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Introducing the UDS Brief Introduction to UDS Available Assistance Definitions Used in the UDS Report Step by Step inst

Agenda. Introducing the UDS Brief Introduction to UDS Available Assistance Definitions Used in the UDS Report Step by Step instructions for completing the UDS tables 2013 Changes Software Demonstration Interpreting the UDS Report. Reference Materials. Copy of the presentation slides

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Introducing the UDS Brief Introduction to UDS Available Assistance Definitions Used in the UDS Report Step by Step inst

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  1. Agenda Introducing the UDS • Brief Introduction to UDS • Available Assistance • Definitions Used in the UDS Report • Step by Step instructions for completing the UDS tables • 2013 Changes • Software Demonstration • Interpreting the UDS Report

  2. Reference Materials • Copy of the presentation slides • CY2013 UDS Manual, Tables, Fact Sheets • Summary of CY2013 changes • UDS Feedback Report • UDS Reference Formula Guide

  3. Do you know? • How many patients are served by the Urban Indian Health Program? (117,557 Patients, 51,646 AI/AN) (507,987) • How many visits? • What % of patients are uninsured? (52%) • on Medicaid? (30%) • What is the average cost per medical visit? ($230) • Where can you get this information? (UIHP UDS for CY2012) • How is this information used? (We’ll discuss in a few moments…) (Accurate Reporting of the UDS Data) • Why are we here today?

  4. 2012 Program Impact • 33 Programs serving 117,557 • Total Visits include Medical, Dental, MH, SA, Vision, Other Professional and Enabling Services • Employees represent FTE- those employed greater

  5. What is the Uniform Data System (UDS)? • A Standardized set of data reported by federally funded programs: • Urban Indian Health programs • Section 330 Grantees – CHC, HCH,MHC and PHPC (for over 15 years) • FQHC Look-Alike agencies • Nurse Managed Health Clinics (NMHCs) • 11 Tables (UIHP UDS)

  6. 11 Tables Provide a Snapshot of Patients and performance from January 1 – December 31

  7. Universal and AI/AN Tables

  8. Why is the UDS important? UDS data is used by IHS to: • Ensure compliance with legislative and regulatory requirements • Report program achievements to Congress and OMB • Monitor performance and identify TA needs UDS data is used by programs to improve performance

  9. Critical Dates in the UDS Process • Software on CD ROM received February 15, 2014 • Software demonstration later in agenda • Report due April 15, 2014 • Before submit you must run audit report and correct errors • Reviewer Technical Assistance to finalize report from April 15-June 15, 2014 • Data finalized July, 2014 • Feedback Report received August 2014

  10. Available Assistance • Regional trainings • On-line training modules, manual and fact sheets available at: www.uihpdata.net • Telephone helpline at: 1-866-698-5976 • Email help at: helpuds@uihpdata.net • Technical support to review submission

  11. Strategies for Success: Submission • Work as a Team • Refer to reporting manual, fact sheets and support resources • Check your data before submitting • Address all edits • Check data trends • Compare data to benchmarks • Refer to last year’s review questions

  12. UDS Tables and Definitions

  13. Each table will be reviewed for: • Definitions of terms for consistent reporting • Step-by-step instructions for table completion • Reference Manual and Quick Fact Sheets • Interrelatedness of Tables • Tables cannot be completed accurately without cross checking • How the data are / can be used for program improvement

  14. CY2013 Changes

  15. General Information Provides general information on program including contacts, service locations and services

  16. Cover Sheet • Contact information for various staff • UDS Contact • Number of service sites (must equal locations) • Participation in various programs – NHSC, FTCA deeming, 340(b) or other drug pricing program

  17. Service Delivery Site Locations • Site name and address • Year round/less than year round • Full-time or part-time • Location code • Medicaid numbers (if site specific)

  18. Table 2: Services Offered and Delivery Methods • For each service indicate if and how service is provided (3 methods of service) • Check all cells that apply • There is no “quantity” measure

  19. Describes the number of patients served and their socio-demographic characteristics including AI/AN patients Patient Profile

  20. Patient Profile Tables Number and socio-demographic characteristics of patients served • Patients by Zip Code • Table 3A – Patients by Age and Gender • Table 3B – Patients by Race/Ethnicity/Language • Table 4 – Other Patient Characteristics • Income and primary medical insurance, special populations • Tables 3A, 3B and 4 are completed for AI/AN patients separately

  21. Who Counts: Patient Defined • An individual who has one or more visits that was reported on Table 5during the calendar year • Medical, dental, mental health, substance abuse, vision, other professional and selected enabling services. • Whenever ‘patients’ are counted, it is an unduplicated count. Each patient is counted once and only once regardless of the number or scope of visits

  22. Who counts as an American Indian/ Alaska Native patient (AI/AN)? • AI/AN Patient: Individuals who qualify as an American Indian/Alaskan Native according to the 25 U.S.C. 1603 (f) definition • “Other” AI/AN Patient: Individuals who are designated AI/AN but do not quality as an AI/AN according to the 25 U.S.C. 1603 (f) • Non-Indian Patients: Individuals who do not qualify as an Indian patient

  23. Patients by Zip Codes Zip Code Table

  24. Patients by Zip Code • Enter zip code and number of patients from each zip code • Account for total patients by zip code • Aggregate zip codes with 3 or less patients • Combine the rest as ‘other zip codes’

  25. Patients by Zip Code (continued) • Additional instructions for reporting zip codes for special populations: • Homeless- Use zip code of location where patient receives services if no better data exists • Seasonal/Migrant Workers-use zip code of the temporary housing they occupy when patient is in the area.

  26. Patient Demographics Tables 3A and 3B

  27. Table 3A: Patients by Age & Gender (Universal and AI/AN) • Age is calculated as of June 30th of the calendar year • Count each patient once and only once on total line of Table 3A • AI/AN table is subset of total • Total on line 39 column a+b is the official total. • Total on line 39 columns a+b must = patient totals reported on Zip Code, 3B, and 4.

  28. Patients self select except AI/AN (line 4a); 4b for “Other” AI/AN • Use Column b (Non-Hispanic) 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 Table 3B: Patients by Race and Ethnicity

  29. Count each patient once and only once on Table 3B • AI/AN Line 4a col d must = total AI/AN patients reported on AI/AN Table 3A • Total on line 8 col d must = Total Patients by Zip Code Table and Age and Gender Table (Table 3A) • If no known race and/or ethnicity, report on line 7 Table 3B: Patients by Race and Ethnicity

  30. 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 • This is the only UDS cell that may be estimated

  31. Other Demographic Data: Income, Insurance, Managed Care, Veterans Table 4

  32. Table 4: Selected Patient Characteristics • Income • Insurance • Managed care • Veterans

  33. Table 4: Patients by Income • Use income as of the most recent assessment • Income may be self-reported if permitted by your policy • Income must be from recent patient data (within last year). Otherwise count as unknown. • Do not use insurance as a proxy for income • Count each patient once and only once by income • AI/AN Table must = total AI/AN patients reported on AI/AN Tables 3A, 3B line 4a • Total on Table 4 line 6 must = total patients

  34. Table 4: Patients by Medical Insurance • 2013 Change: Age Groups on lines 7-12: 0-17 and 18+ • Report principal 3rd party insurance for MEDICAL care (even if patient is not a medical patient) • Do not count as insurance, grant programs that pay for categorical services (e.g., Family Planning, Breast and Cervical Cancer Screening, etc.) • Workers Comp is not medical insurance • Insurance is reported as of the last visit (even if it did not pay for the visit in whole or in part) • State specific reporting of CHIP on Line 8b or 10b

  35. Table 4: Patients by Medical Insurance • Count each patient once and only once by insurance • AI/AN Table must = total AI/AN patients reported on AI/AN Tables 3A, 3B line 4a • Total on Table 4 line 12 col (a) and (b) must = total patients • Patients by insurance reported by age (0-17 and 18+) must match patients by same ages on Table 3A

  36. Table 4: Medical Insurance Reporting Categories • NONE/UNINSURED: patients with no insurance: may include patients for whom program is reimbursed through grant (e.g. BCCCP) or uncompensated care fund • MEDICAID: report all Medicaid patients including those in managed care programs run by commercial insurers • MEDICARE: report all Medicare Patients including Medicare Advantage and Medi-Medi patients

  37. Table 4: Medical Insurance Reporting Categories (continued) • CHIP: is handled differently from state to state: • If provided through Medicaid is reported on line 8b • If provided through a commercial carrier outside of Medicaid it is reported on Line 10b (Other Public- not private) • OTHER PUBLIC: Public coverage for patients for a broad set of benefits- very uncommon • Do not include family planning, breast and cervical programs, EPSDT, etc. • PRIVATE INSURANCE • NOTE: Workers Comp is not medical insurance

  38. Table 4: Managed Care Utilization & Veterans Managed Care • ONLY reported by programs with capitated and/or FFS managed care (HMO) contracts. • Patient is assigned to program’s provider • Patient MUST go to program provider for primary care services • Do not count Primary Care Case Management (PCCM) patients • A member month is 1 member enrolled for 1 month. Report the sum of monthly enrollment for 12 months (generally from HMO reports supplied to program) • In some cases, “members” might not be “patients” Veteran • A veteran is an individual who completed service in the uniformed services of the United States.

  39. Cross Table Issues • Patients by Zip Codes, T3A, T3B and T4 describe the same patients and must be equal. • The number of AI/AN patients reported on the AI/AN T3A L39 cols a + b; T3B line 4a col d; and AI/AN T4 line 6 col a describe the same patients and must be equal. • AI/AN tables are a subset of total (universal table); Numbers on the AI/AN table must be less than or equalthe corresponding number on the universal report for same table. • Managed care member months indicate managed care revenues on Table 9D

  40. Uses of Patient Data • Total number of patients and AI/AN patients • Proportion of AI/AN patients served in area • Socio demographic profile of patients • GIS mapping of service area • Calculated performance measures • Costs, visits, revenues per patient • Patients per provider FTE

  41. Test Your Reviewer Skills 1 • How would you check the reasonableness of these numbers? • Do they get your seal of approval?

  42. Table 5: Staffing and Utilization Describes the types and quantities of services provided and staff who provide these services FTEs, visits, and patients

  43. Table 5: Staffing and Utilization • Col (a) – Staff full-time equivalents (FTEs) reported by position • Col (b) – Clinic visits reported by provider type • Col (c) – Patients reported by service

  44. Who is included as a Full-time Equivalent (FTE)? • Include all workers providing services at approved sites • Employees, contracted staff, residents, and volunteers • FTE is actual for the year, not as of last day • Do not use staff list as of December 31 • Do not count FTE’s for paid referral providers (but docount the referral provider’s paid visits/patients).

  45. How are FTEs calculated? • 1.0 FTE is equivalent to one person working full-time for one year • FTE is adjusted for part-time work and for part-year employment • Calculate FTE by dividing worked hours by “full-time” hours • Each agency defines the number of paid hours it considers to be “full-time” work (e.g.,2080 hrs./yr., 1872 hrs./yr.)

  46. How are FTEs calculated? (Continued) • Calculate the FTE for hourly workers (including volunteers and residents) who received no paid leave by dividing hours worked by the comparable hours worked in that position less leave days. For example: • Resident worked 250 hours during the year • Full time doctor works 2080 hours less vacation (160) holidays (96) and CME (40) hours = 1784 • 250 / 1784 = 0.14 FTE

  47. Where are FTEs reported? • FTEs are reported based on work performed • FTEs can be allocated across multiple categories • Clinicians are not allocated from clinical • Allocate only corporate time to non-clinical for Medical Director • Reporting of FTEs of Table 5 must correspond to allocation of costs on Table 8A by cost center • See “Appendix A” in the UDS Reporting Manual for guidance on where to report staff

  48. Where are FTEs reported? (Continued) • Other Professional (line 22) • Other professional includes nutritionists, podiatrist, traditional healers, Physical/Occupational Therapists, etc. (See Appendix A) • Other Programs/Services (line 29a) • Activities that are in the scope of the project, but are not direct health care delivery services. Includes: • WIC, job training programs, child care, education and Head Start, food bank, shelter and housing programs, fitness and exercise programs, adult health daycare

  49. What is a Visit? • Face to face, 1:1 between patient and provider • Except for Behavioral Health visits (group and telemedicine) • Licensed provider for medical, dental, vision • Acting independently • Exercising independent judgment • The service must be charted (documented in patient record)

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