3000 Psychology Productivity wrvus per FTE(C), VISN Averages FY 2010 2500 2000 VA Mean Productivity = 1,957 RVUs per FTE(C) 1500 1000 500 0 2 3 10 23 9 1 5 7 6 8 20 15 18 11 21 17 16 19 4 22 12 VISN
7000 Psychology Practice Productivity RVUs per FTE(C) FY 2010 6000 5000 RVUs per FTE(C) 4000 3000 2000 VA Mean Productivity = 1,957 1000 0 VA Practices in Order of Ascending Productivity
4000 Psychiatry Productivity wrvus per MD FTE(C), VISN Averages FY 2010 3500 3000 VA Mean Productivity = 2,643* TE(C) Wo ork RVUs per MD F 2500 2000 1500 1000 500 0 23 2 1 19 21 9 10 7 6 3 20 12 18 11 16 5 15 22 8 4 17 *Average of 139 practices, includes only outpatient workload VISN
5,000 Psychiatry Practice Productivity wrvus per MD FTE(C) FY 2010 4,500 4,000 3,500 (C) wrvus per MD FTE( 3,000 2,500 2,000 VA Mean Productivity = 2,643* 1,500 1,000 500 0 VA Practices in Order of Ascending Productivity *Average of 139 practices, includes only outpatient workload
2500 Social Work Productivity wrvus per FTE(C), VISN Averages FY 2010 2000 1500 VA Mean Productivity = 1,448 C) RVUs per FTE( 1000 500 0 2 1 6 11 21 22 3 23 15 10 9 12 7 20 18 19 5 17 16 4 8 VISN
8000 Clinical Nurse Specialist wrvus per FTE(c), VISN Averages, FY2010 7000 6000 5000 ) RVUs per FTE(C) 4000 3000 VA Mean Productivity = 2,117 2000 1000 0 17 6 5 3 23 21 10 22 12 11 20 2 1 18 4 19 16 8 15 7 9 VISN
4000 Nurse Practitioner wrvus per FTE(C), VISN Averages FY 2010 3500 3000 2500 ) RVUs per FTE(c) 2000 VA Mean Productivity = 1,966 1500 1000 500 0 19 11 6 7 2 9 3 18 10 8 12 16 20 21 1 4 15 5 23 17 22 VISN
4500 Physician Assistants wrvus per FTE(C), VISN Averages FY 2010 4000 3500 3000 ) RVUs per FTE(C) 2500 2000 VA mean Productivity = 2,131 1500 1000 500 0 2 21 15 5 20 19 16 23 9 8 6 22 4 18 11 3 7 1 17 10 VISN
VHA Mental Health productivity it adequate or higher in comparison to other specialties within VHA. VHA Mental Health Productivity data appear to be the same or less variable than other specialties within VHA. Oth VHA i lti t di d All /I l D t l Other VHA specialties studied: Allergy/Immunology, Dermatology, Endocrinology, Gastroenterology, Radiology, Rheumatology, Cardiothoracic Surgery, General Surgery, Neurosurgery, Urology, Ophthalmology, Orthopedics, Otolaryngology, Plastic Surgery, Vascular
Psychiatrists Psychologists Social Workers NPs CNS PA wrvus/ FTE (C) 2578 697 1951 730 1474 683 1322 865 1678 1261 1468 1409 Enc/ FTE (C) Uniques /FTE (C) wrvus/ Unique 2231 1542 1673 1255 1891 1232 665 318 247 405 470 508 3.9 6.4 6.0 3.3 3.6 2.9 Black- means; Red= standard deviations
Psychiatrists Psychologists Social Workers wrvus/fte C 2578 2043 1473 Enc/FTEC 2231 1589 1673 Uniques/FTE C 664 336 247 2003 Workload Guidance Psychiatrists Psychologists Social Workers wrvus/fte 2845-3979 2349-32363236 3236-38453845 Encounters 2800 1740 1740 Uniques/FTE 500 240 300
Psychiatrists Psychologists Social Workers NPs CNS PA wrvus/ FTE (C) 2643 712 1957 693 1448 639 1966 1396 2117 1810 2131 1674 Enc/ FTE (C) Uniques /FTE (C) wrvus/ Unique 1827 1549 1575 1493 2024 1666 513 266 207 453 428 540 5.2 7.4 7.0 4.3 4.9 3.9 Black- means; Red= standard deviations
Psychiatrists Psychologists Social Workers wrvus/fte C 2578 1951 1474 Enc/FTE C 2231 1542 1673 FY 2006- MGMA Psychiatrists Psychologists Social Workers Private 3619 2584 2371 wrvus/fte Academic 2589 1827 NA wrvus/fte Priv. Enc/FTE 2197 1263 1219 Aca. Enc/FTE 1809 NA NA
Psychiatrists Psychologists Social Workers wrvus/fte C 2643 1957 1448 Enc/FTE C 1827 1549 1575 FY 2008- MGMA Psychiatrists Psychologists Social Workers Priv. wrvus/fte 3528 2449 2205 Aca. wrvus/fte 3166 1581 NA Priv. Enc/FTE 1901 1147 1117 Aca. Enc/FTE 1033 NA NA
Productivity and staffing studies conducted thus far (Primary Care, Radiology, Surgical and Medicine Specialties) have conducted a modifier survey to collect information regarding the practice (facility) characteristics hypothesized to be related to productivity and staffing. These surveys have contained the following elements: Teaching Mission number and PGY level of residents. Support Staff number, type of support staff and support staff functions Facility Infrastructure programs and physical plant (i.e., exam rooms) Patient Characteristics DCG risk scores, SHEP, demographics, applicable performance measures.
Current work analyzing 75 possible modifier variables: Support staff (20 variables) Practice characteristics (18 variables) Patient characteristics (24 variables) Facility types (5 variables) Waiting times (3 variables using old 30 day standard) Access (6 variables)
HosHhhhhhhH H Facility Complexity Analysis (FY2010) Complexity Group 1a Complexity Group 1b Complexity Group 1c Complexity Group 2 Complexity Group 3 Psychiatrist wrvus 2705 (22.5) 2777 (15.8) 2844 (12.3) 2505 (9.6) 2414 (6.3) Psychologist wrvus 2004 (25.1) 1901 (19.3) 2104 (15.2) 1752 (10.7) 1794 (7.9) Social Worker wrvu 1422 (31.9) 1368 (27.4) 1420 (21.7) 1287 (15.2) 1363 (13.2) CNS wrvus 2194 (3.8) 2286 (2.6) 3342 (1.2) 2923 (1.6) 2153 (1.6) NP wrvus 1586 (5.6) 1629 (4.1) 2002 (3.4) 1389 (2.6) 1465 (2) PA wrvus 2191 (1.0) 1072 (1.5) 2555 (1.0) 2248 (1.1) 1979 (1.4) Productivity= annual values/ftec; ( )= average total FTEC
Data validation Totally dependent on quality of data entered into National Database Workload- encounter forms, cpt codes Workforce- labor mapping, person class designation
0 wrvu CPT codes 20% of clinical activity reported by Social Worker 10% of clinical activity for all other disciplines OMHS Workgroup Recommendations for adding value to select codes and using alternative CPT codes when appropriate Also looked at Behavioral Health Codes and Evidence Based Therapies
Inpatient Workload VHA Directive 2009-002, PATIENT CARE DATA CAPTURE, January 23, 2009 Mandated inpatient workload capture at the same level as outpatient workload for mental health LIPs. Encounter forms Encounter forms Event capture Coders
Quality, Access, Outcomes Data from other health care specialties have suggested larger VHA panel sizes associated with: No change in patient overall satisfaction Lower primary care costs Longer waits Decreases in quality measure scores Will current metrics effort in mental health allow similar analyses in the future?
Data from other health care specialties have suggested larger VHA panel sizes associated with: No change in patient overall satisfaction Lower primary care costs Longer waits Decreases in quality measure scores Will i ff i l h l h Will current metrics effort in mental health allow similar analyses in the future?
Direct care only Outpatient care only wrvus = primary metric Target productivity at the facility level, not individual provider level Target a range, not a specific number (e.g., median, mean)
Strengths wrvus- a common metric allowing for the comparison of diverse practices across disciplines Data collected exactly the same for all sites Data collected exactly the same within each individual discipline Data collected nationally rather than by each individual facility or VISN
Challenges Absence of national business rules for the reporting of workload and labor mapping For associated mental health care providers, workload and workforce data are collected from different sources Nationally, productivity can be seen at the individual provider level only for psychiatrists. No single metric tells the whole story
VACO Review and Approval of Draft Directive Establishing Mental Health Productivity Standards/Guidance Buy-in from all affected disciplines/ VACO leadership Determine metric value and range Decide outstanding issues: 0 wrvu codes.
Develop National Business Rules for Capturing and Reporting Mental Health Workload and Labor Mapping Create a tool to provide data on a quarterly Create a tool to provide data on a quarterly basis to the field and VACO.
Incorporate inpatient productivity National labor mapping data at the individual provider level for all professions studied Identify relationship between productivity and other important domains (quality/access)