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

VHA Office of Finance – Managerial Cost Accounting Office 2

 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

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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
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 Major Categories of Data

Costs
Examples
• Equipment
Resources • Supplies Workload
Labor Hours
Examples
• Physician
• Nursing staff
• Clerical Staff Products and services used
for patient care
Examples

Data about the patient • 15 minute clinic visit

Patient Examples • 30 minute emergency
Data •Diagnoses department visit
•Demographics • 60 minute radiology
•Treatment procedure

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 Workload
• Products and services supplied to patients
• From VistA
– Scheduling or Event Capture System (ECS)
• Mapped to department that produces work

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 Resources

• Costs
– Labor
– Supplies
– Equipment
• FTE: Costs and hours
• From financial sources
• Mapped to areas where they are used

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 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
Dr. Jones
203001

5% Resident Supervision
ALBCC 203PL1ED
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 Labor Mapping affects…
Department and Product Costs
t1
Effec

Labor Department Productivity

Effect 2
Mapping
Effect 3
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

HUD/VASH Clinic
203PL1

Mapping HCHV/HCMI
Resources 203QZ1
Tables

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.

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 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

VHA Office of Finance – Managerial Cost Accounting Office 13

Cost distribution – Inpatient & Outpatient

VHA Office of Finance – Managerial Cost Accounting Office 14

 Cost per Clinic Stop Code Report – FY16
(Feb)
%
Unique Average Average
Fixed Total Clinic Variance
Clinic THRU Fixed Direct Variable Patients Cost per Nat'l
Network Network Name Clinic Name Indirect Stop Code Encounters to
Stop Month Cost Direct Cost through Encounter Cost per
Cost Costs $ (TOT) National
Fiscal Period $ Enctr $
Avg

522 HUD-VA SHARED HOUSING

- Your VAMC Feb 182,347 4,246,580 3,814,179 8,243,105 16,990 2,985 485 349 39.1
VASH
522 HUD-VA SHARED HOUSING
- Your VAMC Feb 1,116,897 5,016,443 5,024,409 11,157,749 32,401 5,724 344 349 -1.3
VASH
522 HUD-VA SHARED HOUSING
- Your VAMC Feb 229,159 2,661,099 2,049,885 4,940,143 18,190 3,108 272 349 -22.1
VASH
522 HUD-VA SHARED HOUSING
- Your VAMC Feb 490,463 2,148,802 1,952,387 4,591,651 18,783 2,966 244 349 -29.9
VASH
522 HUD-VA SHARED HOUSING
- Your VAMC Feb 310,436 1,859,674 1,471,577 3,641,686 16,651 3,635 219 349 -37.3
VASH
522 HUD-VA SHARED HOUSING
- Your VAMC Feb 550,319 4,289,811 3,796,904 8,637,034 30,137 5,656 287 349 -17.8
VASH
522 HUD-VA SHARED HOUSING
- Your VAMC Feb 546,751 7,573,780 6,720,884 14,841,415 43,398 7,143 342 349 -1.9
VASH
522 HUD-VA SHARED HOUSING
- Your VAMC Feb 224,816 2,246,994 1,892,591 4,364,401 11,183 2,929 390 349 11.9
VASH
522 HUD-VA SHARED HOUSING
- Your VAMC Feb 174,259 2,383,412 2,015,929 4,573,599 12,276 2,263 373 349 6.8
VASH
522 HUD-VA SHARED HOUSING
- Your VAMC Feb 243,552 2,566,108 1,959,580 4,769,241 15,499 3,152 308 349 -11.8
VASH
522 HUD-VA SHARED HOUSING
- Your VAMC Feb 547,412 2,999,714 2,205,278 5,752,403 24,788 3,713 232 349 -33.5
VASH
522 HUD-VA SHARED HOUSING
- Your VAMC Feb 312,495 1,795,934 1,422,248 3,530,676 11,311 2,040 312 349 -10.5
VASH
522 HUD-VA SHARED HOUSING
- Your VAMC Feb 389,170 5,916,069 3,546,196 9,851,435 25,290 5,623 390 349 11.7
VASH
522 HUD-VA SHARED HOUSING
- Your VAMC Feb 192,170 3,692,970 2,654,654 6,539,794 20,241 4,517 323 349 -7.4
VASH
522 HUD-VA SHARED HOUSING
- Your VAMC Feb 1,831,778 1,203,185 934,495 3,969,458 7,641 1,851 519 349 49
VASH
522 HUD-VA SHARED HOUSING
- Your VAMC Feb 129,936 3,358,403 2,544,870 6,033,209 19,293 3,380 313 349 -10.3
VASH
522 HUD-VA SHARED HOUSING
- Your VAMC Feb 426,677 4,747,054 4,059,317 9,233,048 21,024 4,570 439 349 25.9
VASH
522 HUD-VA SHARED HOUSING
- Your VAMC Feb 2,252,409 7,670,765 7,857,712 17,780,886 31,349 6,629 567 349 62.6
VASH
522 HUD-VA SHARED HOUSING
- Your VAMC Feb 606,621 9,861,271 6,657,975 17,125,867 47,563 9,004 360 349 3.2
VASH
522 HUD-VA SHARED HOUSING
- Your VAMC Feb 680,605 2,310,173 1,759,693 4,750,471 18,515 2,496 257 349 -26.4
VASH
          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

VHA Office of Finance – Managerial Cost Accounting Office 16

 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)

VHA Office of Finance – Managerial Cost Accounting Office 17

 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)
VHA Office of Finance – Managerial Cost Accounting Office 18
 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.

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 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 indirect research support ALBCC (xxx01*)
in proportion (%) to the time spent in these activities
• Fixed Direct Labor (FDL)

VHA Office of Finance – Managerial Cost Accounting Office 21

 Drive time…where 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

VHA Office of Finance – Managerial Cost Accounting Office 23

Labor Mapping Reports (2)

SSN CC T&L SUBACCT ALBCC Percent

XXX-XX-XXX1 8221 196 1020221 203PL1 0.18
XXX-XX-XXX1 8221 196 1020221 203PL1 0.82
XXX-XX-XXX2 8221 196 1051221 203PL1 0.17
XXX-XX-XXX2 8221 196 1051221 203PL1 0.83
XXX-XX-XXX3 8221 198 1001221 203PL1 1
XXX-XX-XXX4 8221 198 1020221 203PL1 0.1875
XXX-XX-XXX4 8221 198 1020221 203PL1 0.8125
XXX-XX-XXX5 8221 198 1020221 203PL1 0.1875
XXX-XX-XXX5 8221 198 1020221 203PL1 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 Clin
ical Encounters for Mental Health Providers
• Administrative Labor and FDL Mapping
• Education Support Mapping
• Research Support Mapping
• Resident Supervision Mapping
• MCA Financial Lexicon

VHA Office of Finance – Managerial Cost Accounting Office 29

 To Learn More

• MCA Learning Community

• Contact the MCAO Training Team

– VHAMCAOTraining@va.gov

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