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2008 - 2009 BPHC Uniform Data System Training. Objectives. The 2008 Basic UDS training is designed to ensure that participants will know: Why the UDS is important How and when to submit your UDS report What is included in the UDS How each table is accurately completed

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2008 2009 bphc uniform data system training
2008 - 2009

BPHC Uniform Data System Training

objectives
Objectives
  • The 2008 Basic UDS training is designed to ensure that participants will know:
    • Why the UDS is important
    • How and when to submit your UDS report
    • What is included in the UDS
    • How each table is accurately completed
    • What help is available to assist you
your handouts
Your Handouts
  • Today’s agenda
  • Copy of the presentation slides
  • 2008 UDS Manual
    • Set of blank tables
  • National Roll-up tables for 2007
  • Summary of 2007 UDS Data
introduction to the uds

Introduction to the UDS

What is the UDS and why is it important?

the uds what is it
The UDS: What is it?
  • The Uniform Data System (UDS) is a standardized reporting system that provides consistent information about the performance of BPHC funded grantees and programs including:
    • Community Health Centers
    • Migrant/Farmworker Health Centers
    • Health Care for the Homeless Centers
    • Public Housing Primary Care Centers
information included
Information Included
  • The number and socio-demographic characteristics of people served
  • Types and quantities of services provided
  • Types of staff who provide these services
  • Enhanced clinical characteristics of patients
  • Cost and efficiency of delivering services
  • Sources and amounts of income
importance of the uds
Importance of the UDS
  • The BPHC has been collecting data documenting health center performance since 1977
  • Data are used to document the effectiveness of the BPHC programs to
    • The Office of Management and Budget (OMB)
    • Congress (Congressional Committees)
    • HRSA (BPHC and OPR) staff
    • PCAs, PCOs and other who “tell the story”
    • Researchers
importance cont
Importance – cont.
  • Data are used to
    • Evaluate impact of BPHC programs on the nation
    • Guide BPHC support decisions
    • Provide data for HRSA-OPR Performance Review process
    • Support program development and improvement at the grantee level
sac bpr use
SAC / BPR Use
  • BPHC has targeted clinical and financial UDS measures to be included in the SAC and BPR grant applications
  • For new clinical measures, 2008 data will serve as the baseline for reporting
    • NOTE: There are no established, normative, or standardized benchmarks!
  • Program monitoring will be facilitated through annual UDS reporting of required measures
getting help
Getting Help
  • Help and information is available year round (not just at submission time) through multiple mechanisms including:
    • These training programs
    • An annually revised UDS Manual
    • A telephone help line (866-UDS-HELP)
    • An on-line help site:

(udshelp330@bphcdata.net)

getting started

Getting Started

Who needs to report, how and when?

who reports
Who Reports
  • All grantees funded before October 1, 2008 (including New Starts) with one or more of the following BPHC grants:
    • 330(e): Community Health Center
    • 330(g): Farmworker Health Center
    • 330(h): Health Care for the Homeless
    • 330(i): Public Housing Primary Care Centers
what is reported
What is Reported
  • All activity included in your current “scope of project”
    • Includes everything in your most recent grant application and budget, funded expansions and approved changes of scope
    • Excludes all out of scope services
  • Activity is reported for the period January 1, 2008 - December 31, 2008
    • Regardless of when you were funded or first drew down funds
what tables are submitted
What Tables are Submitted
  • Agencies funded under only one BPHC funding authority complete only the “Universal” report
  • Agencies with multiple funding will also complete grant reports
    • An abbreviated report including only Tables 3A, 3B, 4, 5 and 6A
    • Covering only special populations programs
how and when to report
How and When to Report
  • UDS data will be entered through the HRSA “Electronic Handbook” (EHB) which will then be available for integration with other BPHC data
    • Demo of application on Day 2
  • UDS report is due March 2
    • Extra time provided this year because of new clinical reporting requirements
    • Will return to February 15th due date in 2010
data editing and correction
Data Editing and Correction
  • Your report is assigned to an Editor who reviews the report for accuracy and completeness
  • Your Editor will contact you for corrections and/or clarification as necessary
  • Editor completes editing June 15, 2009
  • No prior year revisions will be processed after September 1, 2008
table by table instructions

Table by Table Instructions

What is reported in each table:

tips for success
Tips for Success
  • Tables are interrelated – they cannot be completed without cross checking
  • Refer to the manual for step-by-step instructions for each table
  • Keep and update your work papers so you can remember what you did next year and make corrections more easily this year
overview of the tables
Patient Profile

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

Provider and Utilization Profile

Table 5 – Staffing and Utilization

FTEs, encounters and patients

Overview of the Tables
tables continued
Clinical Profile

Table 6A – Selected Diagnoses and Services

Table 6B – Quality of Care Indicators

Table 7 – Health Outcomes and Disparities

Financial Profile

Table 8A – Costs

Accrued costs by cost center

Table 9D – Patient related revenues

Charges, collections, allowances and discounts by payor type

Table 9E – Other revenues

Grants, contracts and other non-patient related income

Tables – continued
patient profile patients by zip code and tables 3a 3b and 4

Patient Profile- Patients by Zip Code andTables 3A, 3B and 4

Characteristics of patients including origin, age and sex, race and ethnicity, language, income and insurance

patients defined
Patients - Defined
  • Total Patients: Individuals who receive one or more documented encounter during the reporting year. (Encounters will be discussed when we get to Table 5!)
  • Grant Program Patient: An individual who receives one or more documented encounter supported by one of the special population grant programs (Homeless, Farm Worker, or Public Housing)
patients by zip code
Complete contact information for person responsible for UDS submission

Report number of patients by zip code for all patients

Patients by Zip Code
  • Special treatment of Special Populations:
    • Homeless – use zip code of location where patient receives services
    • Migrant – use zip code of temporary housing they are using where patient receives services
  • Report all zip codes with more than 10 patients
    • Combine the rest as “other zip codes”
table 3a patients by age gender
Report all patients who had any type of encounter reported on Table 5 during 2008

Age is calculated as of June 30

Count each person once and only once!

Table 3A Patientsby Age & Gender
table 3b patients by ethnicity
Total patients on Line 4 equals patients reported on line 11 and on Table 3A Line 39 Columns (a) and (b)

Ethnicity is self reported by patients

Table 3B: Patients by Ethnicity
table 3b patients by race
Total patients on Line 11 equals patients on line 4 and patients on Table 3A Line 39 Columns (a) and (b)

Race is self reported by patients; patients must have the option to select multiple races

Report patients who code race as Latino on Line 10

Note change in line numbers and subtotal (Lines 5a-5)

Table 3B: Patients by Race
table 3b patients by language
Patients best served in a language other than English include:

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 PR 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 patients by income
Total Patients on Line 6 equals Table 3A Line 39 Columns (a) and (b)

Use most recent income data including self-reported income

Income must be based on data obtained from patient – otherwise report as unknown

Table 4: Patients by Income
table 4 patients by insurance
Total Patients on Line 12 equals Line 6 and Table 3A Line 39 Columns (a) and (b)

Report principal 3rd party payor for medical care (even if patient is not a medical patient)

Insurance is reported as of the last visit

Table 4: Patients by Insurance
table 4 insurance
Include as “insurance” payors such as Medicaid, Medicare, Blue Cross, etc. which “belong” to the patient

Programs such as family planning, BCEDP, immunization grants, TB control and most state and local safety net programs belong to the clinic – the patient may not take the benefit elsewhere; these patients are often uninsured

Workers Comp is not medical insurance

SCHIP is handled differently in each state:

SCHIP which is provided through Medicaid is reported on

Line 8a

SCHIP which is provided through a commercial carrier is reported on Line 10a

Some states have both: Report patients for combined programs on the appropriate line

Table 4: Insurance
table 4 managed care utilization
To be completed ONLY by health centers with managed care contracts

A member month is defined as 1 member being enrolled for 1 month. Total member months equals the sum of the monthly enrollment for 12 months

Member month information should be obtained from monthly enrollment lists supplied by managed care companies to their providers

This information was previously reported on Table 9C

Table 4: Managed Care Utilization
table 4 target populations
Table 4: Target Populations
  • Grantees receiving special populations funding must report additional information:
    • 330(g) MHC Grantees report migrant and seasonal farmworkers separately
    • 330(h) HCH Grantees - report type of shelter arrangement at the time of first visit in 2008
  • Veteran is an individual who completed service in the Uniformed Services of the United States

All grantees must report the

total number of patients on

Lines 16, 23, 24 and 25.

tables 3a 3b 4 tips for success
Tables 3A, 3B, 4: Tips for Success
  • Health center patients are counted ONCE AND ONLY ONCE on each table regardless of the number of times that they received services and the type of services received
  • The total number of unduplicated patients reported on Tables 3A, 3B and 4 must be equal
  • If a you submit grant tables, the total number of patients reported on the grant table must be less than or equal to the corresponding number on the universal table for each and every cell!
  • You can aggregate zip codes with less than 10 patients each
table 5 staffing and utilization

Table 5Staffing and Utilization

Staff FTEs, patient visits/encounters and patients by service

table 5 staffing utilization
Col (a) – Staff full-time equivalents (FTEs) reported by position

Col (b) – Clinic encounters reported by position

Col (c) – Patients reported by service type

Table 5:Staffing & Utilization
col a ftes defined
Col (a): FTEs Defined
  • 1.0 “FTE” is defined as being the equivalent of one person working full-time for one year
  • Each agency defines the number of hours for “full-time” work
    • (e.g., if a physician is hired full-time and works 36 hours per week, she is 1.0 FTE)
  • FTEs are based on employment contracts for clinicians and exempt employees; FTE is calculated based on paid hours for non-exempt employees (e.g., 2080 hrs/yr)
  • FTEs are adjusted for part-time work or for part-year employment
col a ftes reported
Col (a): FTEs reported
  • Report FTEs on lines corresponding with work performed, not by job title
  • Include as FTEs:
    • Employees
    • Contract personnel (not paid by unit of service)
    • Volunteers based on hours worked
    • Residents based on hours worked
  • Do not reduce clinical FTEs for vacation, CME, meetings, holidays, etc.
  • Do not allocate a portion of MDs’ and midlevel practitioners’ time to non-clinical functions
col a changes
Col (a): Changes
  • New positions added to Table 5 in 2008
    • Line 20a1 LCP
    • Line 20a2 LCSW
    • Line 30a Management and Support Staff
      • Management team including CFO, secretaries, AAs, etc.
    • Line 30b Fiscal and Billing staff
      • Accounting and billing staff excluding CFO
    • Line 30c IT Staff
  • Enabling positions (lines 24 – 28) changed to conform with changes on Table 8A (inclusion of lines from 8B)
col b encounters defined
Col (b) Encounters Defined
  • To qualify: An encounter must be face to face between the patient and the provider
      • An exception is provided for behavioral health telemedicine
  • Medical and dental providers must be licensed
      • Mental health has lines for licensed and unlicensed
      • All others are credentialed by the center
  • The provider must be acting independently
  • The provider must be exercising professional judgment
      • Not all interactions require professional judgment
  • The service must be charted
col b encounters reported
Col (b) Encounters: Reported
  • Report encounters on lines corresponding with staff performing the service
    • Medical encounters are provided by physicians, mid-level practitioners and licensed nurses only
    • Dental encounters are provided by dentists and dental hygienists only
  • Include Encounters:
    • Provided by paid and volunteer staff
    • Provided by a third party and paid for in full by grantee, including managed care referrals or voucher program encounters.
    • Performed by staff rounding on patients in the hospital
col b encounters visits per day
Col (b) Encounters - Visits per day
  • One encounter per patient (user), per provider type, per day
    • One medical – One dental
    • One mental health – One substance abuse
    • One Health Education – One Case Management
    • One of each type of “Other Health” service
  • Exception: Two encounters of the same type with two different providers at two different locations may both be counted
  • (NOTE: This UDS rule is not consistent with the rules of each and everythird party payor)
col b encounters defined visits per provider
Col (b) Encounters Defined – Visits per Provider
  • A provider counts only one encounter with a patient during a day regardless of the number of services provided to that patient
    • A pediatrician providing fluoride drops during a medical visit cannot count a dental encounter
    • Case managers frequently provide case management and health education – but there is just one encounter
    • Dentists may count only one visit, regardless of the number of teeth worked on
col b encounters interactions that are not encounters
Col (b) Encounters -Interactions that are not encounters
  • “Group encounters”
    • Only mental health group counseling encounters may be counted – if and only if it is charted in each patient’s chart and each patient is charged
    • No medical group visits may be counted
    • Group health education interactions are not counted
  • Other uncounted interactions:
    • Health education classes
    • Community meetings
    • Health fairs or mass screenings
    • “Immunization clinics” or “immunization only” services
    • Lab tests or “lab only” visits, x-rays or x-ray only visits
    • Pharmacy visits, refills, “Clinical Pharmacist” services
    • Outreach which provides only information on services
col c patients
Col (c) Patients
  • Service Patient: An individual who receives one or more documented “encounter” of any specific service type:

– Medical – Dental

– Mental Health – Substance Abuse

– Enabling – Perinatal

col c patients46
Col (c) Patients
  • A patient should be counted once and only once in each category in which they receive services
    • Thus, the same individual must! be counted as both a medical patient and a dental patient if they used both services
    • But they would be counted only once in any given category regardless of the number of visits they had
  • The total of any combination of patient categories should not equal total patients on Tables 3A and 4 unless only one type of service is offered!
table 5 grant tables
Table 5 - Grant Tables
  • Table 5 Grant Reports will include only visits (column b) and patients by service (column c)
    • FTEs are not reported on the grant report
    • All activity for grant report patients (those included on Tables 3A, 3B, and 4) is included on the Table 5 grant report, regardless of funding sources
      • e.g., a dental encounter for a public housing “patient” is included on the public housing Grant Table, regardless of the source of the funds which pay for the visit
table 5 tips for success
Table 5 – Tips for Success
  • Tables 5, and 8A are closely related. All FTEs reported on Table 5 must be included in the same cost center on Tables 8A. Preparation of Tables 5 and 8A must be coordinated
  • Encounters and patients reported in any cell of the grant tables cannot exceed the number reported on the universal table
  • Review definitions of patients, encounters and FTE employees
table 6a selected diagnoses and services rendered

Table 6ASelected Diagnoses and Services Rendered

Patients and encounters for selected primary diagnoses and services

table 6a col a diagnoses
Lines 1-20d reports patient and encounters for selected primary diagnoses

Diagnoses not typically reported as primary will likely appear underreported (e.g., SA and MH)

Typically only a fraction of total encounters are recorded on this table

Table 6A Col (a) – Diagnoses
table 6a col a services
Use ICD-9 or CPT codes for lines that provide an option – not both

Encounter is to be counted once for each countable service

a single visit can be on the pap test, mammogram and family planning service lines

Count visit only once for each service code even if multiple services are given (e.g. 5 vaccines or two fillings in one visit is counted only once)

Table 6A Col (a) – Services
table 6a col b patients
Unduplicated number of patients seen during the year with this primary diagnosis (lines 1-20) or having received this service (lines 21-32)

Each patient may be counted once and only once on each line, as appropriate

Adding dental patients by type should exceed total dental patients on T5

Table 6A Col (b) – Patients
table 6a tips for success
Table 6A – Tips for Success
  • Encounters and patients reported in any cell of the grant tables cannot exceed the number reported on the universal table
  • Review ratios of services per patient to assess reasonableness of data (e.g., pap tests, HIV tests, mammograms, etc.)
  • Use ICD-9 or CPT but not both or services will be overcounted
table 6b quality of care indicators

Table 6BQuality of Care Indicators

Measures commonly seen as indicators of overall community health

quality of care indicators
Quality of Care Indicators
  • These are all “process measures”: If patients receive timely routine and preventive care, then we can expect improved health status
    • Early entry into prenatal care: If women enter care in their first trimester then probability of adverse birth outcome will be reduced
    • Childhood immunizations: If children receive their vaccinations in a timely fashion then they will be less likely to contract vaccine preventable diseases or to suffer from the sequela of these diseases
    • Pap tests: If women receive Pap tests as recommended then they can be treated earlier and will be less likely to suffer adverse outcomes from HPV and cervical cancer
early entry into prenatal care
Early Entry into Prenatal Care

Section A is ONLY completed by grantees with Prenatal Programs. This section was reported on Table 7 in 2007

  • Section A: Prenatal patients by age
    • Report all patients who received prenatal care during the year, regardless of whether they delivered, including women whose only service in 2008 was their delivery
    • Include women who transferred or were “risked out”, as well as women who were delivered by another provider
    • Do not include patients who were tested but did not have a clinical visit
early entry into prenatal care57
Early Entry into Prenatal Care

Section B is ONLY completed by grantees with Prenatal Programs. This section was reported on Table 7 in 2007

  • Section B: Trimester of entry into prenatal care
    • 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 begins with 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, etc)
childhood immunizations
Childhood Immunizations
  • Col (a) Universe: All children who turned 2 in 2008; had with at least one medical visit in 2008; and were first ever seen prior to their 2nd birthday.
  • Col (b) Sample: Universe or sample of 70 patients
  • Col (c ): Number of children in Col (b) who are fully immunized meaning that they have received vaccine, or had evidence of disease or contraindication for vaccine by their second birthday
required vaccines
Required Vaccines
  • Fully immunized means:
    • 4 DTP/DTaP,
    • 3 IPV,
    • 1 MMR,
    • 3 Hib,
    • 3 HepB,
    • 1VZV (Varicella)
    • 4 Pneumoccocal conjugate
  • Or evidence of the disease
  • Or allergic reaction to a vaccine or its components ICD-9: 999.4
additional guidance
Additional Guidance
  • BPHC follows NQF criteria – see manual for details.
  • 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 provider does not constitute sufficient evidence of immunization for this measure.
  • 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
pap tests
PAP Tests
  • Col (a) Universe: All women aged 21 – 64; with at least one medical visit in the health center clinic in the reporting year; who was first seen before age 65
  • Col (b) Sample: Universe or sample of 70 patients
  • Col (c ): 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.
handling exclusions
Handling Exclusions
  • Exclusions: Women with a hysterectomy
  • If your system can identify all women in the universe with a hysterectomy, exclude these women:
    • Col (a) will equal all women without a hysterectomy
  • If your system cannot identify all women in the universe with a hysterectomy, report the universe unadjusted:
    • Col (a) will equal the universe (including women with a hysterectomy)
    • Use a sample to complete Col (b) and Col (c)
    • NOTE: If a women with a hysterectomy is identified in the sample, do not reduce Col (a) but substitute the excluded patient with another patient from the sample
additional guidance63
Additional Guidance
  • Count as in compliance a medical record with
    • A copy of the test result
    • A provider note in the patient chart including test date and result
  • A note that “patient was referred” or “patient reported receiving pap test” that does not have provider confirmation of date and test result does not constitute sufficient evidence of pap test for this measure.
  • Good faith efforts which fail remain “non-compliant” including
    • Patient refusal
    • Patient failure to return for scheduled test
table 7 outcome and disparity measures

Table 7Outcome and Disparity Measures

Measures commonly seen as indicators of overall community health

health outcomes
Health Outcomes
  • These are all “intermediate outcome measures”: If this measurable intermediate outcome is improved, then later negative health outcomes will be less likely.
    • Normal Birthweight: If there are fewer low birthweight children born, then there will be fewer children who suffer the multiple negative sequela of low birthweight
    • Controlled Hypertension: If there is less uncontrolled hypertension, then there will be less cardiovascular damage, fewer heart attacks, less organ damage later in life
    • Controlled Diabetes: If there is less uncontrolled diabetes then there will be fewer amputations, less blindness, less organ damage later in life
disparities
Disparities

All outcome data are collected by Race

and by Ethnicity:

birthweight
Birthweight
  • Line 1 Universe: Report all women from Table 6B Section B who were known to have delivered during the year, even if the delivery was done by another provider.
  • Line 2: Report the total number of deliveries performed by center clinicians including non-health center patients.
  • Lines 3-6: All live children by weight, including multiples born to CHC perinatal care patients in program year regardless of who performed the delivery.

Section A is ONLY completed by grantees with Prenatal Programs. This section was reported on Table 7 in 2007

controlled hypertension
Controlled Hypertension
  • Line 6 Universe: All patients aged 18 or more; with a diagnosis of hypertension prior to 6/30/08; with at least 2 medical visits during the reporting year
  • Line 7 Sample: Universe or sample of 70 patients
  • Line 8 Compliance: Number of adult patients in Line 7 whose most recent blood pressure was less than 140/90

Note: No documented blood pressure during the reporting year is counted as out of compliance.

controlled diabetes
Controlled Diabetes
  • Line 9 Universe: All patients aged 18 or over; with a diagnosis of diabetes; with at least 2 medical visits during the reporting year
  • Line 10 Sample: Universe or sample of 70 patients
  • Line 11-13 Test result: Number of adult patients in Line 10 whose most HBA1c in the reporting year is in the given range

Note: No documented HBA1c test during the reporting year is reported on Line 13 as uncontrolled diabetes.

handling exclusions70
Handling Exclusions
  • No diabetic patients are to be excluded, except that patients whose diagnosis is of gestational diabetes or steroid-induced diabetes are not to be included in the sample.
  • If a diabetic patient with an exclusion is identified in the sample, do not reduce Line 9, but substitute the excluded patient with another patient from the sample.
options for reporting
Options for Reporting
  • Options exist only for:
    • Childhood immunizations
    • Pap tests
    • Controlled hypertension
    • Controlled diabetes
  • Report universe (may be less than 70 if there are fewer than 70 in the universe)
  • or sample of 70
  • There is no BPHC preference for reporting universe or sample
reporting on the universe
Reporting on the Universe
  • Universe defined: All patients who meet the reporting criteria
  • To report on the entire universe, the data source must:
    • Include all patients from all sites and programs (e.g., HCH, CHC, PH, MHC)
    • Include searchable fields with required clinical measures over the required time frame (e.g., 3 years)
    • Identify patients with exclusions:
      • Pap tests: women with hysterectomy
      • Diabetes: Gestational diabetes and steroid-induced diabetes
reporting on a sample
Reporting on a Sample
  • Alternatively, health center can report on a random sample…a part of the universe where each member of the universe has the exact same chance of being selected as every other member of the universe.
step 1 finding the universe
Step 1 – Finding the Universe
  • The initial query must at a minimum find all patients who meet the criteria.
    • Not a problem if all patient data are on a single system with at least three years of data
    • If different sites are on different systems, qualifying patients chart numbers (or names) will need to be downloaded so that they can be merged.
      • This is the same process that is being done to get unduplicated patients for Table 3A etc.
step 2 selecting sample
Step 2 – Selecting Sample
  • Identify 70 random charts
  • Two methods can be used:
    • Random number generator
    • Interval
  • Either method can be used to create a “replacement list” used to replace patients who are excluded.
method 1 random generator
Method 1: Random # Generator
  • Prepare numbered list of all patients in universe
  • Use web site to generate random numbershttp://www.randomizer.org/form.htm
  • Random numbers correspond with the number list of patients
example using random number
Example using Random Number

Sets of numbers = 1

Numbers per set = 70

Number range = 1- “n” (maximum number in universe)

Unique numbers – Yes

Sort numbers – Yes: Least to Greatest

step 3 replacements
Step 3 – Replacements
  • Create a second “set” of random numbers using same method with 5 records in the set
  • Do NOT sort the sample!
  • If a record in the sample of 70 patients is identified which should be excluded (e.g., a woman with a hysterectomy for pap tests), replace that record with a record from the second set (sample of 5)
method 2 interval
Method 2: Interval
  • Calculate sampling interval by dividing number of patients in the universe by 70:Universe / 70 = SI (sampling interval)
  • Pick a number between 1 and SI

That will be your first record sequence number

  • Skip down the list “SI” records first sequence # + SI = second #
  • Continue through list until all 70 have been identified
slide81

Example using Interval Method

Sample Interval (SI) = 3

First record = #2 (selected at random from between 1 and 3)

Next records = #5 (2+3)

#8 (5+3)

#11 (8+3)

#14 11+3)

step 3 replacements82
Step 3 – Replacements
  • If a record in the sample of 70 patients is identified which should be excluded (e.g., a woman with a hysterectomy for pap tests), replace that record with the record immediately after that onein the list as the replacement
use of data from other sources
Use of data from other sources
  • Before charts are actually pulled and reviewed, other sources may be queried for the “answer” on compliance:
    • EHRs, EMRs, PMSs
      • May not cover all patients or be in place for a long enough time, but may still be used to review patients and periods which are recorded
    • Immunization registries maintained by the state.
    • Collaborative registries maintained by the clinic for some, but not all of the patients who meet the criteria
    • Logs or other “off line” lists
reviewing the charts
Reviewing the Charts
  • Eventually, some or all charts in the sample for one or more of the measures will need to be reviewed.
  • With multiple locations:
    • All charts may be brought to a central point
    • Single reviewer may travel to each site
    • Multiple reviewers may review at each site
  • Tools are available from the Helpline
table 8a financial costs

Table 8A Financial Costs

Costs by cost center

table 8a financial costs87
Col (a) Accrued Costs:

Direct costs

Report donated costs on line 18 only

Exclude bad debt

Col (b) Allocation of Facility and Admin:

Allocate indirect costs from Line 16 to cost centers

Col (c ) Total Cost:

Sum of direct and indirect expenses

Table 8A – Financial Costs
table 8a financial costs88
Table 8A – Financial Costs
  • Include direct costs for each cost center consistent with FTEs reported on Table 5
table 8a lines 1 10
Table 8A - Lines 1 - 10
  • Medical Care Costs:
    • Line 1 Medical staff salaries and benefits including staff on contract and contracted visits
    • Line 2: All medical lab and x-ray costs including supplies, etc.
    • Line 3: All other direct medical costs – dues, supplies, depreciation, travel, CME, etc.
  • Other Clinical Services Costs:
    • Lines 5 to 7and 9 Include all direct personnel and supplies expenses
table 8a lines 8a 8b pharmacy
Table 8A - Lines 8a/8b Pharmacy
  • Pharmacy costs are divided:
    • Line 8b = cost of pharmaceuticals only.
    • Line 8a = all other 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 – “pharmaceuticals”
    • Note: do not include donated pharmaceuticals on either line! This is shown on line 18
table 8a lines 11a 13
Table 8A - Lines 11a -13
  • Enabling:
    • Line 11a-11g Include all direct personnel and supplies expenses for enabling services
    • Enabling categories from Table 8B moved to Table 8A Lines 11a – 11g
  • Other Program Related:
    • Line 12 Include all direct personnel and supplies expenses for “pass through” funds and non-health-care services such as:
      • WIC Housing Corporations
      • Job training  Home-maker chore programs
table 8a lines 14 16 overhead
Line 14: Facility costs include rent or depreciation, interest payments, utilities, security, janitorial services, maintenance, etc.

Line 15: Admin costs include costs for corporate admin staff, billing and collections staff, medical records and intake staff and associated costs including supplies, equipment, depreciation, travel, etc.

Table 8A - Lines 14 –16 Overhead
allocation of overhead
Allocation of Overhead
  • Overhead costs on Line 16 (facility and administration) are allocated to cost centers in Col (b)
  • Traditional methods are described in manual but are not necessarily the best or most accurate way of doing the allocation
  • More accurate alternative methods – especially for administrative costs – should be used whenever possible
allocation of overhead facility
Allocation of Overhead - Facility
  • Traditional method:
    • Facilities costs are allocated based on total square footage utilized by cost center
  • Common modifications:
    • Each building allocated separately.
    • Dedicated buildings (admin, dental clinic, etc.) have full costs allocated directly
    • Improvements of a specific area (e.g., converting storage to exam rooms) are allocated to that specific area
allocation of overhead admin
Allocation of Overhead - Admin
  • Traditional method:
    • Administrative costs, including allocated facility costs, are allocated based on a straight line method using the proportion of total costs excluding overhead attributable to the service category)
  • Common modifications:
    • Medical records allocated only to medical or to medical + dental + behavioral health as appropriate (based on chart pulls??)
allocation of overhead admin96
Allocation of Overhead - Admin
  • Common modifications – continued:
    • Billing functions allocated to Medical + Dental + Behavioral as appropriate. (Based on charges? Codes entered?)
    • Minimal allocation to cost of pharmaceuticals
    • Minimal allocation to cost of contracted services (e.g., contract dental program)
    • Minimal or no allocation to depreciation elements (e.g., depreciation of expensive facility)
table 8a tips for success
Table 8A – Tips for Success
  • Staff FTEs reported by service on Table 5 must be consistent with costs reported on Table 8A by cost center
    • (e.g., FTEs reported for Case Management on Table 5 should be included under Case Management Costs on Table 8A).
  • Donated pharmaceuticals should be valued at the 340b discount pricing (Line 18); donated drugs are not reported on line 8b.
  • Complete “specify” boxes.
table 9d patient revenues

Table 9D Patient Revenues

Charges, collections and allowances by payor

table 9d charges col a
Undiscounted, unadjusted charges for services based on fee schedule; charges should cover costs

Include all charges (e.g., pharmacy, dental and mental health)

Do not include “charges” where no collection is attempted or expected such as enabling services or pharmacy samples

Table 9D – Charges Col (a)
table 9d collections col b
Amount collected as payment for health care services:

Cash collections from patients

Including nominal fees

Not including “donations” (which are shown on Table 9E)

Payments from third party payors

Including all private insurance companies

Including public payors such as Medicaid, S-CHIP and Medicare

All capitation payments

If capitations are not recorded in the receivables system, be sure to recover this number from the GL and enter it in Col (b) of Table 9D.

Table 9D – Collections Col (b)
table 9d adjustments col c1 c4
These amounts are also included in col (b)

Columns (c1) and (c2): FQHC payments for settlements (difference between established per-visit rate and actual capitations) and reconciliations (submission of a cost report)

Col (c3) – “Other Retroactive Payments” including

risk pools / incentives: bonuses paid for successfully controlling utilization or for quality of care

withholds: amounts deducted from capitation for specific services and paid back if not spent

Table 9D – Adjustments Col (c1-c4)
table 9d 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

non-payment of bills which were not submitted in a timely fashion or properly signed / submitted

deductibles or co-payments that are not paid by a third party and not collected from patient

Table 9D – Allowances (Col d)
table 9d allowances
Allowances in capitated programs

For capitated plans only, the allowance is calculated a the difference between total charges and collections unless there are early or late capitation payments: (col d = col a – col b)

Reduce the allowance in col d by the amount of FQHC adjustments

Table 9D – Allowances
table 9d sliding discounts col e
A reduction in the amount due or paid for services rendered which is based solely on the patient’s documented income and family size as it relates to the poverty level

May be applied to co-payments, deductibles and non-covered services for insured patients when the charge has been moved to self pay

Table 9D – Sliding discounts Col (e)
table 9d 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

Bad debt is never reported as a “cost” on Table 8A.

Table 9D – Bad debt Col (f)
table 9d payors
Lines 1 - 3: Medicaid includes

All routine Medicaid under any name

EPSDT

Medicaid part of Medi-Medi or crossovers

SCHIP, if paid through Medicaid

In some states, may also include fees for other state programs which are paid by the Medicaid intermediary

Lines 4-6: Medicare includes

All routine Medicare

Medicare portion of Medi-Medi or crossovers

Table 9D - Payors
table 9d payors107
Lines 7-9: Other Public includes

State or other public insurance programs

Non-Medicaid SCHIP programs

State-based programs which cover a specific service or disease such as BCCCP, Title X, Title V, TB

Does not include indigent care programs

Lines 10-12: Private includes

Private and commercial insurance

Includes medi-gap programs, Tricare, Trigon, Workers Comp, etc.

Table 9D - Payors
table 9d payors108
Line 13: Self Pay includes

All charges that patients are responsible for and all associated collections including those for:

Full fee patients

Patients receiving sliding discounts

“nominal fee” or “zero-pay” patients

Co payments and/or deductibles

Services not otherwise covered by a patient’s insurance

Services which form or will form the basis for state or local safety net (uncompensated care) funds

Table 9D - Payors
table 9d tips for success
Table 9D – Tips for Success
  • It is essential to reclassify charges:
    • Co-payments and deductibles and amounts rejected by third parties because the service or the patient wasn’t covered are moved:
      • Remove from charges under Medicare, Private and any other payor that calls for such payments
      • Add to charges on line 1 (for Medicaid cross-over) or line 9 (for MediGap or multiple policies) or Line 13 (for patient responsibility)
      • Show collections of these amounts on the appropriate line
table 9d tips for success110
Table 9D – Tips for Success
  • Include the net of the amounts reported in Cols c1-c4 in col (b)
  • Be sure to reduce the allowances in Column (d) by amounts received in c1-c3
  • Do not include bad debt in allowances
  • Reclassify any portion of a charge which has been re-billed to another party
table 9e other revenues

Table 9E Other Revenues

Non-patient-service income

table 9e other revenues112
Report non-patient service income

Cash basis – amount received during year

Report “last party” to handle funds before you receive them

Federal dollars received through the state are reported as “state”

Grant passed through another health center is “private”

Table 9E – Other Revenues
table 9e bphc grants
Line 1: BPHC Grants

All funds received from BPHC regardless of their end use must be reported

If funds are passed through to another agency and:

You count the users on Tables 3A, 3B, 4 and 5 and the staff and production on Table 5:

Show costs by type of Table 8A

You report nothing else about the grant:

Show costs (usually, the same amount) as “other” on Table 8A Line 12

Table 9E – BPHC Grants
table 9e other revenues114
Line 5: Other Federal Grants

Grants received directly from Federal Government except BPHC

Do not report Ryan White Title I or II funds or Title III funds from another grantee.

Absolutely no BPHC funds are to be reported on these lines!

(Except H-CAP, Black Lung and Radiation grants)

Do not include IHS funds for compacted and contracted tribes

These are considered “safety net” (line 6A)

Line 6: State Grants ~~ and ~~ Line 7: Local Grants

Non health service delivery grants (WIC, prevention, outreach)

Grants for health services which are not tied to service delivery

Includes grants that pay for line items rather than products

Are not “product sensitive” -- won’t be reduced if you under-produce or be increased if you over-produce

Table 9E – Other Revenues
table 9e other revenues115
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

May be based on a pre-set “per-visit” fee

Full charges for these programs are reported on Table 9D as self-pay charges and everything not due from the patient is written off as a sliding discounts.

Table 9E – Other Revenues
table 9e other revenues116
Line 8: Foundation / Private Grants

Funds received from foundations or private organizations (including funds received from another health center)

Line 10: Other Revenues

Contributions, fund raising income, rents and sales, patient record fees, etc.

Table 9E – Other Revenues
table 9e tips for success
Table 9E – Tips for Success
  • Do not include value of donated services supplies or facilities
  • Do not include capital received as a loan
  • Do not include patient-related revenues (e.g., pharmacy, BCCCP, etc.)
  • Complete the “specify” box describing source of funds and amount
  • Explain large changes in funding
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