Labor Mapping Basics VHA Homeless Programs - PowerPoint Presentation

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Labor Mapping Basics

VHA Homeless Programs

VHA Office of Finance – Managerial Cost Accounting Office

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Objectives

Managerial Cost Accounting (MCA)

What it is and why we have it

Understand basics of the Decision Support System (DSS)

Labor Mapping

ConceptsBusiness rules“Types” of timeClinical (Direct patient care)AdministrativeEducationResearchLabor mapping scenariosMapping impactsCostsProductivity

VHA Office of Finance – Managerial Cost Accounting Office

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What are MCA and DSS?

Managerial Cost Accounting – MCA

Observes and calculates the actual costs of operations

Determines where the money goesDecision Support System – DSSOfficial managerial cost accounting system for VAA software system and secondary databaseAccepts and matches data from other sourcesDoes not create data, this is your dataRequires input from managersA reporting systemCostWorkloadPatient DemographicsProductivity

VHA Office of Finance – Managerial Cost Accounting Office

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Where does the data come from?

VHA Office of Finance – Managerial Cost Accounting Office

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DSS Database Structure

DSS Production Units describe the labor activity

L1 = Emergency Department (ED)

MM = Patient Aligned Care Team (PACT)DSS Cost Centers (ALBCCs) hold dollars and hours204L1* = Emergency Department (ED) ALBCC204MM* or 201MM* = Patient Aligned Care Team (PACT) ALBCCsDSS Departments hold workloadEach cost center has a DSS department Intermediate products = workload30 minute Clinic VisitIntermediate products are costedPatient encounter records show cost and workload

VHA Office of Finance – Managerial Cost Accounting Office

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Major Categories of Data

Costs

ExamplesEquipment

Supplies

Labor Hours ExamplesPhysicianNursing staffClerical Staff

Data about the patient

Examples

Diagnoses

Demographics

Treatment

Products and services used for patient care

Examples

15 minute clinic visit

30 minute emergency department visit

60 minute radiology procedure

VHA Office of Finance – Managerial Cost Accounting Office

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Workload

Products and services supplied to patients

From

VistA Scheduling or Event Capture System (ECS)Mapped to department that produces work

VHA Office of Finance – Managerial Cost Accounting Office

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Resources

Costs

Labor

SuppliesEquipmentFTE: Costs and hoursFrom financial sourcesMapped to areas where they are used

VHA Office of Finance – Managerial Cost Accounting Office

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Labor Mapping – what is it?

A process of assigning labor resources to the work

areas where they belongLabor hours are mapped to the areas where the employees work and are paidAssigns 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.

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Labor Mapping

affects…

In order for all of these to be accurate,

service leaders need to ensure that labor mapping is reviewed and adjusted monthly.

Labor Mapping

Effect 1Effect 2Effect 3

Department and Product Costs

Department Productivity

Patient/Encounter Costs

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Resource data flow

Financial Extracts

ALB Cost Centers

HUD/VASH Clinic

203PL1

HCHV/HCMI

203QZ1

Grant and Per Diem

203PG1

VHA Office of Finance – Managerial Cost Accounting Office

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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

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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 IPDsWorksheetsAccess database interface

VHA Office of Finance – Managerial Cost Accounting Office

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Cost distribution –

Inpatient & Outpatient

VHA Office of Finance – Managerial Cost Accounting Office

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Cost per Clinic Stop Code Report – FY16 (Feb)

VHA Office of Finance – Managerial Cost Accounting Office

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Network

Network Name

Clinic Stop

Clinic Name

THRU Month

Fixed Direct Cost

Variable Direct Cost

Fixed Indirect Cost

Total Clinic Stop Code Costs $ (TOT)

Encounters

Unique Patients through Fiscal Period

Average Cost per Encounter $

Average Nat'l Cost per Enctr $

% Variance to National Avg

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Your VAMC

522

HUD-VA SHARED HOUSING VASH

Feb

182,347

4,246,580

3,814,179

8,243,105

16,990

2,985

485

349

39.1

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Your VAMC

522

HUD-VA SHARED HOUSING VASH

Feb

1,116,897

5,016,443

5,024,409

11,157,749

32,401

5,724

344

349

-1.3

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Your VAMC

522

HUD-VA SHARED HOUSING VASH

Feb

229,159

2,661,099

2,049,885

4,940,143

18,190

3,108

272

349

-22.1

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Your VAMC

522

HUD-VA SHARED HOUSING VASH

Feb

490,463

2,148,802

1,952,387

4,591,651

18,783

2,966

244

349

-29.9

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Your VAMC

522

HUD-VA SHARED HOUSING VASH

Feb

310,436

1,859,674

1,471,577

3,641,686

16,651

3,635

219

349

-37.3

-

Your VAMC

522

HUD-VA SHARED HOUSING VASH

Feb

550,319

4,289,811

3,796,904

8,637,034

30,137

5,656

287

349

-17.8

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Your VAMC

522

HUD-VA SHARED HOUSING VASH

Feb

546,751

7,573,780

6,720,884

14,841,415

43,398

7,143

342

349

-1.9

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Your VAMC

522

HUD-VA SHARED HOUSING VASH

Feb

224,816

2,246,994

1,892,591

4,364,401

11,183

2,929

390

349

11.9

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Your VAMC

522

HUD-VA SHARED HOUSING VASH

Feb

174,259

2,383,412

2,015,929

4,573,599

12,276

2,263

373

349

6.8

-

Your VAMC

522

HUD-VA SHARED HOUSING VASH

Feb

243,552

2,566,108

1,959,580

4,769,241

15,499

3,152

308

349

-11.8

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Your VAMC

522

HUD-VA SHARED HOUSING VASH

Feb

547,412

2,999,714

2,205,278

5,752,403

24,788

3,713

232

349

-33.5

-

Your VAMC

522

HUD-VA SHARED HOUSING VASH

Feb

312,495

1,795,934

1,422,248

3,530,676

11,311

2,040

312

349

-10.5

-

Your VAMC

522

HUD-VA SHARED HOUSING VASH

Feb

389,170

5,916,069

3,546,196

9,851,435

25,290

5,623

390

349

11.7

-

Your VAMC

522

HUD-VA SHARED HOUSING VASH

Feb

192,170

3,692,970

2,654,654

6,539,794

20,241

4,517

323

349

-7.4

-

Your VAMC

522

HUD-VA SHARED HOUSING VASH

Feb

1,831,778

1,203,185

934,495

3,969,458

7,641

1,851

519

349

49

-

Your VAMC

522

HUD-VA SHARED HOUSING VASH

Feb

129,936

3,358,403

2,544,870

6,033,209

19,293

3,380

313

349

-10.3

-

Your VAMC

522

HUD-VA SHARED HOUSING VASH

Feb

426,677

4,747,054

4,059,317

9,233,048

21,024

4,570

439

349

25.9

-

Your VAMC

522

HUD-VA SHARED HOUSING VASH

Feb

2,252,409

7,670,765

7,857,712

17,780,886

31,349

6,629

567

349

62.6

-

Your VAMC

522

HUD-VA SHARED HOUSING VASH

Feb

606,621

9,861,271

6,657,975

17,125,867

47,563

9,004

360

349

3.2

-

Your VAMC

522

HUD-VA SHARED HOUSING VASH

Feb

680,605

2,310,173

1,759,693

4,750,471

18,515

2,496

257

349

-26.4

 

 

 

 

 

11,438,272

78,548,239

64,340,762

154,327,274

442,523

 

 

 

 

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Types of Labor and Time

Labor

Variable Labor (VL)

Fixed Direct Labor (FDL)TimeDirect Patient Care TimeAdministration TimeEducation TimeResearch Time

VHA Office of Finance – Managerial Cost Accounting Office

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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 activitiesVariable Labor (VL)

VHA Office of Finance – Managerial Cost Accounting Office

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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 (xxx00*) in proportion (%) to the time spent in each of these activities

Fixed Direct Labor (FDL)VHA Office of Finance – Managerial Cost Accounting Office

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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/departmentFDL/VL Split – map as percentageFDL (Fixed Direct Labor) = Administrative time; mapped to the place where the employee worksVL (Variable Labor) = Clinical time; mapped where the employee worksVHA Office of Finance – Managerial Cost Accounting Office

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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 (xxx02*) in proportion (%) to the time spent in each of these activitiesFixed Direct Labor (FDL)

NOTE: Time spent

receiving training is considered a cost of direct patient care. VHA Office of Finance – Managerial Cost Accounting Office

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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 VistA.

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 (xxx01*) in proportion (%) to the time spent in these activities

Fixed Direct Labor (FDL)VHA Office of Finance – Managerial Cost Accounting Office

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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) costVL RVU An average travel time may be added to the Labor RVU for the visitExample: 30 minute drive time & 30 minute visit : RVU = 60PhysicianVL RVU An average travel time may be added to the Labor RVU for the visitExample: 30 minute drive time & 30 minute visit : RVU = 60No FDL/VL splits allowedIf FDL, must be mapped to Clinical Administrative ALBCC (i.e. 203001)VHA Office of Finance – Managerial Cost Accounting Office

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Labor Mapping Reports

VHA Office of Finance – Managerial Cost Accounting Office

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Labor Mapping Reports

(2)VHA Office of Finance – Managerial Cost Accounting Office

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SSN

CC

T&L

SUBACCT

ALBCC

Percent

XXX-XX-XXX1

8221

196

1020221

203PL1

0.18

XXX-XX-XXX1

8221

196

1020221

203PL1

0.82

XXX-XX-XXX2

8221

196

1051221

203PL1

0.17

XXX-XX-XXX2

8221

196

1051221

203PL1

0.83

XXX-XX-XXX3

8221

198

1001221

203PL1

1

XXX-XX-XXX4

8221

198

1020221

203PL1

0.1875

XXX-XX-XXX4

8221

198

1020221

203PL1

0.8125

XXX-XX-XXX5

8221

198

1020221

203PL1

0.1875

XXX-XX-XXX5

8221

198

1020221

203PL1

0.8125

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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 CompensationTo ensure standardization, the following Workers Compensation BOCs should be mapped to the Directors Office (40100*):

BOC 1094 Employee Compensation (FDO)BOC 1095 Employee Salary Continuation (FDL)BOC 1096 Employee on Sick Leave Pending Disability Retirement (FDL)Maternity leaveContinue 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

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Common Labor Mapping Questions

(2):

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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/studentsMap 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

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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 workA 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

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Questions?

VHA Office of Finance – Managerial Cost Accounting Office

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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 MappingEducation Support MappingResearch Support Mapping

Resident Supervision MappingMCA Financial Lexicon

VHA Office of Finance – Managerial Cost Accounting Office

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To Learn More

MCA Learning Community

Contact the MCAO Training Team

VHAMCAOTraining@va.govVHA Office of Finance – Managerial Cost Accounting Office