1. 1 Navy Medicine Leadership Symposium January 2011 Resource Discussion Managing the workforce

2. 2 Outline Resource Outlook ― Budget & PPS ― Contract planning & deobligations Where Can I Find Money? Coding - Data Quality Feedback Patient-Centered Process Improvement Internal Control & SOPs

3. 3 Budget FY 11: Budget (CR until 4 March) $3.6B - Includes WII, TBI/PH, PDHRA - Medical Home—major push FY 12 Plan: delayed until after 14 Feb $3.6B ― Gates initiatives (contracts & medical supply optimization) ― Better BAG alignment POM13: underway - Continuing impact of Gates initiatives - Ongoing: OPNAV discussion about medical mission 1.FY11 CR ‘process' may be used to hold spending to FY10 levels. 2.Expect pressure to prioritize and justify, especially contracts.

4. PPS Performance RWP Production is above FY09 Baseline RVU Production is above FY09 Baseline 18.2M RVU Baseline 54.6K RWP Baseline Total workload is up over the baseline!!

5. 5 Acquisition Contract Planning & Forecasting Last year -- first M4 - M8 letter to Regions / Activities -- still maturing…needs CO’s engagement. Deadlines: ― 15 Feb: validate existing & continuing contracts and submit funding (or expected date of funding) ― 1 April: submit contractor performance reports & finalize funding ― 1 June: submit new requirements and associated funding Results: better contract responsiveness from NMLC De-obligations from previous year: inefficient use of resources Improved!  FY09: $33M de-obligated by Jan 2010  FY10: $ 3M de-obligated by Jan 2011 Better alignment between comptrollers and logisticians Goal: improved $$ & total force planning FISC moving away from medical…

6. 6 Where Can a C-O Find Money? Government Purchase Cards ― Have MATMAN analyze what you buy; purchase cards = spot market ― Large $$ and quantities  contracts (strategic sourcing) Pharmacy & Inventory Levels Administrative & Overhead contracts ― What services are you buying and why? ― When was the last line-by-line review? ― Where are you setting the limits? Workload ― How much work are you doing vs. how much are you investing (contracts, GS, military)? Coding ― Poor coding  work not reported  lost PPS earnings If the C-O doesn’t push on these, who will? … soon to be PMPM?

7. Top DQ CO “Explanations” – “Coding accuracy for outpatient E&M, ICD-9, & CPT codes has decreased. We are reviewing our POAM's.” – “Coding Auditor is constantly training the coders on the proper codes to use.” – “One year vacancy of the coding auditor/trainer will be filled in July.” – “Audit performed by (my boss).” – “20 of 29 E&M were correct.” – “AHLTA disposition defaults to an incorrect E&M code.” Need C-O help on better explanations

8. 8 CNI Coordination Transfer base-type functions to CNI:  Done! FY12 & out for 6 “stand-alones” ― Hospitals remain with BUMED under Maintenance UICs ― Building maintenance & special projects remain with BUMED / DHP ― Any residual items  POM13/14 ― No impact to hospitals on USMC bases / Cairo / Lima. Regions / Activities: coordinate / communicate on specific resource questions ― CNI & BUMED HQ working an integrated shift via site-specific ISSA to CNI responsibility ― Do not transfer additional resources to CNI Key for BUMED is historic funding levels Bethesda, Portsmouth, Beaufort, Balboa, Bremerton, Guam.

9. 9 Process Improvement Industrial Engineering: scientific approach to process improvement that relies on current data, systemic analysis of solutions, and metrics to measure improvement / quality ― Partnership with Johns Hopkins ― Similar to efforts by Intermountain Health et al ― Projects owned by MTF / Region ― Enterprise-wide application of lessons under study by M3 9 projects completed; 10 projects underway. Goal: best processes for patient & family centered care POC: Tim Ward 202-762-1639 3-year working plan in place Maximizing our return on existing investments

10. 10 Completed: NMC San Diego -- Inpatient OB, Orthopedic supply chain NMC Portsmouth -- Orthopedic Patient Flow, Pharmacy NH Camp Lejeune -- Medical Evaluation Boards; Outpatient OB NH Camp Pendleton -- Outpatient OB NNMC Bethesda – OR Replenishment and Central Sterile operations In Process: NNMC Bethesda -- OR performance, CDD & WR Integration tasks NMC San Diego -- Ambulatory Procedure Visits NH Camp Pendleton -- Orthopedic outpatient, Medical Evaluation Boards Multiple locations -- Pharmacy operations and Automation procurement NHC Cherry Point, NH Camp Lejeune, NH Bremerton, NMC San Diego NH Camp Lejeune -- Inpatient OB (starts Jan 11) Summary of IE Projects to Date OB, Ortho, Pharmacy consistent areas of concern

11. 1. Overall Process: (Federal Managers’ Financial Integrity Act (FMFIA)) 2. Financial Reporting: (FMFIA) no new weaknesses/accomplishments for FY10 Previously reported weaknesses that remain in work :  Overall  Anti Fraud, Command Evaluation Program, Medical Coding, Personnel Security  Financial  MERCHF, Accounts Payable, Accounts Receivable, Funds Balance w/ Treasury Annual Statement of Assurance - FIP SOPs - Reducing Med Coding Errors - HQ Purchase Card Program - 3 rd Party Collections -Workload Productivity -Civ Time & Attendance - FIP SOPs - Reducing Med Coding Errors - FIP SOPs Accomplishments - Pharmacy Inventory - Reimbursable Funding at R&D Activities - Pharmacy Inventory (none reported) Weaknesses SECNAVCNOBUMED Navy-wide issues

12. SOPs Are Mandatory Since 1 Oct 09 Comptroller AORDFA AOR NEW! Equipment Contract Establishment Contract Closeout Purchase Card NEW! Inter-Agency Billing for Medical Services (IAB) Medical/Surgical Prime Vendor Management (Med/Surg) NEW! Outpatient Third Party Collections (TPC) Billing Personal Property Defense Travel System (DTS)Electronic Catalog (ECAT) Daily AccountingReal Property Non-Daily Accounting Coming Soon! Personal Services Contract Establishment Support Agreements: Receiver-Side Coming Soon! Contracting Officer’s Representative (COR) Coming Soon! Budget Formulation Clinical Support Services Coming Soon! Budget ExecutionPharmacy Inventory Management