UNIFORM DATA SYSTEM Calendar Year 2012 Bureau of Primary Health Care - - PDF document

12/11/2012 1

UNIFORM DATA SYSTEM Calendar Year 2012 Bureau of Primary Health Care

Agenda

• Brief Introduction to UDS

— See Webinars for more

• Available Assistance
• 2012 Changes; 2013 Proposed Changes
• Definitions
• Step‐by‐Step Instructions for Completing

UDS Tables

2

12/11/2012 2

Important Facts about the UDS

• WHO: 330 Grantees and LALs who were

“funded” prior to October 2012

• WHAT: “Scope of Project” for the period

January 1, 2012 ‐ December 31, 2012

• WHEN: February 15, 2013 report due;

finalized by March 31 with reviewer

• HOW: Through “Electronic Handbook”

(EHB)

3

12 Tables: Snapshot of Performance

• Patients you serve
• Types and quantities of services you

provide

• Staffing mix and tenure
• Quality of the care you deliver
• Costs to provide services to patients
• Revenue sources

4

12/11/2012 3

5

Who Reports Which Tables Available Assistance

• Regional trainings
• Webinars – Intro, LAL, Clinical, Sampling, Quartile
• On‐line training modules, manual, fact sheets, and
• ther TA materials available:

— www.bphcdata.net — http://bphc.hrsa.gov/healthcenterdatastatistics/ reporting/index.html

• Telephone and email helpline: 866‐UDS‐HELP or

udshelp330@bphcdata.net

• Technical support to review submission
• Primary Care Associations
• EHB Support (see handout)

— HRSA Call Center: 877‐464‐4772 — BPHC Help Desk: 301‐443‐7356

6

12/11/2012 4

7

2012 and 2013 Changes

8

Step by Step Instructions

Tables and Key Definitions

12/11/2012 5

Patient Profile Tables

• Number of patients served and their

socio‐demographic characteristics

— Patients by Zip Code — Table 3A: Patients by Age and Gender — Table 3B: Patients by Race/ Ethnicity /Language — Table 4: Other Patient Characteristics ‐ Income, insurance, special populations

• Tables 3A, 3B and 4 completed for each

additional funding stream

9

Patient Defined: Who Counts?

• An individual who has one or more visits

reported on Table 5 during the calendar year.

— Medical, dental, behavioral health, vision,

• ther professional and selected enabling

services

• Unduplicated Count: Patients count once

and only once regardless of the number

• r scope of visits.

10

12/11/2012 6

Patient Types: What is the Difference?

• Patient is an unduplicated count of individuals who

have one or more visits during the reporting year — Patient reported on Grant Report (only relevant if multiple 330 funding streams) is an individual who receives one or more visits supported by a special population grant — Patient reported by Service Category is an individual who receives one or more documented “visits” of any specific service type: medical, dental, vision, mental health, substance abuse, enabling, other professional

11

Zip Code Table: Patients by Zip Code

12

12/11/2012 7

13

• Additional instructions for Special Populations

— Homeless: Use zip code of location where patient receives services if no better data exist — Agricultural: Use zip code of the temporary housing they occupy when patient is in the — area

• Report all zip codes

with 11 or more patients

— Combine the rest as “other zip codes”

Patients by Zip Code

Tables 3A and 3B: Patient Demographics

14

12/11/2012 8

• Report total patients
• Age is calculated as of

June 30

• Count each patient once

and only once

• Total on line 39 must =

total by zip code

Table 3A: Patients by Age & Gender

16

— Use Column B if patient does not indicate “Latino” or “Hispanic” — Use Line 6 only if patient chooses two or more listed races

• “More than one” shouldn’t be a choice; don’t use for Latino

+ a race to be “more than one race”

• Patients self select

race AND ethnicity

—Use Line 7 Column C if no information —Use Line 7 Column A for Latino with unknown race

Table 3B: Patients by Race and Ethnicity

12/11/2012 9

17

• Report all patients who would best be served

in a language other than English including:

— Bilingual persons not fluent in medical English — Persons who are served by a bilingual provider — Persons who receive interpretation services — Persons using sign language — Persons in Puerto Rico or the Pacific where a language other than English is used

• This is the only UDS cell that may be

estimated Table 3B: Patients by Language

Table 4: Other Demographic Data

18

12/11/2012 10

19

• Use income as of your most

recent assessment

—Income may be self‐reported if permitted by

your policy

• Income must be from recent patient data

(within the last year) – otherwise count as unknown

• Total on Line 6 must = total by zip code

Table 4: Patients by Income

20

• Report principal 3rd party insurance

for medical care (even if patient is not a medical patient)

• Insurance is reported as of the last visit

—Even if it did not pay for the visit in whole or in part

• Total on Line 12 must = total by zip code

Table 4: Patients by Medical Insurance

12/11/2012 11

21

• None/Uninsured – patients with

no insurance; includes patients for whom health center may be reimbursed through grant or uncompensated care funds

• Medicaid – report all “Medicaid” regardless
• f the intermediary
• Medicare – report all “Medicare” regardless
• f the intermediary

— Including Medicare Advantage and — Medi‐Medi patients

Table 4: Medical Insurance Source

22

• CHIP‐RA is handled differently in

each state:

— If provided through Medicaid is reported on Line 8b

(Medicaid)

— If provided through a commercial carrier is

reported on Line 10b (Other public – not private)

• Other Public – Public coverage to patient for

broad set of benefits

— Do not include family planning, breast and cervical

programs, EPSDT

• Private Insurance

— Workers Comp is not

medical insurance

Table 4: Sources Continued

12/11/2012 12

23

• Completed ONLY by health centers

with capitated and/or FFS managed care (HMO) contracts. Do not count PCCM patients.

• A member month is 1 member enrolled for 1
• month. Report the sum of the monthly

enrollments for 12 months (generally from HMO reports to the health center.)

— In some cases, “members” might not be “patients.”

Table 4: Managed Care Utilization

24

All grantees must report total number of targeted patients (if any) on Lines 16, 23, 24 and 25.

• 330(g) MHC Grantees – provide separate

totals for migratory and for seasonal agricultural workers on Lines 14 and 15

• 330(h) HCH Grantees ‐ report patient’s

shelter arrangement as of first visit in 2012 (where they were housed the prior night)

• A veteran is an individual who completed

service in the Uniformed Services of the US

Table 4: Target Populations

12/11/2012 13

25

• An agricultural worker is an individual

whose principal employment is in agriculture on a seasonal basis, who has been so employed within the last 24 months, and/or their dependents.

— Migratory establishes temporary homes for such employment — Seasonal workers do not

• Agriculture means farming, including

— Cultivation and tillage of the soil — The production, cultivation, growing, and harvesting of any

commodity grown on, or in the land, or as an adjunct to or part

• f a commodity grown on or in the land; and

— Any practice (including preparation and processing for market

and delivery to storage or to market or to carrier for transportation to market) performed by a farmer or on a farm incident to or in conjunction with the above.

Table 4: Agricultural Worker Defined

26

• A homeless patient is any person

known to be homeless at the time of any service or who was housed but eligible because of having been a homeless patient within 12 months of the service date.

• Shelter arrangements (at first visit):

—“Street” includes living outdoors, in a car, in an

encampment, in makeshift housing/shelter or in other places generally not deemed “ fit for human occupancy”

—Persons who spent the prior night incarcerated, in an

institutional treatment, a hospital or in jail should be reported based on where they intend to spend the night after their encounter/release. If they do not know, code as “street”

—“Doubled up” must be temporary and unstable

Table 4: Homeless Defined

12/11/2012 14

Tables 5 and 5A: Staffing, Tenure, and Utilization

27

• Types and quantities of services provided

and staff who provide these services

— Table 5: Staffing and Utilization

• FTEs, visits, and patients

— Table 5A: Tenure for Health Center Staff

• Table 5 only: Columns b and c completed for

each additional funding stream (include all activity for patients reported on Grant Tables 3A,3B and 4)

28

Staffing and Utilization Profile Tables

12/11/2012 15

29

• Col (a) – Staff full‐

time equivalents (FTEs) reported by position

• Col (b) – Clinic

visits reported by provider type

• Col (c) – Patients

reported by service type

Table 5: Staffing & Utilization Full-time Equivalent (FTE) Defined

• WHO: All workers providing

services at approved locations

— Employees, contracted staff, residents, and volunteers — Do not count paid referral provider FTEs

• WHERE: Report based on work performed

— FTEs can be allocated across multiple categories

• NOTE: Medical director’s corporate time can be

allocated to non‐clinical; do not allocate other providers

— Line 29a Other Related – non‐health care (e.g., WIC, childcare, housing, fitness, job training) — Line 22 Other Professional includes PT, Chiropractor, nutrition, podiatry, etc.

30

12/11/2012 16

31

• HOW: FTE is actual for the year, not as of

last day

— 1.0 FTE is equivalent to one person working full‐time (as defined by health center) for one year

• Providers: Based on employment contracts
• Based on hours paid including vacation, sick,

continuing education, etc.

— Calculate FTE for persons working part‐time or part‐year (i.e., 6 months full‐time = 0.50 FTE)

Calculating FTEs

32

• HOW: For volunteers, locums,

residents, on‐call providers, etc.

— Calculate the number of hours the comparable position works

• E.g., Provider receives 160 hours vacation, 96

hours sick, 40 hours continuing education, 80 hours holidays = 1704 hours worked

— Calculate number of hours person being evaluated actually works

• E.g., Volunteer worked 30 days @ 8 hours = 240

— Report FTE

• hours worked (240) divided by 1704 = .14 FTE
• (240/1704 = 0.1408)

Calculating FTEs for Hourly Work

12/11/2012 17

Visit Defined

• WHAT: Face to face, one to one

between patient and provider

• Only for behavioral health (group and

telemedicine)

• No group health education, diabetes, etc.

— Licensed provider for medical, dental, vision, etc.

• Include volunteer and contracted provider

— The service must be charted — Providers act independently — Use professional judgment unique to their training and education

33

Visit Defined - continued

— Only 1 visit/patient/provider type/day

• Unless 2 different providers at 2 different sites

— Only 1 visit/provider/patient/day regardless

• f the number of services provided

— Count paid referral, nursing home, hospital visits — Do not count immunization only, lab only, dental varnishing, mass screenings, health fairs, outreach or pharmacy visits — Count visits provided by both paid and volunteer staff

34

12/11/2012 18

35

• Data reported are generally available in

health center Personnel or Human Resource (HR) employment records

— No new data over and above that needed for HR management should be necessary — TENURE may be measured in a form differently than the way SENIORITY information is stated — Virtually all of the work for this can be done well in advance of the submission date

Table 5A: Tenure for Health Center Staff

36

• WHAT: Individuals

employed by the health center

— Full‐ and part‐time, part‐year, contract, NHSC — Locums, volunteers,

• n‐call, residents
• Combined tenure

— In months (not FTE) — As of last work day of year — By job title (consistent with T5)

Table 5A: Tenure

12/11/2012 19

37

• WHO: Snap shot of those who are employed by

health center on December 31. Data are collected for selected clinical and non‐clinical support staff

• nly
• Clinical staff:

– Physicians – NP, PA, CNM providers – Dental providers – Mental Health providers – Vision providers

• Non‐clinical staff:

– CEO / Executive Director – CFO / Fiscal Officer – CIO – CMO / Medical Director

• Note: Line numbers remain the same as

those used for Table 5 for all clinical and non‐clinical staff

Who to include in Census

38

• HOW: Regular employees, persons
• n regular contracts etc. employed at time of

census are each counted as 1 in column A.

— Regardless of when they first started working — Those who are not working that day but who are scheduled to work before and after that day are counted as 1 — Those who are no longer employed on that day are not counted on this table — Those with two jobs (e.g., ObGyn + CMO) are — counted as 1 in each category

Full and Part Time Staff Persons

12/11/2012 20

39

• HOW: Volunteers, locums, on‐call

providers, residents, etc. who are scheduled to work before and after 12/31 are each counted as 1 in column C.

— Regardless of how much time they work but no less than two days per month for at least six months

Other Service Provider Arrangements

40

• HOW: Months are reported from the

time person most recently hired into that position

— Continuous months (regardless of whether or not the census is a regular work day) — Rounded up to the closest whole number

• E.g., Pediatrician hired 8/1/02, promoted to CMO on 9/15/10, and

serves in both roles ‐ Count 125 months as pediatrician and 28 months as CMO

• E.g., COO is hired 11/10/88, promoted to Deputy Director 7/12/97

and then promoted to CEO 6/22/12, retaining the obligations of the Deputy Director ‐ Count 7 months as CEO only

• E.g., CEO hired 5/15/10 to fill the role of CIO, CFO, and CEO –
• Count 32 months as CEO, 32 months as CFO, 32 as CIO

Tenure Months

12/11/2012 21

Tables 6A, 6B, and 7: Diagnoses, Quality of Care, and Outcomes Indicators

41

Clinical Profile Tables

• Quality of care and Outcome indicators

― Table 6A: Selected Diagnoses and Services

• completed for each additional funding stream

― Table 6B: “Quality of Care” Indicators ― Table 7: Health Outcomes and Disparities

• Electronic Health Record (EHR) Addendum

― Series of questions on the adoption of EHRs, certification of systems and how widely adopted the system is throughout the health center’s providers

42

12/11/2012 22

Table 6A: Diagnoses and Services

43 44

• Lines 1‐20d:

Selected diagnoses

― NOTE: Report any appearance not just primary

• Lines 21‐34:

Selected services

―Use ICD‐9 or CPT

codes

Table 6A: Diagnoses and Services

12/11/2012 23

45

Visits and Patients by Diagnosis and Service

• Column A – All visits with the

diagnosis or service

― Multiple visits may occur during the year for the specified diagnosis or service ― Count only one visit for any given service code even if multiple services are given (E.g., five vaccines or two fillings in one visit is counted

• nly once)
• Column B – Unduplicated number of patients

with diagnosis or having received service

― Count a patient only once on each line (e.g., diagnoses or services)

Table 6B and 7: Reporting Methods

46

12/11/2012 24

47

• Report Universe – All patients who meet

the reporting criteria.

― Must report universe when

1) Universe has fewer than 70 patients who meet the criteria; 2) Reporting Prenatal Care and Delivery Outcome variables

• Report Sample – A sample of 70 charts

from the Universe.

Note: You may choose differently for each measure

Options for Reporting

Table 6B: Quality of Care Indicators

48

12/11/2012 25

49

Process Measures

• “Process

measures”: If patients receive timely routine and preventive care, then we can expect improved health

 Early entry into prenatal care  Childhood immunizations  Pap tests  Weight assessment & counseling on nutrition and activities for children  Adult weight screening & follow‐up  Tobacco use assessment  Tobacco cessation intervention  Asthma drug therapy  Lipid lowering therapy for those with coronary artery disease (CAD)  Aspirin or other anti‐thrombotic therapy for those with ischemic vascular disease (IVD)  Colorectal cancer screening

50

New Process Measures

• New “Process measures”:

Lipid lowering therapy for those with

coronary artery disease (CAD)

Aspirin or other anti‐thrombotic therapy for

those with ischemic vascular disease (IVD)

Colorectal cancer screening

12/11/2012 26

51

Section A: Prenatal Patients by Age

• Report all patients who received

prenatal care during the year by age category

― Section A is ONLY completed by grantees with Prenatal Programs ― Regardless of whether they delivered, include women whose only service in 2012 was their delivery ― Include women who transferred or were “risked out”, as well as women who were delivered by another health center’s provider ― Do not include patients who may have had tests, vitamins, assessments or education, and did not have their initial clinical visit with the obstetrical provider

• Trimester of entry into prenatal care

― Section B is ONLY completed by grantees with Prenatal Programs ― For all prenatal patients reported in Section A, indicate what trimester they began care and whether it was with the health center or another provider ― “Entry into prenatal care” occurs when the patient has had a visit with a physician or midlevel provider who initiates prenatal care with a complete physical exam (i.e., not a pregnancy test, nurse assessment)

52

Section B: Early Entry into Prenatal Care

12/11/2012 27

53

• Col (a) Universe: All children who

― turned 2 in 2012 (born 1/1 – 12/31/10) AND ― who had at least one medical visit in 2012 AND ― were first ever seen prior to their 2nd birthday.

(no exclusions)

Section C: Childhood Immunizations

54

• Col (b): Universe or sample of 70

patients

• Col (c) Compliance: Number of children in Col(b)

who, by their 2nd birthday are fully compliant, i.e., for each disease they (1) received vaccine, or (2) had evidence of the disease or (3) have a contraindication for vaccine.

Childhood Immunizations

12/11/2012 28

55

Required Vaccines

• Fully complaint means compliant

for each of 14 diseases normally vaccinated against with:

— 4 DTP/DTaP, — 3 IPV, — 1 MMR, — 2 HIb, — 3 HepB, — 1 VZV (Varicella) — 4 Pneumococcal conjugate — 2 HepA — 2 or 3 Rotavirus (RV) — 2 Influenza (flu)

56

Assessing Immunization Compliance

• BPHC generally follows NQF and

“meaningful use” criteria

• Notes in the medical record indicating that the patient

received the immunization “at delivery” or “in the hospital” may be counted as evidence of compliance

• A note that “patient is up‐to‐date” with immunizations

that does not list the date of each immunization and the name of immunization does not constitute sufficient evidence of compliance

• Good faith efforts to get a child immunized which

nonetheless fail remain “non‐compliant” including

— Parental failure to bring in the patient — Parents who refuse for religious reasons — Parents who refuse because of beliefs about vaccines

12/11/2012 29

57

Section D: PAP Tests

• Col (a) Universe: All women

– aged 24 – 64 (born 1/1/48 – 12/31/88) AND – with at least one medical visit in a health center clinic during the reporting year AND – who were first seen before age 65.

(excluding women with hysterectomy)

58

PAP Tests

• Col (b): Universe or sample of 70 patients
• Col (c) Compliance: Number of women in Col

(b) who received one or more documented Pap tests (regardless of where performed) during the measurement year or during the two years prior to the measurement year.

12/11/2012 30

59

Assessing Pap Test Compliance

• Count as “in compliance” a medical

record with

― A copy of the test result (your lab or another lab) ― An evidence based notation in the patient’s chart

including provider, test date and result, entered by your provider or clinic staff

• A note that “patient was referred” or “patient

reported receiving pap test” does not constitute sufficient evidence of pap test compliance

• Even if a good faith effort was made to get the

patient tested, she is “non‐compliant” even if she

― refused to have test ― failed to return for a scheduled test ― claims to have had one but cannot document it

60

Section E: Child Weight Assessment and Counseling

• Col (a) Universe: All children

―aged 3 through 17 on December 31st (born

1/1/95 – 12/31/09) AND

―with at least one medical visit in a health

center clinic during the reporting year AND

―were was first seen before age 17.

(excluding pregnant adolescents)

12/11/2012 31

61

Child Weight Assessment and Counseling

• Col (b): Universe or sample of 70 patients
• Col (c) Compliance: Number of patients in Col

(b) who had a recorded BMI percentile during 2012 AND had documented counseling on nutrition (not just diet) AND had documented counseling on activity (not just exercise)

62

Assessing Child Weight Assessment Compliance

• Just recording that a well child visit was

done does not meet the requirement

• All three criteria: BMI percentile,

counseling on nutrition, and counseling

• n activity must be documented

12/11/2012 32

63

Section F: Adult Weight Assessment and Follow -up

• Col (a) Universe: All adults

―aged 18 and over on December 31st (born on

• r before 12/31/1994) AND

―with at least one medical visit in a health

center clinic during the reporting year AND

―last seen after they turned 18.

(excluding pregnant women & terminally ill patients)

64

• Col (b): Universe or sample of 70 patients
• Col (c) Compliance: Number of patients in Col

(b) who had their BMI recorded at their last visit or

within 6 months of that visit AND had a follow‐up plan documented if they were

― under age 65 and BMI was ≥ 25 OR < 18.5 or ― age 65 or older and BMI was ≥ 30 OR < 22

64

Adult Weight Assessment and Follow -up

12/11/2012 33

65

Assessing Adult Weight Compliance

• Just recording height and weight is not

adequate – BMI must be visible in chart

• r on template

66

Section G1: Tobacco Assessment

• Col (a) Universe: All adults

―aged 18 and over on December 31st (born on

• r before 12/31/1994) AND

―who have been seen at least twice (ever) in the

practice for medical care AND

―with at least one medical visit in a health

center clinic during the reporting year AND

―last seen after they turned 18.

(no exclusions)

12/11/2012 34

67

Tobacco Assessment

• Col (b): Universe or sample of 70 patients
• Col (c) Compliance: Patients in the sample who

were queried about their tobacco use one or more times by any provider (e.g. dental, vision) during their last visit or within 24 months of their last visit.

68

Section G2: Tobacco Cessation Intervention

• Col (a) Universe: All adults

―who used any form of tobacco within 24 mths AND ―aged 18 and over on December 31st (born on or

before 12/31/1994) AND

―who have been seen at least twice (ever) in the

practice for medical care AND

―with at least one medical visit in a health center

clinic during the reporting year AND

―last seen after they turned 18.

(no exclusions)

68

12/11/2012 35

Tobacco Cessation Intervention

69

• Col (b): Universe or sample of 70 patients
• Col (c) Compliance: Patients in the sample who

received tobacco use cessation services OR received an order for cessation medication (Rx

• r OTC) OR were on medication.

70

Section H: Asthma Pharmacologic Therapy

• Col (a) Universe: Patients aged 5 through 40

―initially diagnosed with persistent asthma AND ―born between 1/1/72 and 12/31/07 AND ―last seen while between ages 5 through 40 AND ―seen at least twice (ever) in the practice AND ―had at least one medical visit in a health center

clinic during the reporting year.

(excluding patients with allergic reaction to asthma meds and intermittent asthma)

12/11/2012 36

71

Asthma Pharmacologic Therapy

• Col (b): Universe or sample of 70 patients
• Col (c) Compliance: Patients in the sample

who received or had a prescription for inhaled corticosteroids OR received or had a prescription for an approved alternative medication OR was on medication.

72

Section I: Coronary Artery Disease Lipid Low ering Therapy

• Col (a) Universe: All adults

―with an active diagnosis of CAD during current or

prior year or had a myocardial infarction (MI) or had cardiac surgery AND

―aged 18 and over on December 31st (born on or

before 12/31/1994) AND

―last seen after they turned 18 AND ―seen at least twice (ever) for medical care AND ―had at least one medical visit in a health center

clinic during the reporting year.

 (excluding individuals whose last LDL lab test was <130 mg/ dL or with an allergy to or a history of adverse outcomes from or intolerance to LDL lowering medications)

12/11/2012 37

73

Lipid Low ering Therapy

• Col (b): Universe or sample of 70 patients
• Col (c) Compliance: Patients in the sample

who received a prescription for, were provided with, or were taking lipid lowering medications.

74

Section J: Ischemic Vascular Disease Aspirin or other Anti- Thrombotic Therapy

• Col (a) Universe: All adults

― with an active diagnosis of IVD during the current

• r prior year OR had been discharged after AMI or

CABG or PTCA between January 1, 2011 and November 1, 2011 AND

― aged 18 and over on December 31st (born on or

before 12/31/1994) AND

― last seen after they turned 18 AND ― had at least one medical visit in a health center

clinic during the reporting year.

(no exclusions)

AMI: acute myocardial infarction CABG: coronary artery bypass graft PTCA: percutaneous transluminal coronary angioplasty

12/11/2012 38

75

Aspirin or other Anti- Thrombotic Therapy

• Col (b): Universe or sample of 70 patients
• Col (c) Compliance: Patients in the sample

who had documentation of aspirin or another anti‐thrombotic medication being prescribed, dispensed, or used.

76

Section K: Colorectal Cancer Screening

• Col (a) Universe: Patients aged 51

through 74

―born between 1/1/38 and 12/31/61 AND ―had at least one medical visit in a health

center clinic during the reporting year.

(excluding patients who have had colorectal cancer)

12/11/2012 39

77

Colorectal Cancer Screening

• Col (b): Universe or sample of 70

patients

• Col (c) Compliance: Patients in the sample

who had documentation of appropriate colorectal cancer screening: ― Colonoscopy conducted during reporting year or

previous 9 years OR

― Flexible sigmoidoscopy conducted during reporting

year or previous 4 years OR

― Fecal occult blood test (FOBT), including the fecal

immunochemical (FIT) test, during the reporting year.

Table 7: Health Outcomes and Disparities

78

12/11/2012 40

79

Intermediate Outcome Measures

• “Intermediate
• utcome

measures”: If this measurable intermediate

• utcome is

improved, then later negative health outcomes will be less likely.

 Normal birthweight  Controlled hypertension  Controlled diabetes

80

Disparities Format

• All outcome data are

reported in a matrix to show ethnicity and race

• Latino patients are

reported in section 1

• Patients who report race

but not ethnicity are assumed non‐Hispanic and reported in section 2

• Patients with neither race

nor ethnicity are reported as Unreported in section 3

12/11/2012 41

81

HIV Pregnancy and Deliveries by Health Center Clinicians

• Line “0”: Pregnant HIV patients seen in the

clinic, regardless of whether or not they received prenatal care.

―All grantees report, including those with no

prenatal care program

• Line 2: Total number of deliveries performed

by health center clinicians including deliveries to non‐health center patients.

―Only agencies which provide prenatal care

report this line

82

• Column 1a: All prenatal care patients from

Table 6B who were known to have delivered during the year, even if the delivery was done by another provider.

― Column 1a need not / will not / should not equal the

sum of columns 1b + 1c + 1d except by coincidence

• Columns 1b – 1d: Live births born to prenatal

care patients during the year by weight, including multiples, regardless of who performed the delivery.

Section A: Birthw eight

12/11/2012 42

83

Section B: Controlled Hypertension

• Col (2a) Universe: Patients aged 18 to 85

―diagnosed with hypertension prior to 6/30/12 AND ―born between 1/1/28 and 12/31/94 AND ―seen at least twice during the reporting year for any

medical service.

(excluding pregnant women and patients with End Stage Renal Disease)

84

Controlled Hypertension

• Col (2b): Universe or sample of 70 patients
• Col (2c) Compliance: Patients in the sample

whose most recent blood pressure is less than 140/90.

―No documented blood pressure during the

reporting year is out of compliance

12/11/2012 43

85

Section C: Controlled Diabetes

• Col (3a) Universe: Patients aged 18 to 75

―diagnosed with diabetes AND ―born between 1/1/38 and 12/31/94 AND ―seen at least twice during the reporting year

for any medical service.

(excluding those with only a diagnosis of gestational diabetes or steroid‐induced diabetes)

86

Controlled Diabetes

• Col (3b): Universe or sample of 70

patients

• Col (3c‐3f) Test Result: Patients in the

sample whose last HBA1c during the reporting year is in the given range

―No test during the reporting year is out of

compliance and reported in Column 3f

12/11/2012 44

Tables 8A, 9D, and 9E: Financial Profile

87

Financial Profile Tables

• Cost and efficiency of delivering services

and sources and amounts of income

―Table 8A: Financial Costs ―Table 9D: Income from Patient Services ―Table 9E: Other Revenues

88

12/11/2012 45

Table 8A: Financial Costs

89 90

Table 8A: Financial Costs

• Accrued costs and

allocation of facility and non‐clinical services

• Exclude bad debt
• Include

depreciation

• Report donated

(“in‐kind”) costs on line 18, only

12/11/2012 46

91

Table 8A and Table 5 Crossw alk

92

Table 8A: Lines 1 - 10

• Line 1: Medical Care Costs

―Medical staff salaries and benefits ―Staff dedicated to operation of EHR and QI ―Staff on contract and contracted visits

• Excludes Ophthalmologists and Psychiatrists
• Line 2: All medical (not dental) lab and x‐

ray costs including supplies, lab staff, etc.

• Line 3: All other direct medical costs

including dues, supplies, depreciation, travel, CME, EHR system, etc.

• Lines 5,6,7,9,&9a: Other Clinical Services

Costs

―Personnel (hired or contracted) and all

“other” direct expenses

12/11/2012 47

• Pharmacy Costs

―Line 8b ‐ costs of pharmaceuticals, only ―Line 8a ‐ all other pharmacy costs including MIS,

staff, equipment, non‐pharmaceutical supplies, etc.

• If you cannot separate non‐drug cost from total cost ‐

report all costs on line 8b

• All pharmacy overhead is on Line 8a col b

Note: Do not include donated pharmaceuticals on either line. This is shown on line 18.

93

Table 8A: Lines 8a and 8b

94

Table 8A: Lines 11a -13

―Include costs associated with staff reported on

Table 5 Line 29a as well as other related direct expenses for non‐health‐care services such as:

* WIC * Housing Corporations * Job training * Head Start /Early Head Start * Child care * Adult Day Health Care * Shelters * Fitness programs

― Include any “pass through” funds here

• Line 11a‐11g: Enabling

―Personnel detail (hired

• r contracted) and all

“other” direct enabling expenses

• Line 12: Other Program

Related Costs

12/11/2012 48

95

Table 8A: Lines 14 –16 Non-Clinical Support and Facility

• Line 14: Facility costs include rent or depreciation,

mortgage interest payments, utilities, security, janitorial services, maintenance, etc.

― No CIP or FIP costs, but include appropriate depreciation

• Line 15: Non‐clinical support staff costs include costs for

corporate non‐clinical, billing and collections, and medical records and intake staff as well as all associated costs including supplies, equipment, depreciation, travel, etc.

96

Allocation of Facility

• Facility

―Allocate each building separately

• Captures differences in costs per building

such as improvements, donated space, etc.

―Allocate based on proportion of square

footage utilized by each cost center

―Add non‐clinical space expenses to non‐

clinical costs to be allocated

12/11/2012 49

97

Allocation of Non-Clinical Support

• Non‐clinical support staff and costs

―Allocate based on actual use

• Billing, medical records, front desk, etc.

―Alternative: straight line method, using the

proportion of total costs to the service category excluding all Non‐Clinical Support costs and Facility costs

Table 9D: Patient Related Revenue

98

12/11/2012 50

99

Table 9D: Patient Related Revenue

• Cash basis
• Patient revenues are

reported by payor: Medicaid, Medicare, Other public, private and self‐pay

100

Charges

• Full Charges Col(a):

― Undiscounted, unadjusted charges for services

based on fee schedule; charges should cover costs

― Include all charges (i.e., medical, dental, pharmacy,

mental health, etc.)

― Do not include “charges” where no collection is

attempted or expected such as charges for enabling services, donated pharmaceuticals, or free vaccines

12/11/2012 51

101

Collections

• Collections Col(b):

― Report all amounts collected as payments for

health services including payments from patients, third party insurance, FQHC reconciliation payments and contract payments (e.g., schools, jails, etc.) received during the year

― Report by payor ― Do not include “meaningful use” payments

102

Adjustments

• Adjustments Col(c1‐c4):

Note: Adjustments are included in col(b), but do not = col(b)

― Columns (c1) and (c2): reconciliation payments

for FQHC or CHIP‐RA settlements

― Col (c3): “Other Retroactive Payments” including

risk pools, incentives, PFP, withholds and court

• rdered payments

― Col (c4): amounts which are returned to third

party (report as positive number)

12/11/2012 52

103

Allow ances

• Allowances Col(d):

― Reductions in payment by a third party based on a

contract

― Allowances do not include:

• non‐payment for services that are not covered by the

third party or rejected by the 3rd party

• deductibles or co‐payments that are due from the

patient and not paid by a third party

― Reduce allowances by amount of FQHC payments ― For capitated plans, col d = col a – col b

104

Sliding Discounts

• Sliding Discounts Col(e):

―A reduction in the amount charged (paid or

• wed) for services rendered which
• Is based solely on the patient’s documented

income and family size at the time of service as it relates to the federal poverty level

• May be applied to insured patients’ co‐

payments, deductibles and non‐covered services when the charge has been moved to self pay if consistent with how uninsured patients are treated

• May not be applied to past due amounts

12/11/2012 53

105

Bad Debt

• Bad Debt Col(f):

―Amounts considered to be uncollectable and

formally written off during the current calendar year, regardless of when the service was provided

―Only self‐pay bad debt is reported, not third

party bad debt

―Do not report as a “cost” on Table 8A ―Bad debt can never be changed to a sliding

discount

106

Payors: Medicaid and Medicare

• Lines 1 ‐ 3: Medicaid

― All routine Medicaid ― EPSDT – under any name ― Medicaid part of Medi‐Medi or

crossovers

― CHIP, if paid through Medicaid ― May also include fees for other state

programs which are paid by the Medicaid intermediary

• Lines 4 ‐ 6: Medicare

― All routine Medicare ― Medicare Advantage ― Medicare portion of Medi‐Medi or

crossovers

12/11/2012 54

107

Payors: Other Public and Private

• Lines 7 ‐ 9: Other Public

― State or other public insurance programs ― Non‐Medicaid CHIP programs ― State‐based programs which cover a specific

service or disease (i.e., BCCCP, Title X, Title V, TB)

― Does not include indigent care programs ― NOTE: Patients who benefit from services paid

for by “other public payers” are not necessarily counted as “other public insurance” on Table 4

• Lines 10 ‐ 12: Private

― Private and commercial insurance ― Medi‐gap programs, Tricare, Workers Comp. etc. ― Contracts with schools, jails, head start, etc.

108

• Line 13: Self Pay

―Charges for which patients are responsible

and all associated collections including:

• Full fee patients
• Patients receiving sliding discounts
• “Nominal fee” or “zero‐pay” patients
• Co payments and/or deductibles
• Services not covered by a patient’s insurance
• Services which form or will form the basis for state
• r local safety net (uncompensated care) funds
• Dental patients who only have medical insurance

Payors: Self Pay

12/11/2012 55

109

Reclassify Charges

• It is essential to reclassify rejected charges:

―This includes co‐payments and deductibles as

well as charges for non‐covered services which are rejected by third parties

• Deduct unpaid charges or portion of charge from
• riginal payor (Medicaid, Medicare, Private, etc.)
• Add to charges on line for the secondary (tertiary,

etc.) payor

• Show collections of these amounts on the

appropriate line

Table 9E: Other Revenues

110

12/11/2012 56

111

• Report non

patient‐service income

• Cash basis – amount

received/drawn down during the year

• Report “last party” to

handle funds before you received them

• Do not include:

― Capital received as loan ― Patient‐related revenue ― Value of donated services,

supplies, or facilities

― Donated “community value”

Table 9E: Other Revenues

112

• Line 1: BPHC Grant drawdowns

― Report all funds received directly from BPHC

regardless of their end use

― Include funds received from BPHC and passed

through to another agency

• If you do not report activity for grant, report as cost on

Table 8A, Line 12

• Line 3: Other Federal Grants

― Report funds received from Federal government

grants management system

― Do not report Ryan White unless you are an entity

that receives the funds directly

― Do not include IHS funds for compacted and

contracted services (report as “safety net” (line 6a))

Federal Grants

12/11/2012 57

113

• Line 3a: Medicare and Medicaid EHR

Incentive Payments for Eligible Providers

―Payments made directly to providers and

turned over to the health center are also recorded here

• Line 4a: ARRA – CIP and FIP drawdowns
• Line 6: State Grants ‐ and ‐ Line 7: Local

Grants

―Do not include grant funds which reimburse

for units of service

Other Government Grants

114

• Line 6a: Indigent Care Programs

―State and local programs that pay for

health care in general and are based on a current or prior level of service, though not on a specific fee for service

• Report full charges on Table 9D as self‐pay

charges and everything not due from the patient is written off as a sliding discount

• Do not include state insurance plans
• Line 8: Foundation / Private Grants
• Line 10: Other Revenues

―Contributions, fund raising income, rents,

sales, patient record fees, etc.

Other Revenue Sources

12/11/2012 58

Ongoing questions can be addressed to UDSHelp330@BPHCDATA.NET 866‐UDS‐HELP Thank you for attending this training and for all of your hard work to provide comprehensive and accurate data to BPHC!