Why MEPRS Matters
More Than Ever
Mike Dinneen, MD, PhD
Director, Office of Strategy Managment
Office of the Assistant Secretary of Defense for Health Affairs
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.
MHS Vision: A world-class health system that supports the
military mission by fostering, protecting, sustaining and
restoring health.
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.
Patient Care,
Sustain Skills
and Training
Manage and Deliver
Beneficiary Care
to
Promote &
Protect
Health of the
Force and
Communities
Medically Ready and
Protected Force
and
Deploy to
Support the
Combatant
Commanders
Deployable Medical
Capability
Support Homeland Defense
Provide Humanitarian Aid
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 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.
Stakeholder Perspective
S2 Warrior Care –
Before, during
and after
operations
S1 Force medical
readiness and
community
protection
Customer Perspective
DoD Beneficiaries
“Total Customer Solution”
C1 Health
Partnerships
C2 Convenience
and accessibility
Internal Process Perspective
Patient Centered Care
IP3
Patient
centered,
effective
processes
IP1 Evidence
based
Learning & Growth Perspective
medicine
F1 Manage
health care
costs
Commanders and Service Members
“Product Leadership”
C3 Care anytime,
anywhere
Deployable Medical Capability and Homeland
Defense for Communities
C4 Readiness
partnership
Medically Ready and Protected Force
IP7 Humanitarian missions
IP5 Joint
and homeland defense
processes
deliver care
IP8 New product and service
anytime,
development
anywhere
IP6 Globally accessible health and
performance information
Learning & Growth Perspective
Organization & Culture
Organization & Culture
L1 Customer
focus
L2 Performance
based
management
S4 Healthy
communitie
s
S3
Beneficiary
satisfaction
Mission Centered Care
Manage and Deliver the Health Benefit
IP2
Partnerships
with
beneficiaries
Financial Perspective
L3 Culture of jointness and
interagency cooperation
L4 Authority and
accountability are aligned
Human Capital
L5 Total
force
developmen
t
IP10 Individual
medical
readiness
IP9 Health and
environmental
monitoring
Science and Technology
L6
Coordinated
Biomedical
R&D
Resource Perspective
R1 Transparent and reliably available resources
R2 Infrastructure management
L7 IM/IT
optimall
y
leverage
d
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
Hypothetical Example of Group Practice and Clinical Work
Center Monthly Financial Reports
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)
Net Earnings
($20,000)
$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)
Profit (or loss)
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!
($300,000)
$120,000
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 multiService 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