Understanding Managerial Cost Accounting and Decision Support System in VHA Programs
Explore the fundamentals of Managerial Cost Accounting (MCA) and Decision Support System (DSS) in the context of VHA Homeless Programs and the Office of Finance. Learn about labor mapping, data sources, database structures, major categories of data, and the significance of cost centers, departments, and workload in analyzing costs and productivity.
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Labor Mapping Basics VHA Homeless Programs VHA Office of Finance Managerial Cost Accounting Office 1
Objectives Managerial Cost Accounting (MCA) What it is and why we have it Understand basics of the Decision Support System (DSS) Labor Mapping Concepts Business rules Types of time Clinical (Direct patient care) Administrative Education Research Labor mapping scenarios Mapping impacts Costs Productivity 2 VHA Office of Finance Managerial Cost Accounting Office
What are MCA and DSS? Managerial Cost Accounting MCA Observes and calculates the actual costs of operations Determines where the money goes Decision Support System DSS Official managerial cost accounting system for VA A software system and secondary database Accepts and matches data from other sources Does not create data, this is your data Requires input from managers A reporting system Cost Workload Patient Demographics Productivity VHA Office of Finance Managerial Cost Accounting Office 3
Where does the data come from? VHA Office of Finance Managerial Cost Accounting Office 4
DSS Database Structure DSS Production Units describe the labor activity L1 = Emergency Department (ED) MM = Patient Aligned Care Team (PACT) DSS Cost Centers (ALBCCs) hold dollars and hours 204L1* = Emergency Department (ED) ALBCC 204MM* or 201MM* = Patient Aligned Care Team (PACT) ALBCCs DSS Departments hold workload Each cost center has a DSS department Intermediate products = workload 30 minute Clinic Visit Intermediate products are costed Patient encounter records show cost and workload VHA Office of Finance Managerial Cost Accounting Office 5
Major Categories of Data Blue cylinder - Workload. Green cylinder- Resources. Costs Examples Equipment Supplies Labor Hours Examples Physician Nursing staff Clerical Staff Resources Resources Workload Workload Products and services used for patient care Examples 15 minute clinic visit 30 minute emergency department visit 60 minute radiology procedure Orange cylinder - Patient Data. Data about the patient Examples Diagnoses Demographics Treatment Patient Data Data Data Patient Patient VHA Office of Finance Managerial Cost Accounting Office 6
Workload Products and services supplied to patients From VistA SchedulingorEvent Capture System (ECS) Mapped to department that produces work bar graph chart representing workload numbers. See slide notes for additional information conveyed with this slide. 7 VHA Office of Finance Managerial Cost Accounting Office
Resources dollar sign representing resource data Costs Labor Supplies Equipment FTE: Costs and hours From financial sources Mapped to areas where they are used 8 VHA Office of Finance Managerial Cost Accounting Office
Labor Mapping what is it? A process of assigning labor resources to the work areas where they belong Labor hours are mapped to the areas where the employees work and are paid Assigns labor costs to the Account Level Budgeter Cost Center (ALBCC) where the work occurred. Services are asked to distribute their employees labor time (based on percentages) to the various ALBCCs where they work. 5% Education ALBCC 203021 80% Red Clinic ALBCC 203PL1 10 % Admin Time ALBCC 203001 Dr. Jones 5% Resident Supervision ALBCC 203PL1ED 18
Labor Mapping affects Department and Product Costs Department Productivity Labor Mapping Patient/Encounter Costs In order for all of these to be accurate, service leaders need to ensure that labor mapping is reviewed and adjusted monthly. 18
Resource data flow ALB Cost Centers Audiology Clinic - 228R31 HUD/VASH Clinic 203PL1 HUD/VASH Clinic 203PL1 Resources Mapping Tables Speech Clinic - 228R41 HCHV/HCMI 203QZ1 Mapping Mapping Tables Tables HCHV/HCMI 203QZ1 Resources Resources Resources Resources Picture of a traffic police officer Speech - 228EBE1 Grant and Per Diem 203PG1 Financial Extracts Grant and Per Diem 203PG1 VHA Office of Finance Managerial Cost Accounting Office 11
The Golden Rule of MCA Workload and cost must be kept together. All employees must be labor mapped to the department where their workload is produced. VHA Office of Finance Managerial Cost Accounting Office 12
Who does mapping? MCA site team members perform technical steps to do mapping Local managers need to tell MCA staff how and where to map employee labor Knowledge of MCA/DSS IPDs Worksheets Access database interface picture showing person standing looking at arrows pointing in all different directions to symbolize mapping 13 VHA Office of Finance Managerial Cost Accounting Office
Cost distribution Inpatient & Outpatient VHA Office of Finance Managerial Cost Accounting Office 14
Cost per Clinic Stop Code Report FY16 (Feb) % Unique Patients through Fiscal Period Average Cost per Encounter $ Average Nat'l Cost per Enctr $ Fixed Indirect Cost Total Clinic Stop Code Costs $ (TOT) Variance to National Avg Clinic Stop THRU Month Fixed Direct Cost Variable Direct Cost Network Network Name Clinic Name Encounters HUD-VA SHARED HOUSING VASH HUD-VA SHARED HOUSING VASH HUD-VA SHARED HOUSING VASH HUD-VA SHARED HOUSING VASH HUD-VA SHARED HOUSING VASH HUD-VA SHARED HOUSING VASH HUD-VA SHARED HOUSING VASH HUD-VA SHARED HOUSING VASH HUD-VA SHARED HOUSING VASH HUD-VA SHARED HOUSING VASH HUD-VA SHARED HOUSING VASH HUD-VA SHARED HOUSING VASH HUD-VA SHARED HOUSING VASH HUD-VA SHARED HOUSING VASH HUD-VA SHARED HOUSING VASH HUD-VA SHARED HOUSING VASH HUD-VA SHARED HOUSING VASH HUD-VA SHARED HOUSING VASH HUD-VA SHARED HOUSING VASH HUD-VA SHARED HOUSING VASH - Your VAMC Feb 182,347 4,246,580 3,814,179 8,243,105 16,990 2,985 485 349 39.1 522 522 - Your VAMC Feb 1,116,897 5,016,443 5,024,409 11,157,749 32,401 5,724 344 349 -1.3 522 522 - Your VAMC Feb 229,159 2,661,099 2,049,885 4,940,143 18,190 3,108 272 349 -22.1 522 522 - Your VAMC Feb 490,463 2,148,802 1,952,387 4,591,651 18,783 2,966 244 349 -29.9 522 522 - Your VAMC Feb 310,436 1,859,674 1,471,577 3,641,686 16,651 3,635 219 349 -37.3 522 522 - Your VAMC Feb 550,319 4,289,811 3,796,904 8,637,034 30,137 5,656 287 349 -17.8 522 522 - Your VAMC Feb 546,751 7,573,780 6,720,884 14,841,415 43,398 7,143 342 349 -1.9 522 522 - Your VAMC Feb 224,816 2,246,994 1,892,591 4,364,401 11,183 2,929 390 349 11.9 522 522 - Your VAMC Feb 174,259 2,383,412 2,015,929 4,573,599 12,276 2,263 373 349 6.8 522 522 - Your VAMC Feb 243,552 2,566,108 1,959,580 4,769,241 15,499 3,152 308 349 -11.8 522 522 - Your VAMC Feb 547,412 2,999,714 2,205,278 5,752,403 24,788 3,713 232 349 -33.5 522 522 - Your VAMC Feb 312,495 1,795,934 1,422,248 3,530,676 11,311 2,040 312 349 -10.5 522 522 - Your VAMC Feb 389,170 5,916,069 3,546,196 9,851,435 25,290 5,623 390 349 11.7 522 522 - Your VAMC Feb 192,170 3,692,970 2,654,654 6,539,794 20,241 4,517 323 349 -7.4 522 522 - Your VAMC Feb 1,831,778 1,203,185 934,495 3,969,458 7,641 1,851 519 349 49 522 522 - Your VAMC Feb 129,936 3,358,403 2,544,870 6,033,209 19,293 3,380 313 349 -10.3 522 522 - Your VAMC Feb 426,677 4,747,054 4,059,317 9,233,048 21,024 4,570 439 349 25.9 522 522 - Your VAMC Feb 2,252,409 7,670,765 7,857,712 17,780,886 31,349 6,629 567 349 62.6 522 522 - Your VAMC Feb 606,621 9,861,271 6,657,975 17,125,867 47,563 9,004 360 349 3.2 522 522 - Your VAMC Feb 680,605 2,310,173 1,759,693 4,750,471 18,515 2,496 257 349 -26.4 522 522 11,438,272 78,548,239 64,340,762 154,327,274 442,523 VHA Office of Finance Managerial Cost Accounting Office 15
Types of Labor and Time Labor Variable Labor (VL) Fixed Direct Labor (FDL) Time Direct Patient Care Time Administration Time Education Time Research Time 16 VHA Office of Finance Managerial Cost Accounting Office
Direct Patient Care Time Time to prepare, to provide for, and follow-up on the clinical care needs of patients including: Time spent in reviewing patient data. Consulting about patient care with colleagues. Reviewing medical literature. Contacting the patient or caregivers to discuss their needs. The labor hours provided by a physician or dentist who is supervising house staff residents providing care in a clinical setting. Allocated (mapped) to direct care ALBCCs/departments in proportion (%) to the time spent in each of these activities Variable Labor (VL) 17 VHA Office of Finance Managerial Cost Accounting Office
Administration Time Administration Time includes time spent on managerial or administrative duties, generally at the level of the department, service, medical facility, VISN, or nationally, both within and outside VA including: In support of service-wide administrative activities, such as completing performance reviews, and medical center and VA Central Office reporting requirements. Managing a program within a clinical department, service, or hospital. Working on service or hospital-wide committees. Serving on state and national committees, advisory boards, or professional societies. Allocated (mapped) to the indirect service Administrative ALBCC (xxx00*) in proportion (%) to the time spent in each of these activities Fixed Direct Labor (FDL) 18 VHA Office of Finance Managerial Cost Accounting Office
FDL/VL Splits for Administrative Time Not for physicians and dentists Used to reflect time clinical employees spend on purely administrative duties (FDL) and direct patient care (VL) within a Direct care ALBCC/department FDL/VL Split map as percentage FDL (Fixed Direct Labor) = Administrative time; mapped to the place where the employee works VL (Variable Labor) = Clinical time; mapped where the employee works VHA Office of Finance Managerial Cost Accounting Office 19
Education Time Time spent providing formal training (didactic education). This includes preparation as well as actual classroom or lecture time for educators or presenters. Giving conferences in the community or nationally. In a classroom teaching medical school curriculum. In a classroom teaching residents and fellows. In managing a resident, fellow, or other type of student teaching program. Working on medical school committees. Allocated (mapped) to the indirect service Education/Support ALBCC (xxx02*) in proportion (%) to the time spent in each of these activities Fixed Direct Labor (FDL) NOTE: Time spent receiving training is considered a cost of direct patient care. 20 VHA Office of Finance Managerial Cost Accounting Office
Research Time Defined as time spent performing formal, approved health care research, or in activities in direct support of approved research. Working on research projects that have been approved by the local VA medical center Research and Development Committee which does not produce recorded patient care encounter workload in VistA. Working in an actual research laboratory or in a controlled setting that involves no direct patient care or treatment. Serving on hospital or affiliate research committees. Supervising a student s, resident s, or fellow s non-clinical research. Writing for publications or grants. Attending meetings explicitly related to research activities. Presenting papers at research meetings. Sitting on a national study section or grant approving board. Allocated (mapped) to the indirectresearch support ALBCC (xxx01*) in proportion (%) to the time spent in these activities Fixed Direct Labor (FDL) 21 VHA Office of Finance Managerial Cost Accounting Office
Drive timewhere is it included? Clinical professional (Not a physician) FDL/VL Split Travel time mapped as FDL to the Direct ALBCC DO NOT map FDL to administrative ALBCCs Results in overstated indirect (overhead) cost VL RVU An average travel time may be added to the Labor RVU for the visit Example: 30 minute drive time & 30 minute visit : RVU = 60 Physician VL RVU An average travel time may be added to the Labor RVU for the visit Example: 30 minute drive time & 30 minute visit : RVU = 60 No FDL/VL splits allowed If FDL, must be mapped to Clinical Administrative ALBCC (i.e. 203001) VHA Office of Finance Managerial Cost Accounting Office 22
Labor Mapping Reports 23 VHA Office of Finance Managerial Cost Accounting Office
Labor Mapping Reports (2) SSN XXX-XX-XXX1 XXX-XX-XXX1 XXX-XX-XXX2 XXX-XX-XXX2 XXX-XX-XXX3 XXX-XX-XXX4 XXX-XX-XXX4 XXX-XX-XXX5 XXX-XX-XXX5 CC T&L SUBACCT 1020221203PL1 1020221203PL1 1051221203PL1 1051221203PL1 1001221203PL1 1020221203PL1 1020221203PL1 1020221203PL1 1020221203PL1 ALBCC Percent 8221 8221 8221 8221 8221 8221 8221 8221 8221 196 196 196 196 198 198 198 198 198 0.18 0.82 0.17 0.83 1 0.1875 0.8125 0.1875 0.8125 VHA Office of Finance Managerial Cost Accounting Office 24
Common Labor Mapping Questions: How do we map ? Extended leave Continue to map the employee to their regular assigned ALBCC/department unless there is an official SF-52 changing their assignment Workers Compensation To ensure standardization, the following Workers Compensation BOCs should be mapped to the Directors Office (40100*): a. BOC 1094 Employee Compensation (FDO) b. BOC 1095 Employee Salary Continuation (FDL) c. BOC 1096 Employee on Sick Leave Pending Disability Retirement (FDL) Maternity leave Continue to map the employee to their regular assigned ALBCC/department unless there is an official SF-52 changing their assignment VHA Office of Finance Managerial Cost Accounting Office 25
Common Labor Mapping Questions (2): How do we map ? Non-physician, non-dentist employees supervising students/trainees Continue to map the employee to the clinic, ward or service (direct ALBCC) where the student or trainee is performing patient care work Paid trainees/students Map the trainee/student to the clinic, ward or service (direct ALBCC) where they are performing patient care work VHA Office of Finance Managerial Cost Accounting Office 26
Common Labor Mapping Questions (3): How do we map ? Clinical Supervision Map the employee to the clinic, ward or service (direct ALBCC) where they are performing patient care work A VL/FDL split may be necessary if the employee performs any administrative supervisory duties such as conducting performance appraisals or approving time VHA Office of Finance Managerial Cost Accounting Office 27
Questions? VHA Office of Finance Managerial Cost Accounting Office 28
Mapping References VHA Directive 2011-009, Physician and Dentist Labor Mapping VHA Directive 1161-Productivity and Staffing in Outpatient Clinical Encounters for Mental Health Providers Administrative Labor and FDL Mapping Education Support Mapping Research Support Mapping Resident Supervision Mapping MCA Financial Lexicon 29 VHA Office of Finance Managerial Cost Accounting Office
To Learn More MCA Learning Community Contact the MCAO Training Team VHAMCAOTraining@va.gov VHA Office of Finance Managerial Cost Accounting Office 30
