Army "Revenue Producers"

[Zenman1]

I'm in Army behavioral health and we bring in the most revenue in the hospital. Can someone explain to me this tenacious idea of trying to do this with the most inefficient organization in the world? For Crist's sake, they probably blow our entire budget in a couple days at the range firing off TOW missiles!

---

Members don't see this ad.

 

[HighPriest]

Because the Army's primary job is blowing $#!t up! not taking care of people. What you (and I) do is an afterthought.

 

[Apollyon]

Because the Army's primary job is blowing $#!t up! not taking care of people. What you (and I) do is an afterthought.

Yeah, keep the war machine rolling. That's it.

 

[Zenman1]

I get the Army mission, but if they want to focus on BH making money they need to cut out all the crap obstacles they put in our way.

 

[HighPriest]

They don't. They really don't want to focus on that. What they want is some kind of vague, arbitrary means of demonstrating that BH (or anything medical) isn't losing more money than would be considered an acceptable loss. And that's only MEDCOM justifying it's budget. Big Army couldn't care less how much you make or lose. Ultimately, you're not even trying to get into the black. You're just trying to justify an annual budget.

The only reason that they even care about that is that they want to make sure they have the necessary support should conflict arise. Just like making sure you have enough ammo, socks, or gasoline. Beyond that, patient care or the efficiency of patient care, is meaningless.

 

[BlackFrancis33]

It is one of the more interesting parts of being an Army physician. That is, we have to justify our very existence. I don't think we are very good at this as we certainly aren't taught this in medical school. We are lead to believe that our duties are important somewhere along the way. The whole RVU thing is a way to justify our existence to the command, so that the command can justify a budget based on this productivity. Hopefully, that budget includes you getting more support staff, office space, or maybe just being left alone to do your job (emphasize hopefully). It is hard when filling out your DHMRSI to try to imagine that through all the layers of bureaucracy somehow this will lead to anything that will benefit you, or the patient care you provide.

 

[Homunculus]

it's whatever the flavor of the month is. the same debates cycle through every few years. sitting in on the debate of MGMA vs FTE vs "clinical availability" and GME is no different than it was 10 years ago. same song, different verse.

you can massage the numbers any direction you want, really. you just have to know what your command wants. which, like the wind, changes periodically and sometimes randomly. for example, at my current duty station, when i first arrived everything was about "clinical availability" and access to care and how much of an FTE you were. MGMA or RVU's were secondary. now we are "all in the red" for meeting our arbitrarily assigned MGMA standards (which civilians even have issues with i've been told). the numbers massaging for this is decreasing your clinical time so your RVU's per clinical hour increase. but now suddenly your clinical availability has decreased.

in the past at my MEDDAC (and others), ORs and mother-baby units typically generate the most revenue. ultimately though like @HighPriest mentioned they don't want to make money-- they just want to justify the loss and get money for next year- any maybe generate a positive OER bullet in the process.

-- your friendly neighborhood liquid hot MGMA caveman

 

[HighPriest]

What'll really cool your noodle is that on the civilian side, coders really crank down on your notes/op reports, what have you, to ensure that you're maximizing what you do. We have coders in the Army, but they're basically worthless. On three separate occasions, I've tried to sit down with our coders to determine what we're doing, where we can improve, and to try to get some credit for what we do in the OR. All three times, they couldn't answer any of my questions, they were totally unaware of where I sat from a productivity standpoint (despite having a month's notice to prepare for our meeting), they didn't know how to code for any of our common procedures, and we continued to dramatically mis-code and under-code our OR cases (billing for one portion of a case when there were actually 5 associated CPT codes). Ultimately, what they do is what gets dumped into the machine and then spit back out to command. So always keep in mind that no matter how hard you work, there's a lazy, undedicated, ignorant civilian employee out there who's job it is to misrepresent you.

 

[Homunculus]

What'll really cool your noodle is that on the civilian side, coders really crank down on your notes/op reports, what have you, to ensure that you're maximizing what you do. We have coders in the Army, but they're basically worthless. On three separate occasions, I've tried to sit down with our coders to determine what we're doing, where we can improve, and to try to get some credit for what we do in the OR. All three times, they couldn't answer any of my questions, they were totally unaware of where I sat from a productivity standpoint (despite having a month's notice to prepare for our meeting), they didn't know how to code for any of our common procedures, and we continued to dramatically mis-code and under-code our OR cases (billing for one portion of a case when there were actually 5 associated CPT codes). Ultimately, what they do is what gets dumped into the machine and then spit back out to command. So always keep in mind that no matter how hard you work, there's a lazy, undedicated, ignorant civilian employee out there who's job it is to misrepresent you.

i'm reasonably sure we're at the same MEDCEN, and have had similar experiences. feedback on our self coding is rare, and the thing i've noticed other than the "i don't really know" response you mention is you could ask the same question to someone else or the same person a month later and get a different answer. i also struggle with the fact our data is months old. i've asked about our outpatient procedures getting accounted for (since we are "RED" for productivity) and they "think" our procedures are being counted but can't prove it to me. there's no reason other than lack of desire or putting forth the resources that they can't have our last week's productivity available. especially since our notes have 72 hr deadlines. imagine if we could actually change our practice to most efficiently reflect our work. blasphemy!

"high reliability organization"-- if the organization is reliably dysfunctional, it is by definition still reliable, yes?

--your friendly neighborhood reliably pragmatist caveman

 

[Perrotfish]

What'll really cool your noodle is that on the civilian side, coders really crank down on your notes/op reports, what have you, to ensure that you're maximizing what you do. We have coders in the Army, but they're basically worthless. On three separate occasions, I've tried to sit down with our coders to determine what we're doing, where we can improve, and to try to get some credit for what we do in the OR. All three times, they couldn't answer any of my questions, they were totally unaware of where I sat from a productivity standpoint (despite having a month's notice to prepare for our meeting), they didn't know how to code for any of our common procedures, and we continued to dramatically mis-code and under-code our OR cases (billing for one portion of a case when there were actually 5 associated CPT codes). Ultimately, what they do is what gets dumped into the machine and then spit back out to command. So always keep in mind that no matter how hard you work, there's a lazy, undedicated, ignorant civilian employee out there who's job it is to misrepresent you.

The fact that the numbers are all made up by providers, and are never audited, really does make RVUs the most meaningless of all of the numbers we periodically try to chase. The various Pediatricians in my command, who all have the exact same clinic workload, somehow always have wildly different RVUs. Some of us are estimated to provide nearly half a million in care a year and some of us less than 250K. Apparently some of us take the time to code every single thing and some of us don't.

Chasing access is like a race where some of the people are given a head start. Its wildly unfair, but you can at least get an idea if you are getting better as an individual from year to year. Chasing RVUs is like a race where everyone is running on a different track, and no one has a watch, and the winner is determined by who ran the race the fastest.