Labor Mapping Basics VHA Homeless Programs VHA Office

Labor Mapping Basics VHA Homeless Programs VHA Office of Finance – Managerial Cost Accounting Office 1

Objectives • Managerial Cost Accounting (MCA) – What it is and why we have it • Understand basics of the Decision Support System (DSS) • Labor Mapping – Concepts – Business rules – “Types” of time • • Clinical (Direct patient care) Administrative Education Research – Labor mapping scenarios – Mapping impacts • Costs • Productivity VHA Office of Finance – Managerial Cost Accounting Office 2

What are MCA and DSS? • Managerial Cost Accounting – MCA – Observes and calculates the actual costs of operations – Determines where the money goes • Decision Support System – DSS – Official managerial cost accounting system for VA – A software system and secondary database – Accepts and matches data from other sources – Does not create data, this is your data – Requires input from managers – A reporting system • • Cost Workload Patient Demographics Productivity VHA Office of Finance – Managerial Cost Accounting Office 3

Where does the data come from? VHA Office of Finance – Managerial Cost Accounting Office 4

DSS Database Structure • DSS Production Units describe the labor activity – L 1 = Emergency Department (ED) – MM = Patient Aligned Care Team (PACT) • DSS Cost Centers (ALBCCs) hold dollars and hours – 204 L 1* = Emergency Department (ED) ALBCC – 204 MM* or 201 MM* = Patient Aligned Care Team (PACT) ALBCCs • DSS Departments hold workload – Each cost center has a DSS department – Intermediate products = workload • 30 minute Clinic Visit – Intermediate products are costed • Patient encounter records show cost and workload VHA Office of Finance – Managerial Cost Accounting Office 5

Major Categories of Data Costs Examples • Equipment • Supplies Labor Hours Examples • Physician • Nursing staff • Clerical Staff Products and services used for patient care Examples Data about the patient Examples • Diagnoses • Demographics • Treatment • 15 minute clinic visit • 30 minute emergency department visit • 60 minute radiology procedure VHA Office of Finance – Managerial Cost Accounting Office 6

Workload • Products and services supplied to patients • From Vist. A – Scheduling or Event Capture System (ECS) • Mapped to department that produces work VHA Office of Finance – Managerial Cost Accounting Office 7

Resources • Costs – Labor – Supplies – Equipment • FTE: Costs and hours • From financial sources • Mapped to areas where they are used VHA Office of Finance – Managerial Cost Accounting Office 8

Labor Mapping – what is it? • A process of assigning labor resources to the work areas where they belong – Labor hours are mapped to the areas where the employees work and are paid • Assigns labor costs to the Account Level Budgeter Cost Center (ALBCC) where the work occurred. Services are asked to distribute their employees’ labor time (based on percentages) to the various ALBCCs where they work. Dr. Jones 80% Red Clinic ALBCC 203 PL 1 5% Education ALBCC 203021 10 % Admin Time ALBCC 203001 5% Resident Supervision ALBCC 203 PL 1 ED 18

Labor Mapping affects… Department and Product Costs t 1 c e f f E Labor Mapping Effect 2 Effect 3 Department Productivity Patient/Encounter Costs • In order for all of these to be accurate, service leaders need to ensure that labor mapping is reviewed and adjusted monthly. 18

Resource data flow ALB Cost Centers HUD/VASH Clinic 203 PL 1 HCHV/HCMI 203 QZ 1 Financial Extracts Grant and Per Diem 203 PG 1 VHA Office of Finance – Managerial Cost Accounting Office 11

The Golden Rule of MCA • Workload and cost must be kept together. • All employees must be labor mapped to the department where their workload is produced. VHA Office of Finance – Managerial Cost Accounting Office 12

Who does mapping? • MCA site team members perform technical steps to do mapping • Local managers need to tell MCA staff how and where to map employee labor – Knowledge of MCA/DSS IPDs – Worksheets – Access database interface VHA Office of Finance – Managerial Cost Accounting Office 13

Cost distribution – Inpatient & Outpatient VHA Office of Finance – Managerial Cost Accounting Office 14

Cost per Clinic Stop Code Report – FY 16 (Feb) Network Name Clinic Stop - Your VAMC 522 - Your VAMC 522 - Your VAMC 522 - Your VAMC 522 - Your VAMC 522 Clinic Name HUD-VA SHARED HOUSING VASH HUD-VA SHARED HOUSING VASH HUD-VA SHARED HOUSING VASH HUD-VA SHARED HOUSING VASH HUD-VA SHARED HOUSING VASH THRU Fixed Direct Variable Month Cost Direct Cost Fixed Indirect Cost Total Clinic Stop Code Encounters Costs $ (TOT) % Unique Average Variance Patients Cost per Nat'l to through Encounter Cost per National Fiscal Period $ Enctr $ Avg Feb 182, 347 4, 246, 580 3, 814, 179 8, 243, 105 16, 990 2, 985 485 349 39. 1 Feb 1, 116, 897 5, 016, 443 5, 024, 409 11, 157, 749 32, 401 5, 724 349 -1. 3 Feb 229, 159 2, 661, 099 2, 049, 885 4, 940, 143 18, 190 3, 108 272 349 -22. 1 Feb 490, 463 2, 148, 802 1, 952, 387 4, 591, 651 18, 783 2, 966 244 349 -29. 9 Feb 310, 436 1, 859, 674 1, 471, 577 3, 641, 686 16, 651 3, 635 219 349 -37. 3 Feb 550, 319 4, 289, 811 3, 796, 904 8, 637, 034 30, 137 5, 656 287 349 -17. 8 Feb 546, 751 7, 573, 780 6, 720, 884 14, 841, 415 43, 398 7, 143 342 349 -1. 9 Feb 224, 816 2, 246, 994 1, 892, 591 4, 364, 401 11, 183 2, 929 390 349 11. 9 Feb 174, 259 2, 383, 412 2, 015, 929 4, 573, 599 12, 276 2, 263 373 349 6. 8 Feb 243, 552 2, 566, 108 1, 959, 580 4, 769, 241 15, 499 3, 152 308 349 -11. 8 Feb 547, 412 2, 999, 714 2, 205, 278 5, 752, 403 24, 788 3, 713 232 349 -33. 5 Feb 312, 495 1, 795, 934 1, 422, 248 3, 530, 676 11, 311 2, 040 312 349 -10. 5 Feb 389, 170 5, 916, 069 3, 546, 196 9, 851, 435 25, 290 5, 623 390 349 11. 7 Feb 192, 170 3, 692, 970 2, 654 6, 539, 794 20, 241 4, 517 323 349 -7. 4 Feb 1, 831, 778 1, 203, 185 934, 495 3, 969, 458 7, 641 1, 851 519 349 49 Feb 129, 936 3, 358, 403 2, 544, 870 6, 033, 209 19, 293 3, 380 313 349 -10. 3 Feb 426, 677 4, 747, 054 4, 059, 317 9, 233, 048 21, 024 4, 570 439 349 25. 9 Feb 2, 252, 409 7, 670, 765 7, 857, 712 17, 780, 886 31, 349 6, 629 567 349 62. 6 Feb 606, 621 9, 861, 271 6, 657, 975 17, 125, 867 47, 563 9, 004 360 349 3. 2 Feb 680, 605 2, 310, 173 1, 759, 693 4, 750, 471 18, 515 2, 496 257 349 -26. 4 154, 327, 274 442, 523 11, 438, 272 78, 548, 239 64, 340, 762 VHA Office of Finance – Managerial Cost Accounting Office 15

Types of Labor and Time • Labor – Variable Labor (VL) – Fixed Direct Labor (FDL) • Time – Direct Patient Care Time – Administration Time – Education Time – Research Time VHA Office of Finance – Managerial Cost Accounting Office 16

Direct Patient Care Time • Time to prepare, to provide for, and follow-up on the clinical care needs of patients including: – – – Time spent in reviewing patient data. Consulting about patient care with colleagues. Reviewing medical literature. Contacting the patient or caregivers to discuss their needs. The labor hours provided by a physician or dentist who is supervising house staff residents providing care in a clinical setting. • Allocated (mapped) to direct care ALBCCs/departments in proportion (%) to the time spent in each of these activities • Variable Labor (VL) VHA Office of Finance – Managerial Cost Accounting Office 17

Administration Time • Administration Time includes time spent on managerial or administrative duties, generally at the level of the department, service, medical facility, VISN, or nationally, both within and outside VA including: – In support of service-wide administrative activities, such as completing performance reviews, and medical center and VA Central Office reporting requirements. – Managing a program within a clinical department, service, or hospital. – Working on service or hospital-wide committees. – Serving on state and national committees, advisory boards, or professional societies. • Allocated (mapped) to the indirect service Administrative ALBCC (xxx 00*) in proportion (%) to the time spent in each of these activities • Fixed Direct Labor (FDL) VHA Office of Finance – Managerial Cost Accounting Office 18

FDL/VL Splits for Administrative Time • Not for physicians and dentists • Used to reflect time clinical employees spend on purely administrative duties (FDL) and direct patient care (VL) within a Direct care ALBCC/department – FDL/VL Split – map as percentage • FDL (Fixed Direct Labor) = Administrative time; mapped to the place where the employee works • VL (Variable Labor) = Clinical time; mapped where the employee works VHA Office of Finance – Managerial Cost Accounting Office 19

Education Time • Time spent providing formal training (didactic education). This includes preparation as well as actual classroom or lecture time for educators or presenters. – – – Giving conferences in the community or nationally. In a classroom teaching medical school curriculum. In a classroom teaching residents and fellows. In managing a resident, fellow, or other type of student teaching program. Working on medical school committees. • Allocated (mapped) to the indirect service Education/Support ALBCC (xxx 02*) in proportion (%) to the time spent in each of these activities • Fixed Direct Labor (FDL) NOTE: Time spent receiving training is considered a cost of direct patient care. VHA Office of Finance – Managerial Cost Accounting Office 20

Research Time • Defined as time spent performing formal, approved health care research, or in activities in direct support of approved research. – Working on research projects that have been approved by the local VA medical center Research and Development Committee which does not produce recorded patient care encounter workload in Vist. A. – Working in an actual research laboratory or in a controlled setting that involves no direct patient care or treatment. – Serving on hospital or affiliate research committees. – Supervising a student’s, resident’s, or fellow’s non-clinical research. – Writing for publications or grants. – Attending meetings explicitly related to research activities. – Presenting papers at research meetings. – Sitting on a national study section or grant approving board. • Allocated (mapped) to the indirect research support ALBCC (xxx 01*) in proportion (%) to the time spent in these activities • Fixed Direct Labor (FDL) VHA Office of Finance – Managerial Cost Accounting Office 21

Drive time…where is it included? • Clinical professional (Not a physician) – FDL/VL Split • Travel time mapped as FDL to the Direct ALBCC • DO NOT map FDL to administrative ALBCCs – Results in overstated indirect (overhead) cost – VL RVU • An average travel time may be added to the Labor RVU for the visit • Example: 30 minute drive time & 30 minute visit : RVU = 60 • Physician – VL RVU • An average travel time may be added to the Labor RVU for the visit • Example: 30 minute drive time & 30 minute visit : RVU = 60 – No FDL/VL splits allowed • If FDL, must be mapped to Clinical Administrative ALBCC (i. e. 203001) VHA Office of Finance – Managerial Cost Accounting Office 22

Labor Mapping Reports VHA Office of Finance – Managerial Cost Accounting Office 23

Labor Mapping Reports (2) SSN CC XXX-XX-XXX 1 XXX-XX-XXX 2 XXX-XX-XXX 3 XXX-XX-XXX 4 XXX-XX-XXX 5 T&L 8221 8221 8221 SUBACCT ALBCC 196 1020221 203 PL 1 196 1051221 203 PL 1 198 1001221 203 PL 1 198 1020221 203 PL 1 VHA Office of Finance – Managerial Cost Accounting Office Percent 0. 18 0. 82 0. 17 0. 83 1 0. 1875 0. 8125 24

Common Labor Mapping Questions: How do we map…? • Extended leave – Continue to map the employee to their “regular” assigned ALBCC/department unless there is an official SF-52 changing their assignment • Workers Compensation – To ensure standardization, the following Workers Compensation BOCs should be mapped to the Directors Office (40100*): a. BOC 1094 Employee Compensation (FDO) b. BOC 1095 Employee Salary Continuation (FDL) c. BOC 1096 Employee on Sick Leave Pending Disability Retirement (FDL) • Maternity leave – Continue to map the employee to their “regular” assigned ALBCC/department unless there is an official SF-52 changing their assignment VHA Office of Finance – Managerial Cost Accounting Office 25

Common Labor Mapping Questions (2): How do we map…? • Non-physician, non-dentist employees supervising students/trainees – Continue to map the employee to the clinic, ward or service (direct ALBCC) where the student or trainee is performing patient care work • Paid trainees/students – Map the trainee/student to the clinic, ward or service (direct ALBCC) where they are performing patient care work VHA Office of Finance – Managerial Cost Accounting Office 26

Common Labor Mapping Questions (3): How do we map…? • Clinical Supervision – Map the employee to the clinic, ward or service (direct ALBCC) where they are performing patient care work – A VL/FDL split may be necessary if the employee performs any administrative supervisory duties such as conducting performance appraisals or approving time VHA Office of Finance – Managerial Cost Accounting Office 27

Questions? VHA Office of Finance – Managerial Cost Accounting Office 28

Mapping References • VHA Directive 2011 -009, Physician and Dentist Labor Mapping • VHA Directive 1161 -Productivity and Staffing in Outpatient Clinical Encounters for Mental Health Providers • Administrative Labor and FDL Mapping • Education Support Mapping • Research Support Mapping • Resident Supervision Mapping • MCA Financial Lexicon VHA Office of Finance – Managerial Cost Accounting Office 29

To Learn More • MCA Learning Community • Contact the MCAO Training Team – VHAMCAOTraining@va. gov VHA Office of Finance – Managerial Cost Accounting Office 30