Navy Performance Based Budget (PBB) Indices

January 2008

BUMED (M8)BUMED (M8)

POCs: BUMED PA&E (M81)LCDR Matt Bouma, MSC, (202)762-3533, DSN 762Mr. Robert Willis, (202)762-3542

4-Jan-08

PBB Definitions

2

Variable Description Variable Description

Parent DMIS IDDMIS ID of Parent MTF. Subordinate children rolled up into parent

PBB Metrics AdjustmentTotal sum of adjustments based upon EBHC, Bed Fill, IMR, and Public Health metrics

Parent NameParent MTF Name

Deployment MitigationPositive adjustment based on providers deployed as recorded in the GDA MEPRS code. Source: EAS-IV, FTEs; M2, Workload

RegionRegion of MTF

PBB Total AdjustmentsTotal PBB Adjustment + Deployment Adjustment

Regional PPS ValueSummation of MTFs for each region from most current PPS Reconciliation Report PPS Adjustment

Amount owed or earned in PPS per PPS Reconciliation Report. Calculated as (Rolling 12 Earnings - FY03 Base Earnings) * 0.45

BUMED PPS Value

Summation of Regions from most current PPS Reconciliation Report: BSO 18 PPS Value Adjustment Total

Total Adjustment. Equals PPS Adjustment + PBB Adjustments (inclusive of Deployment adjustment)

FY08 Obligation PlanFY08 Total "Planned" Operations and Maintenance Dollars for all BAGs except BAG 2. Source: SMART

FY03 PPS Base EarningsPPS Earnings of FY03 Base Year per PPS Reconciliation Report

PPS Rolling 12 EarningsCurrent 12 month summation of PPS Earnings per PPS Reconciliation Report Variable Description

PPS AdjustmentAmount owed or earned in PPS per PPS Reconciliation Report. Calculated as (Rolling 12 Earnings - FY03 Base Earnings) * 0.45 FY03 OP Base

Outpatient RVU production in FY03 (PPS Base)

OP Rolling 12Current RVU production for most recent 12 months

RVU Delta % Delta of current RVUs to base RVUs

Variable Description FY03 IP BaseInpatient RWP production in FY03 (PPS Base)

EBHC TotalNumber of targeted EBHC goals that the MTF has reached out of 5 areas being monitored. Source MHSPHP

IP Rolling 12Current RWP production for most recent 12 months

EBHC PercentPercent adjustment to FY08 O&M Funding based upon EBHC total

RWP Delta% Delta of current RWPs to base RWPs

EBHC AdjustmentDollar value adjustment based on EBHC Score

FY03 OBD BaseMental Health Occupied Bed Days production in FY03 (PPS Base)

Bed Fill RatePercent of available staffed beds being filled at MTF. Based on rolling 12 bed fill rate as compared to total beds available being reported by MTF

OBD Rolling 12Current MH Occupied Bed Days production for most recent 12 months

BedCap % AdjustPercent adjustment to FY08 O&M Funding based upon Bed Fill Rate

OBD Delta% Delta of current MH OBDs to base MH OBDs

BedCap Adjustment Dollar value adjustment based on Bed Fill Rate

Indeterminate RatioPercent of individuals at each MTF categorized in the "Indeterminate" category. Source: MRRS

IMR % AdjustPercent adjustment to FY08 O&M Funding based upon Not Ready Percent

IMR Adjustment Dollar value adjustment based on IMR ScorePH Executed to Plan Execution Rate to Plan. Source: SMART, PE0807705

Public Health % AdjustPercent adjustment to FY08 O&M Funding based upon Public Health Execution

Public Health Adjustment Dollar value adjustment based on PH Score

These represent the Rolling 3 Averages for each EBHC metric and how they compare to the HEDIS goal stated in the Business Planning

PPS Performance to Base

EBHC Performance to Target

Shadowed EBHC Areas

Header Information Funding Execution Areas

PBB Adjustment Factors

EBHC areas being shadowed in FY08, but do not enter into PBB calculations. Subject to review for implementation in FY09.

4-Jan-08 3

PBB Adjustment Scales/Indices

After these adjustments are done a mitigation is considered for each MTF to recognize staffing issues caused by deployments.

Adjustment will be based upon 4 areas:1) Evidenced Based Health Care2) Bed Capacity Fill Rate3) Individual Medical Readiness4) Public Health

Each will produce a weighted score that when summarized correspond to the adjustments recommended in the Adjustment Table below.

% Indeterminate O&M Adjustment<=2% +5%<=5% 2.5%<=10% 0%<=20% -2.5%>20% -5%

Source: Medical Readiness Reporting System (MRRS)Notes: Percent "Indeterminate"

BSO 18 personnel onlyMost Current fiscal month data utilized

IMR Rate (BSO 18 Personnel)

Large Bed Facility (Bed Days >=25k) Adjustment Scale

Medium Bed Facility (25K > Bed Days >=10K) Adjustment Scale

Small Bed Facility (Bed Days <10K) Adjustment Scale

>= 80% +5% >= 61% +5% >= 55% +5%70-79% +2% 51-60% +2% 45-54% +2%33-69% 0% 33-50% 0% 25-44% 0%20-32% -2% 20-32% -2% 20-24% -2%<=19% -5% <=19% -5% <=19% -5%

Capacity Sources: Jun 06 MTF Bed Capacity Report

Mar 07 MTF Bed Capacity Data CallFY07 and FY08 Business Plans

Fill Source: Bed Fill Rate data from M2, Direct Care SIDR, Rolling 12Notes: Bed capacity used is the minimum of source reports.

Bed capacities were for "Active" beds only and ExcludedOR,ER, and Newborn beds.

Bed Capacity Fill Rate% Executed to Plan Adjustment based on PEx<=90% -25%90%< x <=95% -10%95%< x <=97% 0%97%< x <=99% 10%99%< x <=100% 25%100%< x <102% 10%102%< x <=105% 0%105%< x <=110% -10%x>115% -25%

Source: SMART, Certified Obligations+CommitmentsNote: Execution Rate of Last 4 completed qtrs

for Military Public Health PE 0807705No adjustment can be above +/-5% of Total Planned O&M Budget

Public Health

Adjustment made on % of Total Obligation Plan for Public Health PE 0807705

Total ScoreO&M

Adjustment0 or 0.5 -10% Diabetes A1c test w/i 12 mos1 or 1.5 -5% Diabetes A1c <= 9.0%

2 -2% Diabetes LDL < 100mg/dl2.5 0% Breast Cancer Screen3 2% Colorectal Cancer Screen

3.5 or 4 5% Cervical Cancer Screen4.5 or 5 10%

Scoring Criteria for each measure ScoreMTF above HEDIS 90th percentile 1MTF above 75th but below 90th percentile 0.5MTF below HEDIS 75th percentile 0

Source: MHS Population Health Portal (MHSPHP)HEDIS CY06 benchmarks

Notes: Rolling 3 Avg utilized

Evidence Based Healthcare Rates Measures

Asthma

Shadowed measures only. They do not factor in current calculation.

4-Jan-08

PBB Metric Data Collection

Bed Capacity1. Data is pulled from M2, SIDR files (Health Care Services, Direct Care, Inpatient Admissions

Summary) for Bed Days, Raw.2. A rolling 12 is calculated for Bed Days, Raw. A 4-month delay is built in (e.g. a 1 Dec pull

would skip the previous 4 months and use Aug06-Jul07 as a rolling 12).3. Bed Fill Rate is calculated as (Sum of Bed Days)/(Available Beds * 365).4. Adjustment Rates are then based upon the percent fill rate – Unique scales are used based

upon Bed Capacity size of the facility (Large, Medium, Small).

EBHC1. Data is from the MHS Population Health Portal (MHSPHP) via DoDPHP Aggregate Metric

Tables.2. A rolling 3 average for each EBHC measure is calculated based upon the most current 3

months of data. Typically there is about a 3-month lag in data.3. The rolling 3 is compared to the 2006 HEDIS 90 th and 75th percentile Goal as stated in the

MHSPHP Methodology and Measurement documentation.

IMR1. Data is from the Medical Readiness Reporting System (MRRS) Navy/Marine Corp IMR

Reports.2. Data is pulled each month and current month is the basis for comparison to metric goal.3. Indeterminate ratios are recorded for each MTF and scored according to IMR scale.

Public Health1. Data is from SMART, Public Health PE 0807705.2. Data is pulled quarterly from SMART, for the most currently completed 4 quarters.3. Certified Obligations+Commitments is compared to the Obligation Plan over the 4 quarters to

produce the Execution to Plan % amount.4. This Execution to Plan % produces a PBB adjustment based upon Public Health scale.

PPS Recon1. Data is from PPS Reconciliation provided from OSD(HA).2. Data most recent report provided. Typically, there is a 2-month lag in reports.3. Workload data and deltas are loaded into the PBB model for annotation purposes.4. Any remaining FY07 values (75% * PPS Delta) are converted to FY08 values (100% * PPS

Delta).

Deployment Mitigation1. See Deployment Mitigation Flowchart.

4-Jan-08 5

Deployment Mitigation

Notes:

1. Sum of GDA FTEs (MEPRS Rolling 12) is taken for each Parent MTF. FTEs considered are Skill Type I and II Providers. Source: EAS-IV.

2. B RVUs per B Available Skill Type I and II providers for FY06 is calculated for each Parent MTF. Source: M2-RVUs, EAS-IV-Avail B FTEs.

3. GDA FTEs is multiplied by RVU rate per FTE to calculate a prospective lost RVU amount for each MTF.

4. MTF Lost RVUs are multiplied by the FY07 Avg RVU Rate given in PPS for each individual MTF to produce a GDA PPS Value:

a) GDA PPS Value = MTF Lost RVUs x FY07 PPS RVU Rate x PPS FY08 Navy O&M Factor (45%).

5. PPS Recon Evaluation:

a) If an MTF has a Negative PPS Recon, this is the maximum deployment credit they may be given.

b) If an MTF has a Positive PPS Recon, they are not eligible for deployment credit.

6. GWOT Funding is FY07 GWOT Dollars provided to each MTF for Contract Backfill

7. GWOT funding is compared to calculated GDA PPS Value for final adjustment:

a) If PPS Value < GWOT, No deployment credit/adjustment is given.

b) If PPS Value > GWOT, Deployment credit/adjustment is given as follows:

1) GDA PPS Value – GWOT Contract Backfill $$$

Objective: To recognize lost workload at MTFs caused by provider deployment in support of GWOT.

Sum GDA* FTEs

FY06 RVUs per

FTE

MTF Lost RVUs

FY07 PPS RVU Rate

PPS Valu

e>

GWOT

GDA PPS Value

FY07 GWOT Contract

Backfill $$$

X = X = Deployment Adjustment

Yes

No

No Adjustment

PPS ReconStatus