integrating physician pti dtitpractice data into...

Integrating Physician P ti D t i tPractice Data into Performance Manager

Panel DiscussionYlone Xavier, MBA, MPH

©2015 McKesson Corporation. All rights reserved. Confidential and Proprietary.

Session Moderator

Introduction - Panelists

Nicole Fattu, Director, Corporate Decision Support Di it H lth Ph i A iDignity Health, Phoenix, Arizona

Jacqueline Karr, Senior Planning System AnalystNorton Healthcare, Louisville, Kentucky, , y

Rob Beeman Executive Director Decision SupportRob Beeman, Executive Director Decision Support St Francis Hospital and Medical Center, Hartford, Connectic tConnecticut

Dignity Health at a GlanceDignity Health at a Glance

One of the largest health systems in the nation

$16 56,000 39Billion in Assets

Employees Acute Care Hospitals

20 400+ 9,000State

Network Care Sites

Affiliated Physicians

172 101% 45%Days Cash Cash to

DebtDebt to Cap

530,000Attributable Members

(Including 270,000 capitated lives)

Provide integrated, patient‐centered care to more than two million people annually

Di ifi d i ff i d t hi t l ti h lthDiversified service offerings and partnerships support population health

Hospitals in Arizona, California, and Nevada

G i ti l f t i t

3As of December 31, 2014

Growing national footprint

Dignity Health at a Glance

Next Generation Digital Physician Alignment

Dignity Health at a Glance

Expanding

Partnerships and Investments

Analyticsgy gp g

Access

PriMed

Post Acute Care

Integration

Diagnostic and Treatment

Revenue Cycle Management

4

Dignity Health Decision Support

• Performance Manager, Business Insight, and soon: McKesson Analytics Explorer

Dignity Health Decision Support

• Decision Support Centralized Function– 24 Member Corporate Team

I i• Integrations

• Costing

• Net Revenue

• Corporate Reporting

• RVUs

• Facility Support

– Facility Analysts– Physician Practice Financial Teamy

Norton Healthcare StatisticsNorton Healthcare Statistics

• Healthcare system with over 140 locationsHealthcare system with over 140 locations throughout Louisville and southern Indiana– 5 Hospitals with 1 837 licensed beds– 5 Hospitals with 1,837 licensed beds– 7 outpatient centers and 13 immediate care centerscenters

– Over 12,000 employees with over 700 employed providers and 2,600 physicians on medical staffproviders and 2,600 physicians on medical staff

– Over 63,000 admissions and nearly 51,000 surgeries in 2014g

Norton Healthcare StatisticsNorton Healthcare Statistics

• Hospital and Practice Data both feed from EpicHospital and Practice Data both feed from Epic• Analytics Products

P f M– Performance Manager– McKesson Analytics Explorer

Saint Francis Hospital & Medical Center Key Stats

Located in Hartford, Connecticut 617 Licensed Beds 65 Licensed Bassinets 32,000 Inpatients per year 300,000 Outpatients per year 16,500 Surgeries 82,000 ED VisitsMajor Teaching Hospitalj g p 435 Employed Providers

Decision Support Overview

Performance Manager 18.0 Pathways Contract Modeling 18.0 Business Insight 16.0g McKesson Analytics Explorer 6.5 3M DRG, APR-DRG, APC Grouper and EAPGs Physician Practice EMR Epic (05/01/2015) prior Physician Practice EMR – Epic (05/01/2015) prior

AllScripts PeopleSoft General Ledger & Payroll 7 M b T 7 Member Team

1 Executive Director Decision Support & Reporting 2 Sr. Decision Support Analysts 1 Sr. Cost Accountant 2 BI Analysts 1 Contract Analyst

Question #1

How far in the cost cycle development was your

organizations by the time youorganizations by the time you decided to develop Physician

Practice data?

Response Question #1Response Question #1

• Developed cost structure on the hospital sideDeveloped cost structure on the hospital side, prior to beginning physician costing

• Developed our practice cost structure after• Developed our practice cost structure after successfully integrating practice data into Performance ManagerPerformance Manager

Response Question #1

• Hospital focus for many years– TRENDSTAR then Performance Manager (PM install started 2008 – 2010)


TRENDSTAR then Performance Manager (PM install started 2008 2010)

– 36 Hospitals

– Quarterly costing

– Monthly integrations

– STAR, Meditech, MS4, Invision

• October 2014, began Physician Practice Integration, g y g– IDX– Start with one group

“ ” f• 1 “Entity” out of 13

• 28 Physicians out of 650

• Dedicated Corporate Sr. Analystp y


Hospital since 1992 Hospital since 1992 TSI to Eclipsys to Performance Manager

Daily Integrationy g

Monthly Costing

Source Data - Epic and PeopleSoft

Physician since 2010 Monthly Integration Monthly Costing Monthly Costing Source Data – AllScripts and Epic

Physician Financial & Productivity Dashboards

Question #2

If you started after fully implementing the acute care

side would you have done thingsside, would you have done things differently on the acute side of

the business?


• YES!! Cost Components


– Utilized all 40 on the hospital side

– Physician Practice different breakout needed

– Needed about 15 different• “Doubling Up” on components

• Reporting difficult

• Issues with fixed vs. variable


• Practice costing structure to mirror the hospitalPractice costing structure to mirror the hospital structure, with minor exceptions

• Leadership team comfortable with hospital cost• Leadership team comfortable with hospital cost results C i i h i h ibl• Consistent with processing, as much as possible

• Meetings held with practice leadership prior to designing cost structure


NOPhysician Specialties to mirror our Service

Lines for Reporting.Costing structure is pretty much the same

t f l f t fexcept for a couple of components for Revenue Offsets for Teaching and Administrative TimeAdministrative Time.

Question #3

What is the level of detail of General Ledger information that is available for physicians andis available for physicians and practices at your organization?


• General Ledger (Lawson) is at the Practice/Clinic Level (D t t /A ti U it )


(Departments/Accounting Units)• Remaps used to create “Physician Departments”


• General Ledger includes account level detailGeneral Ledger includes account level detail for each practice locations


General Ledger system PeopleSoftEach Physician is a Cost Center

Each Specialty has a Administrative overhead Cost Center

Question #4

How are costs being allocated to the individual physicians – is it down to the Practice and thendown to the Practice and then based on an RVU down to the

individual physician?


• Remap practice level expense and create physician d t t


departments• Allocate cost from Physician Department down to the

i it l lservice item level• Service item is CPT Code + Modifiers


• Yes Cost is being pushed down to the practiceYes, Cost is being pushed down to the practice level

• Utilizing the CPT RVUs to allocate the cost• Utilizing the CPT RVUs to allocate the cost down to the physician/visit levelR ll l b h h i i h i i• Roll total cost up by the physician on the visits and practice locations


Ph i i (C tPhysician (Cost Center)

CPT (ChargeCode)

CMS Total RVU

Question #5

Can you please share detailed information as to how you allocated costs RVUs thatallocated costs, RVUs that are used, remaps that are

created, etc.


• Data from Lawson– Move $$s from salary expense accounts to new created accounts that reflect


$$ y psalaries at a job code level

– Spread accruals to new job code category accounts

• Perform RemapsPerform Remaps– Spread PSA (Provider Services Agreement) Based on WRVUs

– Other Op Revenue

– Benefits

– Equip Depreciation

– Create Physician Departmentsy p• TRVUs

• One remap per Doctor (Could combine but chose not to)

h b f d h• New Physician Dept # is a Combo of Lawson Dept # and Physician ID #


• Cost Component• Overhead Step‐Down (similar to hospitals with clinic admins)


Overhead Step Down (similar to hospitals with clinic admins)• Service Item Allocation– CPT+Modifier Level– Using RVUs from IDX system

• EncounterFY D t t b E tit– FY Datasets by Entity– Based on date of service– Net Revenue Calculated at the Service Item and Patient (Invoice) Levels( )– IDX sends over the same Department # for the Physicians created in the remap process


• Key Remap ChangesKey Remap Changes – Including Physician Salary and Malpractice Insurance as separate componentsInsurance as separate components

– Creating patient care support cost bucket (direct)– Remapping changes for docs who work in multiple– Remapping changes for docs who work in multiple locations to mirror GL

• RVUs come straight from Epic live on• RVUs come straight from Epic, live on CPT/Mod combinations


C CCharge Item Cost Per-UnitCurrent based on service dateCurrent based on service date

Direct Costs are allocated down to the CPT

level using CMS Total RVU Values

Remaps to build statistics (total charges) toRemaps to build statistics (total charges) to

allocate overhead

Question #6

What item are you using to identify the following:

S i It f Ph i i ?• Service Item for a Physician?• Patient type• Patient type


• Service ItemService Item– Combination of the CPT code and first modifier.

• Patient Type• Patient Type– All practice patients are hard coded as MD– Store place of service code


• CPT codes + Modifiers


• MD Physician Office Patient Type


Each CPT Code & Modifier is a Service ItemUsing a transformation table to map to one of

McKesson standard and bringing in the Epic PB value

Office Visit MD Physician Office

Question #7

What has been done if any regarding data governance to

ensure integrity and credibility ofensure integrity and credibility of the data?


• Reconcile data to the General Ledger and EpicReconcile data to the General Ledger and Epic monthly

• Worked with leadership while developing• Worked with leadership while developing data, costing, and reporting structure to ensure consistency and data validityensure consistency and data validity

• Data governance committees established, l h h k ialthough a work in progress


• Extensive auditing back to Lawson


– Reconcile posting date in Lawson to DOS in Performance Manager

R il N t R– Reconcile Net Revenue

• Extensive auditing back to IDX– Pulled accounts to match data

–Working on a report of #’s in data sent to #’s integrated

• Auditing within Performance Manager– Calc to Zero Audits


Reconcile expenses and revenue (posting date) to the GL

Audit encounters back to EpicMeet regularly with department chairs to

i Fi i l & P d ti it D hb dreview Financial & Productivity Dashboards from McKesson Analytics Explorer

Question #8

Do you have any sample reports that you plan on sharing with

your physicians? How will theseyour physicians? How will these be presented?


• Work in Progress


–Mostly profitability at this time

• Business Insight and soon McKesson AnalyticsBusiness Insight, and soon McKesson Analytics ExplorerPh i i P ti Fi T t t• Physician Practice Finance Team to present data to Physicians


• Produce quarterly reporting shared withProduce quarterly reporting shared with leadership

• Not currently sharing data with a wide range• Not currently sharing data with a wide range of physicians C l h ili i E l• Currently, share reports utilizing Excel

• Process of converting reporting to McKesson Analytics Explorer

Volume

Response Question #8Financials

Physician Dashboard

Originupdated Monthly with the following:

GLVolume ActivityFinancial ActivityActivityPatient OriginGeneral LedgerGeneral LedgerPatient Details

Question #9

Have your organizations used any other applications to report physician practice information?physician practice information?

If so which System and what wasIf so which System and what was the experience?


• Crimson – Market Advantage and MedicalCrimson Market Advantage and Medical Group Advantage– Shows benchmarking and leakage data– Shows benchmarking and leakage data– Still in process, difficult to reconcile

L t d d G l L d• Lawson – standard General Ledger• Clarity/Epic – Standard volume reporting, not flexible


• Crimson at the Hospital Level



Using Advisory Board tool (Crimson Physician Practice )Physician Practice )Team was able to achieve a better product

with McKesson Analytics Explorer and savedwith McKesson Analytics Explorer and saved the hospital $

Success Measures

Initiative Measure

Cost Aware of what different methods are Cost available

Quality Determine the best method that suits your Health System and Physician Practicesy Health System and Physician Practices

Utilization Utilize the process that will get the most value in your Health System

Efficiency Identify the practices that are most efficient through this process

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