For CY2013 - Modular On

Report
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
•
•
•
•
URBAN
INDIAN
HEALTH
PROGRAM
CY2013
1
Reference Materials
•
•
•
•
•
URBAN
INDIAN
HEALTH
PROGRAM
CY2013
Copy of the presentation slides
CY2013 UDS Manual, Tables, Fact Sheets
Summary of CY2013 changes
UDS Feedback Report
UDS Reference Formula Guide
2
Do you know?
• How many patients are served by the Urban Indian Health
Program? (117,557 Patients, 51,646 AI/AN)
• How many visits?
(507,987)
• What % of patients are uninsured?
(52%) on Medicaid? (30%)
• What is the average cost per medical visit?
• Where can you get this information?
• How is this information used?
($230)
(UIHP UDS for CY2012)
(We’ll discuss in a few moments…)
• Why are we here today? (Accurate Reporting of the UDS Data)
URBAN
INDIAN
HEALTH
PROGRAM
CY2013
3
2012 Program Impact
• 33 Programs
serving 117,557
• Total Visits include
Medical, Dental,
MH, SA, Vision,
Other Professional
and Enabling
Services
• Employees
represent FTEthose employed
greater
URBAN
INDIAN
HEALTH
PROGRAM
CY2013
4
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)
URBAN
INDIAN
HEALTH
PROGRAM
CY2013
5
11 Tables Provide a Snapshot of Patients and
performance from January 1 – December 31
What is Reported
Table(s)
Patients you serve
Coversheet/Zip Code
Tables 3A, 3B, 4
Staffing Mix
Table 5
Types and quantities of services
you provide
The care you deliver
Costs of providing services
Revenue sources
Tables 2, 5 and 6A
URBAN
INDIAN
HEALTH
PROGRAM
CY2013
Tables 6A
Table 8A
Tables 9D and 9E
6
Universal and AI/AN Tables
Table
Universal Report
AI/\AN Table
Coversheet, Zip
Code, Table 2
Yes
3A, 3B, 4
Yes
Yes
5
Yes
Visits & Patients, only
6A
Yes
Yes
8A
Yes
9D
Yes
9E
Yes
URBAN
INDIAN
HEALTH
PROGRAM
CY2013
7
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
URBAN
INDIAN
HEALTH
PROGRAM
CY2013
8
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
URBAN
INDIAN
HEALTH
PROGRAM
CY2013
9
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: [email protected]
• Technical support to review submission
URBAN
INDIAN
HEALTH
PROGRAM
CY2013
10
Strategies for Success: Submission
• Work as a Team
• Refer to reporting manual, fact sheets and
support resources
• Check your data before submitting
•
•
•
•
URBAN
INDIAN
HEALTH
PROGRAM
CY2013
Address all edits
Check data trends
Compare data to benchmarks
Refer to last year’s review questions
11
UDS Tables and Definitions
URBAN
INDIAN
HEALTH
PROGRAM
CY2013
12
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
URBAN
INDIAN
HEALTH
PROGRAM
CY2013
13
CY2013 Changes
Table
CY2013
Coversheet,
Zip Code, Table 2
No Change
3A, 3B
No Change
4
Table 4: Change in age groups for insurance data (Table 4 lines 7-12) to:
Ages 0-17 years old (column a) and
Ages 18 and over (column b)
5
No Change
6A
No Change
8A
No Change
9D
No Change
9E
No Change
URBAN
INDIAN
HEALTH
PROGRAM
CY2013
14
General Information
Provides general information
on program including contacts,
service locations and services
URBAN
INDIAN
HEALTH
PROGRAM
CY2013
15
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
URBAN
INDIAN
HEALTH
PROGRAM
CY2013
16
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)
URBAN
INDIAN
HEALTH
PROGRAM
CY2013
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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
URBAN
INDIAN
HEALTH
PROGRAM
CY2013
18
Patient Profile
Describes the number of patients served and their
socio-demographic characteristics including AI/AN patients
URBAN
INDIAN
HEALTH
PROGRAM
CY2013
19
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
URBAN
INDIAN
HEALTH
PROGRAM
CY2013
2020
Who Counts: Patient Defined
• An individual who has one or more visits that
was reported on Table 5 during 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
URBAN
INDIAN
HEALTH
PROGRAM
CY2013
21
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
URBAN
INDIAN
HEALTH
PROGRAM
CY2013
22
Zip Code Table
Patients by Zip Codes
URBAN
INDIAN
HEALTH
PROGRAM
CY2013
23
Patients by Zip Code
•
•
•
•
URBAN
INDIAN
HEALTH
PROGRAM
CY2013
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’
24
Patients by Zip Code
(continued)
Additional instructions for reporting zip
codes for special populations:
•
•
URBAN
INDIAN
HEALTH
PROGRAM
CY2013
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.
25
Tables 3A and 3B
Patient Demographics
URBAN
INDIAN
HEALTH
PROGRAM
CY2013
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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.
URBAN
INDIAN
HEALTH
PROGRAM
CY2013
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Table 3B: Patients by Race and Ethnicity
• Patients self select
except AI/AN (line 4a);
4b for “Other” AI/AN
• Use Column b (NonHispanic) 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
URBAN
INDIAN
HEALTH
PROGRAM
CY2013
28
Table 3B: Patients by Race and Ethnicity
• 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
URBAN
INDIAN
HEALTH
PROGRAM
CY2013
29
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
URBAN
INDIAN
HEALTH
PROGRAM
CY2013
30
Table 4
Other Demographic Data:
Income, Insurance, Managed Care, Veterans
URBAN
INDIAN
HEALTH
PROGRAM
CY2013
31
Table 4:
Selected Patient Characteristics
• Income
• Insurance
• Managed
care
• Veterans
URBAN
INDIAN
HEALTH
PROGRAM
CY2013
32
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
URBAN
INDIAN
HEALTH
PROGRAM
CY2013
33
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
URBAN
INDIAN
HEALTH
PROGRAM
CY2013
34
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
URBAN
INDIAN
HEALTH
PROGRAM
CY2013
35
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
URBAN
INDIAN
HEALTH
PROGRAM
CY2013
36
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 Publicnot 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
URBAN
INDIAN
HEALTH
PROGRAM
CY2013
37
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.
URBAN
INDIAN
HEALTH
PROGRAM
CY2013
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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 equal
the corresponding number on the universal report for
same table.
• Managed care member months indicate managed care
revenues on Table 9D
URBAN
INDIAN
HEALTH
PROGRAM
CY2013
39
Uses of Patient Data
•
•
•
•
•
URBAN
INDIAN
HEALTH
PROGRAM
CY2013
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
40
Test Your Reviewer Skills 1
• How would you check the reasonableness of these numbers?
• Do they get your seal of approval?
URBAN
INDIAN
HEALTH
PROGRAM
CY2013
41
Table 5: Staffing and Utilization
FTEs, visits, and patients
Describes the types and quantities of services provided
and staff who provide these services
URBAN
INDIAN
HEALTH
PROGRAM
CY2013
42
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
URBAN
INDIAN
HEALTH
PROGRAM
CY2013
43
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 do
count the referral provider’s paid visits/patients).
URBAN
INDIAN
HEALTH
PROGRAM
CY2013
44
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.)
URBAN
INDIAN
HEALTH
PROGRAM
CY2013
45
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
URBAN
INDIAN
HEALTH
PROGRAM
CY2013
46
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
URBAN
INDIAN
HEALTH
PROGRAM
CY2013
47
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
•
URBAN
INDIAN
HEALTH
PROGRAM
CY2013
48
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)
URBAN
INDIAN
HEALTH
PROGRAM
CY2013
49
What is a Visit? (continued)
• Only 1 visit per patient per provider type per
day
Unless 2 different providers at 2 different
sites
• Only 1 visit per provider per patient per day
regardless of the number of services provided
URBAN
INDIAN
HEALTH
PROGRAM
CY2013
50
What is a Visit? (continued)
• Count paid referral, nursing home and hospital visits
and visits provided by volunteers and contracted staff
• Do not count:
 Group visits including health education classes
(except behavioral health)
 Health fairs and screenings (e.g., blood pressure,
etc.)
 Immunization-only and lab-only, visits
 Pharmacy visits
URBAN
INDIAN
HEALTH
PROGRAM
CY2013
51
What is a service patient?
• An individual who receives one or more documented
“visits” of any of the service types on Table 5:
• Medical
• Dental
• Vision
• Other Professional
• Mental Health
• Substance Abuse
• Enabling (of selected services)
• A patient should be counted once and only once in
each category in which they receive services
URBAN
INDIAN
HEALTH
PROGRAM
CY2013
52
AI/AN Table 5
• FTEs (Column a) are not reported on the
AI/AN Table 5
• Report visits and services received by AI/AN
patients
URBAN
INDIAN
HEALTH
PROGRAM
CY2013
53
Cross Table Issues
• The sum of patients by service type on T5: should
not equal total patients on 3A (unless only one
type of service is offered)
• Tables 5 and 8A: Staff reported on T5 must be
included in the same cost center on T8A
• Tables 5 and 9D: Billable visits reported on T5
should relate to patient charges reported on T9D
• Visits and patients reported in any cell of the
AI/AN table cannot exceed the number reported
on universal table
URBAN
INDIAN
HEALTH
PROGRAM
CY2013
54
Uses of Utilization and FTE Data
•
•
•
•
•
URBAN
INDIAN
HEALTH
PROGRAM
CY2013
Staffing Ratios
Visits per provider (productivity)
Panel size: Patients per provider
Continuity of Care: Visits per patient
Calculated performance measures
 Costs per patient and per visit
 Charge and collection per visit
55
Test Your Reviewer Skills 2
• How would you check the reasonableness
of these numbers?
URBAN
INDIAN
HEALTH
PROGRAM
CY2013
56
Table 6A: Clinical Profile
Describes patients by selected
diagnoses and services received
URBAN
INDIAN
HEALTH
PROGRAM
CY2013
57
Clinical Profile Table
Table 6A –Selected Diagnoses and Services
• Report visits and patients for the selected diagnosis
on lines 1-20e, regardless of whether it was a
primary or secondary, tertiary, etc. diagnosis
 Changed in CY2012 to allow reporting of selected
diagnoses regardless of primacy. Prior to CY2012 only
primary was reported on lines 1-20e
URBAN
INDIAN
HEALTH
PROGRAM
CY2013
58
Table 6A: Selected Diagnoses and
Services Rendered
• Lines 1-20e
diagnoses regardless
of primacy
• Lines 21-34 Selected
Services
• Column (a) – Visits
• Column (b) – Patients
URBAN
INDIAN
HEALTH
PROGRAM
CY2013
5959
Table 6A: Selected Diagnoses and
Services Rendered
Lines 1-20e: Selected Diagnoses
• For each diagnosis on lines 1-20e, report:
 Total visits for the diagnosis (column a)
 Unduplicated number of patients with this diagnosis (column b)
Lines 21-26d: Selected Services
• For each service, report
 Total visits with the service (column a)
 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)
 Unduplicated number of patients having received this service
(column b)
 For CY2013 -Use ICD-9 or CPT codes
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INDIAN
HEALTH
PROGRAM
CY2013
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Cross Table Issues
• Visits and patients reported in any cell of the
AI/AN table cannot exceed the number
reported on the same line on the universal
table
• Total patients reported on any row cannot
exceed total patients reported on Table 3A or
total medical patients for medical services
• Total AI/AN patients reported on any row
cannot exceed total AI/AN patients reported
on Table 3A
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INDIAN
HEALTH
PROGRAM
CY2013
61
Uses of Clinical Data
• Estimated prevalence of chronic conditions in
patient population
• Continuity of care defined by average visits
per year for selected chronic conditions (HTN,
Diabetes, etc.)
• Frequency of acute care services by service
(well child immunizations)
• Penetration rate for routine preventive services
(well child, family planning, Pap tests)
URBAN
INDIAN
HEALTH
PROGRAM
CY2013
62
Financial Profile
Describes cost and efficiency of delivering
services and sources and amounts of income
URBAN
INDIAN
HEALTH
PROGRAM
CY2013
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Financial Profile Tables
• Table 8A – Financial costs
• Table 9D – Patient related revenues
• Table 9E – Other revenues
Grants, contracts, and other income
not generated by patient services
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INDIAN
HEALTH
PROGRAM
CY2013
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Costs by Cost Center
Table 8A Financial Costs
URBAN
INDIAN
HEALTH
PROGRAM
CY2013
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Table 8A:
Financial Costs
• Col (a) – Accrued costs
• Col (b) – Allocation of
facility and non-clinical
support (Line 16) to cost
centers
• Col (c) – Total costs
• Line 18 - Donated
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INDIAN
HEALTH
PROGRAM
CY2013
66
Cross Table Issues (continued)
Table 8A and Table 5 “Crosswalk”
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INDIAN
HEALTH
PROGRAM
CY2013
67
Table 8A: Direct Costs
Medical Care Costs (Lines 1-4):
• Line 1: Medical staff salaries and benefits including staff on
contract and contracted visits
 Includes Staff dedicated to use or application of EHR QI
programs
 Includes Staff on contract and contracted visits
 Excludes Ophthalmologists (report under Vision) and
Psychiatrists (report under MH)
• Line 2: All medical (not dental) lab and x-ray costs
including supplies, lab staff, etc.
• Line 3: All other direct medical costs: dues, supplies,
depreciation, travel, CME, EHR, etc.
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INDIAN
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Direct Costs (continued)
Other Clinical Services Costs:
•
Lines 5, 6, 7, 9 and 9a include all personnel (hired or
contracted) and all “other” direct expenses for (5) Dental;
(6) Mental Health; (7) Substance Abuse; (9) Other
Professional; (9a) Vision
Pharmacy costs (Lines 8a and 8b) are divided:
• Line 8b = cost of pharmaceuticals only.
• Line 8a = all other costs including MIS, staff, equipment,
non-pharmaceutical supplies, etc.
• All Pharmacy Overhead is reported on line 8a column b
• Note: Do not report donated pharmaceuticals on either
line 8a or 8b. Is reported on Line 18/Donated
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INDIAN
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Direct Costs (continued)
• Line 11 Total Enabling
Costs = sum of lines
11a-11g
 Include all staff and
contract personnel
as well as all other
related direct
expenses for
enabling services.
URBAN
INDIAN
HEALTH
PROGRAM
CY2013
FINANCIAL COSTS OF ENABLING
RELATED SERVICES
AND
OTHER PROGRAM
11a.
Case Management
11b.
Transportation
11c.
Outreach
11d.
Patient and Community Education
11e.
Eligibility Assistance
11 f.
Interpretation Services
11g.
Other Enabling Services (specify: ___________)
11.
12.
13.
Total Enabling Services Cost
(Sum lines 11a through 11g)
Other Related Services (specify:________________)
TOTAL ENABLING AND OTHER SERVICES
(SUM LINES 11 AND 12)
70
Direct Costs (continued)
Table 8A Line 12: Other Program Related Costs:
• Include staff and contract personnel 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
Child care
Shelters
Fitness programs
Head Start /Early Head Start
Adult Day Health Care
• Include any “pass through” funds here
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INDIAN
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Table 8A: Facility and Non-clinical
•
•
URBAN
INDIAN
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CY2013
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 staff, and medical records and intake
staff as well as all associated costs including
supplies, equipment, depreciation, travel, etc.
72
Allocation of Facility
•
•
•
URBAN
INDIAN
HEALTH
PROGRAM
CY2013
Allocate each building separately
 Captures differences in costs per
building such as improvements,
donated space, etc.
Allocate based on proportion of square
footage utilized by each cost center
Add non-clinical space expenses to
non-clinical costs to be allocated
73
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.
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INDIAN
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CY2013
74
Cross Table Issues
•
•
Table 8A and 5 Consistency:
Staff FTEs reported by service on Table 5 should be
consistent with costs reported on Table 8A by cost
center
Calculated performance measures:
Costs per visit and per patient for each service
For example, medical cost per medical visit or
dental cost per dental patient, etc.
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INDIAN
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CY2013
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Uses of Cost Data
• Cost per patient and per service patient
• Cost per service visit (e.g., medical,
dental, etc.)
• % overhead costs (non-clinical support
services and facility)
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INDIAN
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CY2013
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Test Your Reviewer Skills 3
• How would you check the reasonableness of costs
on T8A as they relate to staffing and visits on T5?
Table 5:
Table 8A:
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INDIAN
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CY2013
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Table 9D: Patient
Related Revenues
Charges, collections
and allowances by payor
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INDIAN
HEALTH
PROGRAM
CY2013
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Table 9D: Patient Related Revenue
• Cash Basis
• Patient revenues are
reported by payor:
Medicaid
Medicare
Other Public
Self-Pay
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INDIAN
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CY2013
79
Charges
Col (a) – Full Charges
• Undiscounted, unadjusted charges for
services based on fee schedule; charges
should cover costs
• Include all charges (i.e., medical, dental,
pharmacy, mental health, etc.) for
services rendered during year
• Do not include “charges” where no
collection is attempted or expected such
as charges for enabling services, donated
pharmaceuticals, or free vaccines
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INDIAN
HEALTH
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CY2013
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Collections
• Collections (column b):
• Report all amounts collected as payment 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 collections by payor
Do not include cash “donations” (these are
reported on Table 9E)
Do not include “meaningful use” payments
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INDIAN
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Adjustments
Adjustments Columns (c1-c4):
Note: These amounts 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)
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INDIAN
HEALTH
PROGRAM
CY2013
82
Allowances
Allowances Column(d):
• Reductions in payment by a third party based on
a contract
• Allowances do not include:
 non-payment for services that are not covered
by the third party or rejected by the 3rd party
 deductibles or co-payments that are due from
the patient and not paid by a third party
• Reduce allowances by amount of FQHC
payments
• For capitated plans, col d = col a – col b
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INDIAN
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CY2013
83
Self-Pay Sliding Discounts
Self-Pay Sliding Discounts Column (e) (Line 13)
• A reduction in the amount charged to patients for
services rendered which:
 Is based on the patient’s documented income and
family size at the time of service as it relates to the
Federal Poverty Level
 May be applied to insured patients co-payments,
deductibles and non-covered services when the
charge has been moved to self-pay if consistent
with how uninsured patients are treated
 AI/AN status
 May not be applied to past due amounts
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INDIAN
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CY2013
84
Bad Debt
Bad Debt –Column (f) (Line 13 only):
• 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
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INDIAN
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CY2013
85
Payors: Medicaid and Medicare
Lines 1 - 3: Medicaid
•
•
•
•
•
All routine Medicaid under any name
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
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CY2013
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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 under “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.
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INDIAN
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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
•
•
•
•
•
•
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INDIAN
HEALTH
PROGRAM
CY2013
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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
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INDIAN
HEALTH
PROGRAM
CY2013
89
Cross-Table Issues
• Patient charges by payor related to
enrollment (Table 4)
• Managed care revenues related to member
months (Table 4)
• Patient charges and billable visits on Table 5
• Cash revenues (Table 9D and 9E) and total
costs (Table 8A)
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INDIAN
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CY2013
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Uses of Revenue Data
• Average charge per visit
• Payor mix
• Charge to cost ratio
indication that fees cover
costs
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INDIAN
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PROGRAM
CY2013
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Table 9E: Other Revenues
Non-patient-service income
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INDIAN
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CY2013
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Table 9E: Other Revenues
• Report non patient-service
income
• Cash basis – amount
received/drawn down during
year
• Report “last party” to handle
funds before you receive them
• Do not include:
Capital received as a loan
Patient-related revenue
Value of donated services,
supplies, or facilities
Donated “community
value”
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INDIAN
HEALTH
PROGRAM
CY2013
93
Table 9E:
IHS, Other Federal and State Grants
IHS Grant drawdowns – Lines 1a-1d
Report all funds received directly from IHS
Other Federal Grants – Lines 2-4b
Line 2- do not report Ryan White unless you are
an entity that receives the funds directly
• Line 3a - report “meaningful use payments”
• Lines 4 and 4b for BPHC/330 funded programs
• Line 6: State Grants/contracts
 Grants and contracts from State Agencies
•
•
•
•
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INDIAN
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PROGRAM
CY2013
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Table 9E: Non-Federal
Indigent Care Programs
Line 6a: Indigent Care programs
• If a tribal entity, report 638 Compacting money
received directly from IHS
• 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
• 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 fee discount
• Do not include state insurance plans
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INDIAN
HEALTH
PROGRAM
CY2013
95
Table 9E:
Non-Federal Grants or Contracts
• Line 6b: Maternal and Childcare grants and WIC
• Line 7a and b: Local Grants/ contracts
Grants/contracts from city (line 7A) and county (line
7b) gov’t.
• Line 8: Foundation / Private Grants
Funds received from foundations or private
organizations including money received from a
contract with a tribe
• Line 10: Other Revenues
Contributions, fund raising income, rents and sales,
patient record fees, etc.
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INDIAN
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PROGRAM
CY2013
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What NOT to include on Table 9E
 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.)
URBAN
INDIAN
HEALTH
PROGRAM
CY2013
97
Cross Table Issues
• Table 5 and 9E: Reporting of other related
services including WIC
• Table 9D and 9E: Reporting of patient and
non-patient related revenues
Sliding fee discount versus indigent
care program funds
URBAN
INDIAN
HEALTH
PROGRAM
CY2013
98
Uses of Revenue Data
• Table 9D, 9E, and 5: Total revenues and
revenues per patient, provider FTE, etc.
• Table 9D and 9E versus 8A: Cash
collections compared with costs as
indicator of cash flow
• Table 9D and 9E: diversification of funding
URBAN
INDIAN
HEALTH
PROGRAM
CY2013
99
Demonstration of Software
 Access
 Data Entry
 Validation
 Submission
 Reports
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INDIAN
HEALTH
PROGRAM
CY2013
100
Using UDS for
Decision Making
Interpreting the Feedback Report
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INDIAN
HEALTH
PROGRAM
CY2013
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Focusing Your Efforts
• Too much information and not enough time!
• A Snapshot Approach – focus on a few high
impact measures for initial review to identify
Strengths
Possible areas of improvement
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INDIAN
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CY2013
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Snapshot of Performance
• Patient profile – who are you serving?
• Quality of care – are standards of care
high?
• Efficiency – are we maximizing our
resources?
• Financial security - are we in a good
financial position?
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INDIAN
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CY2013
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Feedback
Report
Performance measures
• Access
 Describes patients you serve
• Quality of Care
 Utilization and GPRA measures
• Efficiency
 Evaluates capacity
• Financial Cost/Viability
 Assesses costs and viability
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INDIAN
HEALTH
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CY2013
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Patient Profile
Evidence that
program is
serving
priority
populations:
URBAN
INDIAN
HEALTH
PROGRAM
CY2013
• % Growth in patients
 AI/AN patients
 % AI/AN of total patients
 Total patients
 % patients using medical services
• Patient demographics
• Patients with financial, cultural and
linguistic barriers
 % Uninsured, Medicaid, other public
 % < 200% FPL
105
Quality of Care
Evidence that
program is
delivering quality
care:
 GPRA Measures
 Continuity of
care
 Prevalence rates
URBAN
INDIAN
HEALTH
PROGRAM
CY2013
• Visits per patient
• Rates of service use
• GPRA
Chronic Disease (diabetes
control)
Routine and Preventive care
(screenings, immunizations
and assessments)
Behavioral health (tobacco,
mental health and domestic
violence)
106
Efficiency
Evidence that
program is operating
a cost effective
services delivery
model:
URBAN
INDIAN
HEALTH
PROGRAM
CY2013
• Growth in visits
• Provider FTEs
• Panel size
(patients/provider FTE)
• Visits per provider
• Staff Ratios
107
Financial/Cost Viability
Evidence that
program is
financially
viable:
URBAN
INDIAN
HEALTH
PROGRAM
CY2013
• Cost
 Cost per patient and visit
 % administrative costs
 Charge to cost ratio
 Surplus/deficit as % of total costs
• Diversification of Funding
 % income from IHS
 % income from patient service
 IHS funding per AI/AN patient
• Financial Viability
 Change in net assets as % of expense
 Working capital to expense ratio
 Debt to equity ratio
108
UDS Reference Guide
• Provides formulas for all measures
• Format “replicates” the report
format
• In the formula section, each
measure is identified with:
 A number
 A name, corresponding to the
name on the report
 A formula for calculating the
measure
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INDIAN
HEALTH
PROGRAM
CY2013
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Calculations for Performance Measures
% Pediatric: (T3A Lines 1-15, Col A+B)
/(T3A L39 CA + T3A L39 CB)
T= Table + = add
- = subtract
L= Line
* = multiply C=
Column
/ = divide
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INDIAN
HEALTH
PROGRAM
CY2013
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Comparison Groups
• Program
 Current year, prior year and 2 year change
 Reported for total patients and AI/AN population
• Averages
 Comparison group – Full Ambulatory, Limited
Ambulatory or Information and Referral
 National average (all UIHP programs)
 BPHC Average (applicable to Full Ambulatory programs)
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INDIAN
HEALTH
PROGRAM
CY2013
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Averages
Average Defined: The value obtained by dividing the sum of
a set of quantities by the number of quantities in the set.
Program Type (Full Ambulatory, Limited
Ambulatory, Information and Referral
UIHP National Averages (from all urban programs)
BPHC National (from FQHCs)
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INDIAN
HEALTH
PROGRAM
CY2013
112
Identifying Strengths
& Weaknesses
• Compare your performance with peer groups
 How do you compare with similar programs?
• Look at your performance over time
 Are things trending in the right direction?
• Identify strengths and weaknesses
• Develop and implement strategy for improvement
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INDIAN
HEALTH
PROGRAM
CY2013
113
Contact Information
Priscilla Davis
John Snow, Inc. (JSI)
UDS Helpline: 1-866-698-5976
email: [email protected]
website: www.uihpdata.net
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INDIAN
HEALTH
PROGRAM
CY2013
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