Military Health System, PPS, Benchmarking, Anesthesia Information Management Systems and YOU ?

Anesthesia Business 101

What is the PPS? MHS way of funding hospitals based on “Outputs” not “Inputs” i.e.productivity. Provide “Incentives” for good health care practices. “Rational” distribution of funds Inpatient Relative Weighted Products (RWP). Put in SADR. Outpatient (RVU). Put in APV

When will it start? FY-05??? Applied to initial allocation. How will it happen? 25% per year to 100% of budget. Reimbursed a Champus Maximum Allowable Charge (CMAC) rate. Current CMAC for anesthesia=$ per anesthetic. $79.00??? per RVU has been quoted. Increased to $84.00 this year. Told it is already implemented. Told by business office at NAVMEDEAST, can’t be done.

Benchmarking

Benchmarking Instruments BUMED MGMA SAAC/AAPD (Abouleish Model)

BUMED Benchmarks

MGMA Data source Definitions Relevance???

Abouleish Model

Evaluation of OR/Anesthesia Productivity Assumption: You can not change your case complexity to improve performance

OR Efficiency (non- anesthesia time) Room turnover not directly measured. If HR/OR is > mean, tASA/OR/HR is > mean, and tASA/FTE is > than mean, and tASA/OR is < mean, than inefficiency must be inbetween cases during room turnovers.

NMCP Benchmarks using SAAC/AAPD data

NAVGAS Recommendations 6333 AU / departmental FTE / year AU/year 75% 55 FTE MD + CRNA More in line with military medicine. Would subtract deployed personnel from FTE.

Anesthesia Information Management Systems Docusys-Navy Hospital Pensacola Draeger Innovian-Navy Medical Center Portsmouth

How does an AIMS help me? Automatic capture. Automatic recording. Limitless database.

Implementing an AIMS IT Department Background Man-hours Policy and Procedures Education and Training Deployment Review Reporting

NMCP Experience Super User training - April Production of Lists and Environments by super users with definitions, policies, and procedures defined - May Education of end users- June Launch – 15 June Data Collection - 1 July Full reporting – 1 Aug

Future Directions USAA committee on AIMS requirements and standardization Recommendations to be reviewed by committee…

Surgeons book cases into S3 or like system by planned CPT code. Patient demographics including CHCS unique identifier, CPT codes, and ICD 9 codes are automatically uploaded into the anesthesia AIMS system. Anesthesia start/stop times are electronically captured in AIMS system at POC. Surgical start/stop times also captured in AIMS. Anesthesia and surgery times automatically uploaded to S3 to prevent differing times across systems.

At end of case, OR nurse verifies with surgeon actual CPT codes performed and updates S3 for actual case performed. This is automatically updated in AIMS. Anesthesiologist codes anesthesia CPT codes in AIMS at POC. AIMS reports patient demographics including surgical date and staff surgeon, Responsible anesthesia provider, surgical CPT codes (provided by surgeon via S3), Anesthesia CPT codes for Base units, Number of anesthesia Base Units per ASA RVU tables, Anesthesia start and stop times, Calculated time units for the case, and any modifiers including Physical Status, directly to CCE.

Coders validate anesthesia coding and surgical coding from records and crosswalk in CCE. 3rd party billing information sent directly to TPOCS for billing purposes. Benchmarking information be sent via MHS Insight for analysis by higher authority, specialty leader, and departmental managers. PDF record from AIMS be placed in CHCS/ALTA for use throughout MHS for follow-up surgeries.