UNIFORM DATA SYSTEM. Calendar Year 2012 Bureau of Primary Health Care

Transcription

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 1

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, 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 2

3 Who Reports Which Tables Table 1 BPHC Funded Program Universal Report More than 1 BPHC Funded program Universal + Special Pop. Grant Reports Look-A-Like Designee Universal Report Zip Codes Yes Yes 3A, 3B, 4 Yes Yes No Managed Care or HCH detail 5 Yes Visits & Patients, only Yes 5A Yes Yes 6A Yes Yes 6B Yes Yes 7 Yes No Race/Ethnicity detail 8A Yes Yes 9D Yes No Managed Care or retroactive details 9E Yes No 330 or ARRA grants 5 Available Assistance Regional trainings Webinars Intro, LAL, Clinical, Sampling, Quartile On-line training modules, manual, fact sheets, and other TA materials available: reporting/index.html Telephone and helpline: 866-UDS-HELP or udshelp330@bphcdata.net Technical support to review submission Primary Care Associations EHB Support (see handout) HRSA Call Center: BPHC Help Desk:

4 2012 and 2013 Changes Table Zip Codes 3A, 3B, 4 5 5A 6A Table 4, lines 14 and 15 removed all agricultural workers reported on line 16 Term change: Administrative to nonclinical support New table All diagnosis to be reported and Line 24b H1N1 removed Proposed zip code of patients by insurance Table 4: Proposed change in the age break in insurance data 6B 3 new measures Proposed changes to two measures 7 8A 9D 9E Term change: Administrative to nonclinical support Line 4 removed 7 Tables and Key Definitions Step by Step Instructions 8 4

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, other professional and selected enabling services Unduplicated Count: Patients count once and only once regardless of the number or scope of visits. 10 5

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 6

7 Patients by Zip Code Report all zip codes with 11 or more patients Combine the rest as other zip codes 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 13 Tables 3A and 3B: Patient Demographics 14 7

8 Table 3A: Patients by Age & Gender 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 15 Table 3B: Patients by Race and Ethnicity 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 T3A 39. Latino with unknown race TOTAL PATIENTS (SUM LINES 1-38) blank blank 16 8

9 Table 3B: Patients by Language 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 17 Table 4: Other Demographic Data 18 9

10 Table 4: Patients by Income 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 19 Table 4: Patients by Medical Insurance Report principal 3 rd 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 20 10

11 Table 4: Medical Insurance Source 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 of the intermediary Medicare report all Medicare regardless of the intermediary Including Medicare Advantage and Medi-Medi patients 21 Table 4: Sources Continued 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 22 11

12 Table 4: Managed Care Utilization 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. 23 Table 4: Target Populations All grantees must report total number of targeted patients (if any) on Lines 16, 23, 24 and (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 24 12

13 Table 4: Agricultural Worker Defined 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. 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 of 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. 25 Table 4: Homeless Defined 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 26 13

14 Tables 5 and 5A: Staffing, Tenure, and Utilization 27 Staffing and Utilization Profile Tables 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 14

15 Table 5: Staffing & Utilization Col (a) Staff fulltime equivalents (FTEs) reported by position Col (b) Clinic visits reported by provider type Col (c) Patients reported by service type 29 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

16 Calculating FTEs 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) 31 Calculating FTEs for Hourly Work 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 8 hours = 240 Report FTE hours worked (240) divided by 1704 =.14 FTE (240/1704 = ) 32 16

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 of 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 17

18 Table 5A: Tenure for Health Center Staff 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 35 Table 5A: Tenure WHAT: Individuals employed by the health center Full- and part-time, part-year, contract, NHSC Locums, volunteers, on-call, residents Combined tenure In months (not FTE) As of last work day of year By job title (consistent with T5) 36 18

19 Who to include in Census 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 only Clinical staff: Physicians NP, PA, CNM providers Dental providers Mental Health providers Non-clinical staff: CEO / Executive Director CFO / Fiscal Officer CIO CMO / Medical Director Vision providers Note: Line numbers remain the same as those used for Table 5 for all clinical and non-clinical staff 37 Full and Part Time Staff Persons HOW: Regular employees, persons on 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 38 19

20 Other Service Provider Arrangements 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 39 Tenure Months 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 40 20

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 21

22 Table 6A: Diagnoses and Services 43 Table 6A: Diagnoses and Services Lines 1-20d: Selected diagnoses NOTE: Report any appearance not just primary Lines 21-34: Selected services Use ICD-9 or CPT codes 44 22

23 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 only 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) 45 Table 6B and 7: Reporting Methods 46 23

24 Options for Reporting 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 47 Table 6B: Quality of Care Indicators 48 24

25 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 49 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 50 25

26 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 51 Section B: Early Entry into Prenatal Care 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)

27 Section C: Childhood Immunizations 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 2 nd birthday. (no exclusions) 53 Childhood Immunizations Col (b): Universe or sample of 70 patients Col (c) Compliance: Number of children in Col(b) who, by their 2 nd 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

28 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) 55 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 56 28

29 Section D: PAP Tests Col (a) Universe: All women aged (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) 57 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

30 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 59 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) 60 30

31 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) 61 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 on activity must be documented 62 31

32 Section F: Adult Weight Assessment and Follow-up Col (a) Universe: All adults aged 18 and over on December 31st (born on or 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) 63 Adult Weight Assessment and Follow-up 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 <

33 Assessing Adult Weight Compliance Just recording height and weight is not adequate BMI must be visible in chart or on template 65 Section G1: Tobacco Assessment Col (a) Universe: All adults 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) 66 33

34 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. 67 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)

35 Tobacco Cessation Intervention 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 or OTC) OR were on medication. 69 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) 70 35

36 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. 71 Section I: Coronary Artery Disease Lipid Lowering 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) 72 36

37 Lipid Lowering 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. 73 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 or 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 74 37

38 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. 75 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) 76 38

39 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. 77 Table 7: Health Outcomes and Disparities 78 39

40 Intermediate Outcome Measures Intermediate outcome measures : If this measurable intermediate outcome is improved, then later negative health outcomes will be less likely. Normal birthweight Controlled hypertension Controlled diabetes 79 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

41 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 81 Section A: Birthweight 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

42 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) 83 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 84 42

43 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) 85 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 86 43

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 44

45 Table 8A: Financial Costs 89 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 90 line 18, only 45

46 Table 8A and Table 5 Crosswalk 91 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 92 other direct expenses 46

47 Table 8A: Lines 8a and 8b 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 Table 8A: Lines 11a -13 Line 11a-11g: Enabling Personnel detail (hired or contracted) and all other direct enabling expenses Line 12: Other Program Related Costs 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 94 Include any pass through funds here 47

48 Table 8A: Lines 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. 95 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 nonclinical costs to be allocated 96 48

49 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 97 Table 9D: Patient Related Revenue 98 49

50 Table 9D: Patient Related Revenue Cash basis Patient revenues are reported by payor: Medicaid, Medicare, Other public, private and self-pay 99 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

51 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 101 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 ordered payments Col (c4): amounts which are returned to third party (report as positive number)

52 Allowances 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 3 rd 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 103 Sliding Discounts Sliding Discounts Col(e): A reduction in the amount charged (paid or owed) 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 copayments, 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

53 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 105 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

54 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. 107 Payors: Self Pay 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 or local safety net (uncompensated care) funds Dental patients who only have medical insurance

55 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 original 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 109 Table 9E: Other Revenues

56 Table 9E: Other Revenues 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 111 Federal Grants 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))

57 Other Government Grants 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 113 Other Revenue Sources 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

58 Thank you for attending this training and for all of your hard work to provide comprehensive and accurate data to BPHC! Ongoing questions can be addressed to 866-UDS-HELP 58