(EXPENSE) NAMES FOR ORGANIZATIONAL COMPONENTS
A thorough review and revision of the organizational codes and MEPRS Codes was necessary to achieve alignment and consistency between the data collection systems. As stated before, the old command structure at the NNMC had 973 organization codes. It was necessary to synchronize data tables to align work centers with the cost centers.
The steps used to devise a strategy appear below.
1) Devise naming conventions, business rules, and review organizational structure.
2) Ensure that Parent Command and Child Clinics are named and coded correctly.
3) Revise organizational codes and align with accounting system.
a) Define purpose of organizational codes.
b) Agree on uniform naming strategy.
c) Delete redundant codes.
d) Rename using standard naming conventions.
e) Create new organization codes to meet structural requirements (Chief of Clinical Staff, Chief Nursing Services).
f) Check names against MEPRS manual and ensure consistency.
g) Obtain budget approval and create new Job Order Numbers as necessary.
h) Ensure that new organizational codes allow placement of all MTF billets.
i) Align MEPRS, Organization Codes, and Cost Account Dictionary.
4) Revise CHCS Tables to ensure synchronization of naming in CHCS with naming in SPMS and that both sets of names reflect organizational structure.
a) Align SPMS cost center designations (Organizational Codes) with CHCS Location Names
1. Link CHCS location names with Organization Codes using MEPRS Codes.
2. Correct mismatched codes and ensure that all location names agree with MEPRS code definitions.
3. Eliminate CHCS locations that do not have sufficient workload to justify inclusion.
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1. Review and Rebuild Command Structure
The NNMC’s original command structure did not have a simple or well-designed classification coding system that included any command echelon. Appendix A, Section B describes the NNMC’s reorganization structure. The reorganization of the NNMC reconfigured the old structure levels from (Directorates, Departments, Divisions) to the
new ordered echelon (Directorates, Service Lines, Services). The differences between Directorates and Service Lines will be explained later in this section. The service code was a seven-character code and only the fourth character denoted structure. It was possible to assign personnel to any of the service codes in the command. The Department Heads created the service codes and could assign any character they desired to the last three spaces of the service code.
The newly adopted seven-digit service code, illustrated in Figure 1, consists three leading filled zeros, followed by four characters each representing a structure of the command echelon. A service code can only be added, changed, or deleted by the CCC. As an example, service code 000112A is “EMERGENCY MEDICINE.” The first three characters are all “0’s.” The fourth character, which is a “1,” represents the Directorate. The fifth character, which is also a “1,” represents the Service Line, and the sixth character, which is a “2,” represents the Service. The last character can be numeric or alphabetic. If the service code ends in a letter, no significance is associated with that character. If the last character is numeric, it can only be a “0” or a “5.”
If the service code ends with a “0,” then it signifies a Service Line or Directorate. Directorates and Service Lines are the only level to which personnel can be assigned. If the service code ends with a “5,” then it signifies a same day surgery service.
Service Code: 000112A
Code Character(s) Significance
1-3 No meaning, padded with zeros 4 Directorate
5 Service Line
6 Service
7 A letter has no meaning at
current time.
Figure 1. Service Code Organization Example
Directorates are the highest echelon of command and Service Lines, the second highest. Services fall under the Service Lines and have no echelon priority. An example of a Directorate, Service Line, and Service is as follows:
Directorate: 0001000 Prevention and Wellness Service Line: 0001200 Primary Care
Service: 000121A Emergency Medicine
It is possible to assign a person to service code 0001200 Primary Care, but not to 000121A Emergency Medicine. This coding scheme simplifies the accounting codes significantly and reduces time and money in accounting for personnel. Service codes ending in “5” or a letter are codes for labor time-allocation only.
2. Devise Naming Conventions
In order for the command re-structuring to be effective, the service codes required a standard naming convention based on the type of medical service, level of care, and MTF or clinic location.
Previous naming conventions contained abbreviations or complex coding descriptions that neither the NNMC’s patients nor the accounting personnel could follow. An example is PULM OP BE, which stood for Pulmonary Outpatient
Bethesda. The new naming strategy allowed complete and comprehensible coding descriptions. The lack of a clinic location in the description implies the work is being performed at the NNMC. An example demonstrates how the improved naming convention makes matters simpler. PULM OP BE is now Pulmonology Medicine. RADIOLOGY BCE is now Radiology Earle and defines the work performed at the location, Branch Clinic Earle, New Jersey.
3. Routinely Check Accuracy of Command Structure in All Data Files
The SPMS organizational file is a dynamic file that includes all the approved organizational codes that the MTF uses to capture labor expenses and workload. The organization codes are also stored in many other data collection systems, which cannot communicate with each other because there is no way to import or export data. A routine verification query must be in place to verify that codes in one system are aligned with the codes in another system. Integrating all the data files from the various data collection systems to validate the data requires the creation of an Access database. The next chapter of this thesis discusses this Access databases.
4. Agree on Business Rules for Organizational Codes The first business rule implemented eliminated all service codes with a function similar to another service code. For example, Cardiology Thoracic Outpatient and Cardiology Outpatient became a single service and were assigned one service code.
Another rule assigned a single MEPR code to a service code. It is possible to assign a MEPR code for one service to another service as long as the functions of the services
were similar. This assignment was similar to the deletion of redundant codes, with a major distinction. A one-to-many relationship would no longer exist between work centers and service codes. For all services, one organizational code would be tied to a single manpower JON and a single MEPRS code. For example, all B**5 codes that accomplish same-day surgery in one place would be associated with MEPRS code DGA*.
Creating business rules prevents the formation of extraneous service codes and forces attrition of service codes that fail to meet the business rule guidelines.
Examples of some implemented business rules appear below:
1) Attempt to eliminate organizational codes with fewer than ten personnel assigned.
2) Eliminate codes that are used infrequently:
A. If fewer than 30 visits per month, then code is eliminated.
B. If fewer than 30 admissions per year, then code is eliminated.
3) All department code names must agree with MEPRS definitions in the BUMED guidance.
E. STEP 5: ASSESS EXPENSE DISTRIBUTION BY STANDARD