!
 Schedule a meeting to sit down with us to look at
what’s possible
 Take advantage of the Prism technology
Announcements: Upcoming
Cognos Training

Next Cognos 7.4 Training scheduled for March 22nd and 23rd
(Tuesday and Wednesday).

Sign up deadline is March 15 (next Tuesday)



Minimum of 3 people needed
Last couple of trainings had to be canceled
Latest Training Schedule can always be accessed by clicking
on the “training and class information” link from the main
data warehouse page, or by going to
https://www.intranet.medschool.ucsf.edu/medgroup/private/dwh/train
ing.aspx


This will be one of our last Cognos 7.4 series trainings. We will
begin Cognos 8 series trainings later this year. We will talk
about this in more detail in future user group meetings.
Today’s presentation will be posted to the Medical Group’s
website in the “User Meeting Notes” section:
https://www.intranet.medschool.ucsf.edu/medgroup/private/dwh/user
mtgs/index.aspx
Appendix: FPSC CFTE Calculation

Formula for Imputing a CFTE (per provider): [Work RVU]/[Work RVU Benchmark]

Work RVU (numerator):




calculated by FPSC
National (non-GPCI) values assigned according to DOS of the charge
Gap-filled: when Medicare has not provided a work RVU for a CPT which
FPSC considers a “pro fee” FPSC will back-fill the value by looking at other
charges in the code range and comparing charge/RVU
Documentation on their website (you need an FPSC account to access)
https://www.facultypractice.org/html/128.htm


Page describes Gap-fill
methodology as well as their
Modifier adjustment process
To find the page from their
website, go to the ACCESS menu
and select “RVU & Modifier
Assignment Process” near the
bottom of the list
Appendix (cont): FPSC CFTE
Calculation

Formula for Imputing a CFTE (per provider): [Work RVU]/[Work RVU Benchmark]

Work RVU Benchmark (denominator):

Benchmarks are determined annually, using the previous year’s data

Result from FPSC’s annual survey – only high volume providers from each
specialty are included

Represents the Mean (average) number of Work RVUs billed by a *theoretic*
academic provider spending 100% of his/her time in clinical practice

Benchmarks are stated in annual terms, but are adjusted in the report according
to the period the user chooses to view; i.e. 10 months of activity will reflect the
benchmark for 10 months, not the entire year

The process is documented on their website:
https://www.facultypractice.org/126.htm


To find the page from their
website, go to the ACCESS menu
and select “Clinical FTE Process &
Tools” near the bottom of the list
You will also find information
under the section “Benchmark
Development Process”
Appendix (cont): Benchmarks for
Previous Years



Can be found by
going to the ACCESS
menu and choosing
“Work and Total RVU
Benchmarks” near the
top of the list
Go as far back at
2006
Note that benchmarks
can appear for certain
years but not others