MMIG 29 Mar 06 Minutes ATTENDEES Attendance noted via telephone Ms. Mona Bacon, Army MEPRS POC* Ms. Jane Cunningham, Navy MEPRS POC* Mr. Darryl Dorrian, AF MEPRS POC Ms. Burma Barfield, Army support* Ms. Nicole Meyers, Navy contract support* Mr. John Babicki , AF MEPRS SME TSgt Jody Callender, AF Consultant Mr. Eric Meadows, TMA-OCFO (PSGS) Mr. Randy Van Nostrand, TMA-MEPRS (PSGS) Ms. Linda Hancock, TMA MEPRS (PSGS) Ms. Dee Baker, TMA-MEPRS (SRA)* Ms. Debbie Kochubka, TMA MEPRS (SRA) Ms. Rachel Snoddy, TMA-MEPRS (PSGS) HANDOUTS – Meeting Agenda External Workload Methodology Proposed by Army Appendix 7- v12_29 MAR 06 Matrix Comparison Data Quality Statement General Observations Examples of NonClinical Duties Copy of DMIS ID FIELD_DESCR_W_CHCS_DMIS_vs28Mar06 Issue Papers o Priority A Issues o SCR_MAR_AI o SCR_ISSUE PAPER Minutes for 03_07_06 DISCUSSION (Commenced at 09:00) External Resource Sharing DMIS ID Data Elements – Mr. Meadows opened the discussion by referencing the document titled, Copy of DMIS ID Field_DESCR_W_CHCS_DMIS_vs28Mar06. He explained this is in response to a task to identify the minimum required data elements needed to support requesting a Child DMIS ID in the DMIS ID Model for Capturing External Resources Sharing. Points made during the discussion are as follows: o The document was created by Ms. Cindy Vance (SAIC) and identifies the DMIS ID data elements, CHCS Field Purpose, and whether the data element is required in the CHCS Data Dictionary and needed for CHCS Workload Assignment Module (WAM). o Mr. Meadows appended the document with a TMA Recommendation, and whether the data element is required by the Navy, Army and AF. He also compared this document with the Tri-Service DMIS ID Request Guide, and the most recent DMIS ID Data Dictionary. In addition, he already captured draft Navy input. The areas colored in yellow are the data elements that need further clarification and research: Facility City Name, Facility Command Code, Facility Name (made a recommendation for standardizing the names), Facility State Code, Installation Name (need UBU determination on who owns the medical record), MEPRS Unit ID, Service Area Code (need to verify with TMA POCs) and US Flag Code. Version 1.0 Page 1 MMIG 29 Mar 06 Minutes o Version 1.0 Ms. Hancock questioned whether additional fields can be added to the DMIS ID Data Dictionary as she thought a combination of data elements could better denote the Facility Name. Mr. Meadows asked the MMIG members to review the document and recommended minimum mandatory fields and submit their input to TMA for final resolution. Army Update on Reporting External Workload with Alternate Proposal On Capturing and Reporting External Workload Performed at Civilian or VA Medical Facility – Mr. Meadows referenced the document and explained that the Army tested the DMIS ID “A*** SADR” approach at Eisenhower Medical Center, Ft Gordon GA, received feedback from the site personnel on the approach and recommended alternatives from the Army. o At Eisenhower Medical Center the Army identified problems with: 1) creating inpatient ward locations and inpatient “A***” MEPRS FCCs to generate admissions which will allow the capture of the A**SADR, 2) issues with bogus admissions, occupied bed days, and dispositions, which will be reported in CHCSI/AHLTA, EASIV, WWR, and the M2, 3) issues with the creation of a medical inpatient record which generates RWPs for the entire professional and institutional care and 4) issues with reporting RWP values in the M2 for PPS when the patient was not admitted to the MTF. o Other issues identified involved the requirement to track Active Duty soldiers admitted to an external facility and the current PASBA methodology to use YYY* codes which doesn’t distort professional an institutional reported workload and you can’t use the DMIS ID A*** SADR methodology for these patients. They also identified issues with their outpatient MTFs not having enough support staff (inpatient specialized coders) to support the additional coding requirement. o They recommended still utilizing the DMIS ID approach, but capturing the professional component in a “B***” MEPRS FCC account, which would be done manually as a “Walk-In” and generate a SADR. They noted however, that this would generate a “count” visit for “ward rounds” that are considered “non-count”. o Their other alternative was to use a MEPRS F*** FCC to capture the ward round and provider man hours for the external workload. o The Navy does not support capturing of external resource sharing ward rounds in the “B***” MEPRS FCC account and stated that the Army paper lacked specific guidance on capturing inpatient workload performed external to the MTF. They want guidance from the UBU on what data elements will be necessary for capturing institutional and professional workload in the future. They also want the process to be automated as opposed to manual capture. o As stated in the paper, the Army does not support the “A*** SADR MEPRS FCC capture of inpatient professional services from external resource sharing facilities. They do support the use of the DMIS ID approach, but with a B*** or F*** MEPRS FCC. o The Air Force agrees with the Army and does not want to capture bogus inpatient admissions, RWPs and SIDRs in order to capture the professional component of an external resource sharing ward round. o The Navy discussed a long-term solution of creating a new “H***” MEPRS FCC which had previously been discussed with the Army PASBA personnel. All three Services agreed to continue discussion and research on the concept and methodology for using the new MEPRS FCC to capture all external resources sharing FTEs and workload via this Page 2 MMIG 29 Mar 06 Minutes concept. Mr. Meadows requested a write-up from the Services on the “H***” MEPRS FCC concept. The Air Force recommended the three Services meet to review the three approaches, and decide on the agreed upon methodology, data requirements and process flow for capturing workload for external resources sharing. o Issue Papers Priority 031002 A Change Assigned FTE to Endstrength Concurs to addition of new data element. Concurs to addition of new data element. 051008 A ED** Originated Concurs tentatively subject to advice from SMEs. Concurs tentatively subject to advice from SMEs. 051009 A Nutrition Accounts Originated. Army will resubmit paper, separating two issues. Concurs tentatively subject to advice from SMEs. Concurs tentatively subject to advice from SMEs. 061002 A Centrally Funded Contracts Take offline Take offline Take offline 061206 A Depreciation Originated Concurs to Time period change. Withdraws concurrence. Requests all depreciation issues be addressed. 060125 A Comp Time Earned Originated Concurs with Army recommendation #2. Concurs with Army recommendation #2. 060316 N RVU Credit for IDC/IDMT Non-concur. Concurs with Navy requirement, but notes AF does not have the same requirement. 051006 A Virtual Colonoscopy Reviewing Paper Reviewing Paper Version 1.0 Short Title Army Responses Air Force Number Navy Originated. Will revise to reflect addition of new data element rather than removal of Assigned FTE. Originated 07/12/2005. Navy will distribute copy dated 11/3/2005. Issue 031002 “Change Assigned FTE to Endstrength” o Discussion: All services agreed that endstrength definition is basically the same, the end of month availability. o Army and Air Force concur to the addition of a new data element for endstrength rather than changing Assigned FTE to endstrength. Navy agreed to revise the issue paper to add a new data element. o Action Item Mar06_01: Navy will revise the issue paper to address addition of a new data element for endstrength rather than changing Assigned FTE to endstrength. Open. Page 3 MMIG 29 Mar 06 Minutes Version 1.0 Issue 051008 “Service Requesting Change to Titles, Descriptions, and Allocation Performance Factor of ED** FCC/MEPRS Codes…” o Discussion: Air Force and Navy concur tentatively subject to consultation with subject matter experts to verify change will create little to no impact on current processes. This issue involves changing the unit of analysis from hours of service to square footage in keeping with civilian practice. Air Force thought this issue involved realignment of plant services which is a different matter. o Action Item Mar06_02 (Replaces Action Item Oct05_01): Air Force and Navy will confer with SMES. Open. Issue 051009 “Inconsistent Guidance and Reporting for Nutrition Accounts” o Discussion: Discovered there are two issues at work here. First, Army proposes deactivation of FCC EIC*. Second, Army proposes FCCs EIA* and EIB* remain unchanged. o Air Force and Navy tentatively concur to the deactivation of EIC*. Army agreed to simplify issue paper and resubmit. o Action Item Mar06_08: Army will resubmit simplified issue paper. Open. Issue 061206 “Depreciation” o Discussion: At last Issue Paper meeting, all services agreed to the concept of changing the reporting timeframe from 8 to 5 years but instructed to read the issue paper to make sure they concur to what was written in the document. Army is already at 5 years which is in line with their Chief Financial Officer’s financial statement and with the Defense Medical Logistics Standard Support (DMLSS) program. o Navy withdraws concurrence because there are many depreciation issues (e.g., thresholds) and does not want to approach management with one issue at a time. Also, Navy notes that the question of why we are collecting depreciation in the first place has not been addressed. Navy agrees to investigate the impact of changing from 8 to 5 years will have on the system. o Action Item Mar06_05: TMA will provide Services related Depreciation issue paper(s). Open. Issue 060125 “Comp Time Earned” o Discussion: Navy and Air Force concur with Army recommendation #2 which states “EASIV should accept the hours without having to add costs in EASIV.” Navy will send concurrences to TMA via email. o Action Item Mar06_09: Navy will send it’s and Air Force concurrences to TMA via email. Closed. Issue 060316 “RVU Credit for IDC/IDMT” o Discussion: In branch clinics (remote areas), Independent Duty Corpsmen (IDC) operate as providers (like Physician Assistants). They are billeted to the MTF. IDCs are certified to provide care but not credentialed. Major difference between similar role in Army vs. Navy, in the Army patients are enrolled to the MTF not to the Battalion Aid Station (BAS) while in the Navy patients are enrolled to the ship not to the MTF. o Air Force concurs with the Navy requirement but does not share issue. Army is researching issue. o Action Item Mar06_10: Army will respond to after reviewing the issue paper. Open 04/06/2006. Issue 051006 “Virtual Colonoscopy” o Discussion: Navy has already acquired interim approval to proceed. According to the Issue Paper Database, the 07/12/2005 issue paper was to be updated taking into consideration Page 4 MMIG 29 Mar 06 Minutes comments from Mr. Wesley. Navy did have a paper dated 11/03/2005 which did not appear to be forwarded to TMA. o Navy will forward updated issue paper to TMA and asks Services to review with a focus on the process. o Action Item Mar06_11: Navy will forward 11/03/2005 issue paper to group. Open. o Action Item Mar06_12: Upon receipt of updated paper, Services will review focusing on the process. Appendix 7 of MEPRS Manual Ms. Meyers provided a copy of the Appendix 7 matrix that the Army and Navy had jointly coordinated. Mr. Van Nostrand reviewed those business rules that had changed since the last version to ensure that The Air Force was aware of changes, as well as to provide an opportunity for the Services to further discuss the issues. The three Services agreed to all business rules in the document with the exception of business rule 3A. Some Discussion included: o Rules 2B, 2C, and 2D require description modifications to better fit the table structure. This will be accomplished by TMA. o Rule 6A #4 (civilian AWOL) was agreed to be moved to rule 20. Ms. Cunningham agreed to this modification with the understanding that military members do not return to the work center when determined to be in an AWOL status, while civilians can return to the work center. TMA will make this adjustment. o Rule 12 description was changed to "Conducting or attending Peacetime Disaster Preparedness or Response, including training.". The Services agreed that account EBG should be deleted. They further agreed that GGB should be deleted. All activity for these accounts should be included in account GGA*. o Rule 15 was expanded to allow the capture of civilian students in the GME/GDE accounts. Army proposed that this be captured in FAMM. Navy and Air Force concur, although Navy also indicated that their Service does not have civilian students in these two programs. o The Services agreed to business rule 16. They also indicated that two additional skill type suffixes should be created to identify these types of students. The Army will develop an issue paper to recommend these additions, which will be vetted through the Table Update process. The Services could not agree on Business Rule 3A. Each of the Services had different opinions as to how administrative time should be treated, whether it should be included in the benefiting FCC, or placed in EBC*. The Services agreed to create lists to better define what they believed should be included within the benefiting FCC versus the overhead account, as well as define what activities should be considered clinical versus non-clinical. Ms. Meyers provided a Navy list to the Services during the meeting to help facilitate this task. Other Issues The Services expressed concerns about the number of EAS IV versions that had been released this Fiscal Year due to errors. This issue has burdened the MTFs in completing their MEPRS products. The Services would like an explanation as to why this issue has occurred. TMA will coordinate with EAS PO on response. The Services indicated that the number of releases available for table updates is insufficient to meet operational requirements. The Services wanted to know what the actual contractual Version 1.0 Page 5 MMIG 29 Mar 06 Minutes requirements are for Fiscal Year version releases. TMA will coordinate with EAS PO on response. The Services requested a list of all new system change requests that will be included in EASi. TMA will coordinate with EAS PO on response. Conclusion The group approved the 19-20 October 2005 MMIG minutes. These minutes were distributed to the MMIG a final time on 2/24/2006. Mr. Wesley was not available to participate in this MMIG session. He will review issues and provide feedback as warranted. The meeting was adjourned at 1600. ACTION ITEMS UBU: Need determination on who owns the medical record (MTF or VA/Civilian Hospital) Services: Review DMIS ID Description Document and provide TMA their recommended minimum mandatory fields. UBU: Guidance on what data elements will be necessary for capturing institutional and professional workload in the future. Services: TMA requests a write-up on the “H***” MEPRS FCC concept. Services: The Air Force recommended the three Services meet to review the three approaches, and decide on the agreed upon methodology, data requirements and process flow for capturing workload for external resources sharing. Navy: Navy will revise the issue paper (031002) to address addition of a new data element for endstrength rather than changing Assigned FTE to endstrength. Navy/AF: Air Force and Navy will confer with SMES regarding issue paper 051008. Army: Army will resubmit simplified issue paper 051009. Navy: Navy agrees to investigate the impact of changing from 8 to 5 years will have on the system (Issue Paper 061206). TMA: TMA will provide Services related Depreciation issue paper(s) (Issue Paper 061206). Navy/AF: Services will send their concurrences to TMA via email (Issue Paper 060125). Army: Army will respond to after reviewing the issue paper (060316). Navy: Navy will forward 11/03/2005 issue paper (051006) to group. AF/Army: Upon receipt of updated paper (051006), Services will review focusing on the process. Army: Provide Services/TMA paper outlining proposed additional suffixes for Skill Type table. Services: Create lists to define clinical versus non-clinical activities, as well as proposed expensed FCC (Benefiting work center vs. Overhead). EAS PO: Services want explanation of cause for number of error related EAS IV version releases. EAS PO: Services want to know the number of releases the vendor is contractually required to provide in a Fiscal Year to accommodate table releases. EAS PO: The Services requested a list of all new system change requests that will be included in EASi. Version 1.0 Page 6 MMIG 29 Mar 06 Minutes Patrick Wesley MEPRS Program Manager Version 1.0 Page 7