Data Warehouse User GroupMarch 10, 2011

Provider CFTE Metrics

Lower Levels of Detail in Future Monthly Dashboards

FPSC Clinical Full-Time Equivalent (CFTE) Metrics

Primary reason that UCSF participates in United Healthcare Consortium is to have access to provider benchmarks

Providers are compared to, and have their work benchmarked against, other providers in the same specialty in other university medical groups

AAMC (FPSC) benchmarks are preferable to MGMA benchmarks, since academic staff practice patterns can vary greatly from private practice

Two separate CFTE figures in FPSC online reports Imputed CFTE: calculated by them. Actual Work RVUs billed by

physician are divided by the benchmark Work RVUs for all provider in the same specialty

Reported CFTE: provided by us and defaulted to 1.0 when no separate value is reported to FPSC

FPSC CFTE MetricsIn the past (prior to 2009), the Medical Group:

Used FPSC’s Imputed CFTE to estimate how many full-time-equivalent physicians make up a given department or practice

Did not encourage departments to supply their own estimates (i.e. Reported CFTE)

Default was 1.0, for every provider If some departments reported percentages, but others didn’t, the

results for the overall group would be skewed Assumed we were really only interested in the resulting Imputed FTEs

If departments wanted to, they could gauge their providers’ productivity themselves

You can export Benchmark and Actual Work RVUs for a given physician from the FPSC Productivity Report, then multiply the benchmark by the known percent of clinical work for that provider

…that was then…

FPSC CFTE Metrics…but this is now!

There’s a strong push to leverage the FPSC tool and make it truly interactive

New Feedback Loop: instead of being just (passive) recipients of Imputed CFTE data, department users can (actively) provide targets (Reported CFTEs) that affect what the tool will return

Allows department administrators and other users to view expected productivity against actual per physician per billing period

No further export and outside calculations would be needed Results can be viewed directly via the FPSC online reports

These numbers are being reported and discussed in financial and operational meetings, where people assume they are accurate

Reported CFTE Calculation – where we stand today

Reported CFTEs are grossly overstated Most providers defaulted to 1 CFTE “Once you’re in, you’re in” rule

if a provider shows billing in a department, even if it’s only one time or in one month, FPSC assumes he/she is a permanent member of that department

Future months will report a 1.0 CFTE for that provider unless instructed not to

What the dashboards

reflect

Reported CFTE Calculation – where we stand today

Reported CFTEs are grossly overstated (cont.)

Dirty charge records create phantom providers…who hang around

If a non-active or non-UCSF provider is accidentally posted to a charge which is later sent to FPSC as part of the quarterly submission, he/she is also assumed to be a permanent member of that department

Note: you’ll sometimes see negative billing & RVUs, which likely come from charge corrections. Ironically, in these cases, the Imputed CFTE will be negative, but the Reported will still be 1.0!

Providers billing out of more than one department are counted multiple times

Providers associated with more than one specialty in the past (i.e. first assignment later corrected) can appear in the same department multiple times

Imputed CFTE Calculation – where we stand today

On the other hand, Imputed CFTEs are probably understated

Biggest Problem: Specialties with no RVU benchmarks Imputed CFTE = [actual Work RVU]/[Work RVU Benchmark] When the [Work RVU Benchmark] doesn’t exist, the formula

defaults to 0.0. Examples include: Neurology: Alzheimers / Dementia Ophthalmology: Oculoplastic / Reconstructive Surgery Orthopedic Surgery: Oncology Pediatrics: Cardiology-Noninvasive Pediatrics: Infectious Disease

What Shaifali calls the “chicken and the egg problem” When a provider is assigned to one of these, the

designation may better reflect the provider’s niche service(s), but because the pool of doctors is so limited, FPSC can’t issue a benchmark.

FPSC won’t discourage us from assigning providers to them in the hopes that, someday soon, a big enough base of these providers will allow them to compute a reliable benchmark

Imputed CFTE Calculation – where we stand today

On the other hand, Imputed CFTEs are probably understated (cont.)

Specialties that had benchmarks in previous years, but not anymore (another version of “chicken and egg”) Examples include:

Pediatrics: Allergy / Immunology Pediatrics: Pulmonology

Both of these had benchmarks in 2009, but they disappeared in 2010

Other Reasons: Some departments (ex. Anesthesiology) don’t lend

themselves to Work RVU benchmarking While it can’t be helped, and until an alternative

benchmark can is adopted, the seemingly low CFTE metric may be your responsibility to explain

Physicians accidentally assigned to the wrong Department Activity for a provider in your department may

incorrectly be attributed to another department – this makes your department look artificially low

What happens now? Mass Cleanup

We are working with Shaifali on a Master Provider List that removes all duplicates so that every provider is assigned to only one Department and only one Specialty

Once the changes are made at FPSC, we need your help to validate the assignments. The master list will be emailed to you after today’s webcast

Many providers on this list will have left the university already. Don’t worry about deactivation just yet – the first step is to make sure we got them into the right Department (or ex-Department) and Specialty

Next week, a Provider Update Template (next slide) will be sent to each department containing only Providers in your department

Once the contact for your department receives it, he/she will be expected to

Specify an Avg CFTE (i.e. your “Reported CFTE” estimate) for each provider Deactivate any providers who have left the practice by providing a Deactivation

Date Correct any Specialty assignments that are still inaccurate Decide whether to move providers from Specialties with no benchmarks to

Specialties with benchmarks (I will specify those providers for you) Call us with any questions!!

Completing the FPSC Provider Update Template

Existing values – section is “read only” Updated values go here

Don’t want their activity counted toward Imputed FTEs in any of the “good”

buckets, so set their specialty to “00 – Other

Physician Specialty” which has no benchmark (Remember: when

assigned specialty has no benchmark, Imputed FTE =

0.00 for that provider)Don’t want these

counted in Reported CFTE metric, so Avg

CFTE is set to 0.0

FPSC Provider Update Templates

New Process: all templates/updates now going through the Medical Group

We now log the assignments you make; if you go to the website and submit them yourselves, we can’t tell if the assignments are new or old, intentional or just dirt

Doing this will prevent duplicate records from appearing again Ensures we are completing the templates in a consistent manner across all dept’s Your assignments and their associated benchmarks can be made available to you

for reporting

Your ability to make the changes directly at via the FPSC website has been disabled

In the future, we’ll be sending out a round of templates after each quarterly submission

If you feel we have the wrong contact person, now is the time to educate us

In order to have the CFTE values updated prior to the Dean’s Office Budget Meeting, we need your templates back to us by the first week of April!

Any questions? (additional slides at the end of this presentation)

Future Dashboard Reports – more detail now possible

Current dashboards are high level: Department

To make them more meaningful, we’d like to provider a greater level of detail

This is *OPTIONAL* -- department level reports will continue to be produced and made available every month.

Future Dashboard Grouping Levels

Some potential groupings are “natural;” i.e. the logic is built into our main production system(s)

Ex: Pediatrics could easily report by “Campus Division”

On the other hand, several departments have provided us Custom Grouping levels

Ex: Orthopedic Surgery has grouped their providers into PODs

Low volume, mid-level providers or those whose activity we’re not so concerned with can be defaulted into a (Blank) or “All Others” folder

Future Dashboard Grouping Levels – maintenance is key

As with the FPSC Specialties, the assignment of Providers (or other entities) into custom groups requires maintenance of these lists

The list needs to be kept current Notify us of new categories (ex. new providers in the case of Ortho) Notify us of assignment changes Work with us to insure your reports look the way you expect them to

look

If you do choose to provide custom lists, the custom groupings will appear in the medical group’s cubes wherever possible

In most Cognos cubes, this is currently the “Div/CG1/CG2/Provider” dimension

Save yourself some work(?) Since you’ll already be maintaining the FPSC Specialty and CFTE

estimate for each provider in your department, you might want to consider having us group your dashboard according to FPSC specialty

Future Dashboard Grouping Levels – limitations

Dashboards have 3 main sections: Revenue, Visits and Expenses

Revenue: SMS Revenue presents a challenge Lowest level of SMS reimbursement data is GL Key SMS cash cannot be allocated at the physician level. If a dashboard is defined for a group of physicians

without considering the GL Key, there is no guarantee that their revenue would be captured accurately.

Any grouping levels you define would have to divide *cleanly* across GL Key

Expenses: even more limited Lowest level of grouping is at the DBS (Cost Center)

level

Future Dashboard Grouping Levels – considerations

Bottom Line: Would a more detailed version of the Dashboards help you understand or manage your department’s activity?

If so, work with us! Schedule a meeting to sit down with us to

look at what’s possible Take advantage of the Prism technology

Announcements: Upcoming Cognos Training

Next Cognos 7.4 Training scheduled for March 22nd and 23rd (Tuesday and Wednesday).

Sign up deadline is March 15 (next Tuesday) Minimum of 3 people needed Last couple of trainings had to be canceled

Latest Training Schedule can always be accessed by clicking on the “training and class information” link from the main data warehouse page, or by going to https://www.intranet.medschool.ucsf.edu/medgroup/private/dwh/training.aspx

This will be one of our last Cognos 7.4 series trainings. We will begin Cognos 8 series trainings later this year. We will talk about this in more detail in future user group meetings.

Today’s presentation will be posted to the Medical Group’s website in the “User Meeting Notes” section: https://www.intranet.medschool.ucsf.edu/medgroup/private/dwh/usermtgs/index.aspx

Appendix: FPSC CFTE Calculation

Formula for Imputing a CFTE (per provider): [Work RVU]/[Work RVU Benchmark]

Work RVU (numerator): calculated by FPSC National (non-GPCI) values assigned according to DOS of the

charge Gap-filled: when Medicare has not provided a work RVU for a CPT

which FPSC considers a “pro fee” FPSC will back-fill the value by looking at other charges in the code range and comparing charge/RVU

Documentation on their website (you need an FPSC account to access) https://www.facultypractice.org/html/128.htm

Page describes Gap-fill methodology as well as their Modifier adjustment process

To find the page from their website, go to the ACCESS menu and select “RVU & Modifier Assignment Process” near the bottom of the list

Appendix (cont): FPSC CFTE Calculation

Formula for Imputing a CFTE (per provider): [Work RVU]/[Work RVU Benchmark] Work RVU Benchmark (denominator):

Benchmarks are determined annually, using the previous year’s data Result from FPSC’s annual survey – only high volume providers from each

specialty are included Represents the Mean (average) number of Work RVUs billed by a *theoretic*

academic provider spending 100% of his/her time in clinical practice Benchmarks are stated in annual terms, but are adjusted in the report

according to the period the user chooses to view; i.e. 10 months of activity will reflect the benchmark for 10 months, not the entire year

The process is documented on their website: https://www.facultypractice.org/126.htm

To find the page from their website, go to the ACCESS menu and select “Clinical FTE Process & Tools” near the bottom of the list

You will also find information under the section “Benchmark Development Process”

Appendix (cont): Benchmarks for Previous Years

Can be found by going to the ACCESS menu and choosing “Work and Total RVU Benchmarks” near the top of the list

Go as far back at 2006

Note that benchmarks can appear for certain years but not others