Uniform Data System Calendar Year 2014 Bureau of Primary Health Care - - PDF document

10/15/2014 1

Uniform Data System Calendar Year 2014

Bureau of Primary Health Care

Agenda

• Brief introduction to UDS
• 2014 changes
• 2015 proposed changes
• Definitions used in the UDS report
• Step‐by‐step instructions for completing UDS

tables

• Available assistance and strategies for

successful reporting

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UDS:

The Who, What, When, Why, and How

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UDS: The Who

• Who:

– 330‐funded grantees under the CHC, HCH, MHC or PHPC programs – Look‐alikes designated by BPHC – BHW primary care clinics – Urban Indian Health Centers (reported under separate system) – Native Hawaiian Health Centers (not through EHB)

• Who were funded or designated prior to

October 2014

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UDS: The What

• What:

– “Scope of Project” which includes (and is limited to) the staff, services, patients, income, expenses,

• etc. that are spelled out in funding or designation

applications

• Does not include sites or services which are not

approved by BPHC

– For the period January 1, 2014 ‐ December 31, 2014

• Calendar year reporting, not based on grant year or

fiscal year

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UDS: The When

• When:

– January 1, 2015: the UDS “opens” in your Electronic Handbook and you can begin to enter data.

https://grants3.hrsa.gov/2010/WebEPSExternal//Interface/common/accesscontrol/login.aspx

– by February 15, 2015: All data tables must be completed and the report must be officially “submitted” by CEO or their assigned delegate. – March 1 ‐ March 31 (approximately): Revisions are made to correct errors or explain apparent issues. (work with reviewer.) – March 31, 2015: Report must be finalized at close of business.

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UDS: The Why

• Why: The UDS is used:

– To inform HHS, OMB and the Executive Branch of the accomplishments of the program – To inform Congress and the legislators who are responsible for funding the program – To provide information to HRSA in evaluating the operation of individual health centers and, occasionally, to alter funding levels – To inform the public of the operations of federally supported health centers – To provide data to scholars studying health care delivery in general and services to poor in particular

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UDS: The How

• How:

– On line through “Electronic Handbook” (EHB)

https://grants3.hrsa.gov/2010/WebEPSExternal//Interface/common/accesscontrol/login.aspx

– By authorized staff at each health center

• More than one person can work on the UDS at the

same time as long as they are in different tables.

– By the CEO or designee certifying by submission that they have reviewed and approved the data being submitted

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12 Tables Provide a Detailed Picture of Your Health Center

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What is Reported Table(s)

Patients served & their socio‐demographic characteristics 3A, 3B, 4, ZIP Code Types and quantities of services you provide 5, 6A Staffing mix and tenure 5, 5A The care you deliver/quality of care 6A, 6B, 7 Costs of providing services 8A Revenue sources 9D, 9E

Table 1 BPHC 330‐Funded Program and BHW Primary Care Clinic: Universal Report More than 1 BPHC 330‐ Funded Program: Universal + Special Pop. Grant Reports Look‐Alike Health Center: Universal Report

ZIP Codes

Yes n/a Yes

3A, 3B, 4

Yes Yes Yes

5

Yes Visits & Patients, only Yes

5A

Yes n/a Yes

6A

Yes Yes Yes

6B

Yes n/a Yes

7

Yes n/a Yes

8A

Yes n/a Yes

9D

Yes n/a Yes

9E

Yes n/a No 330 grants

Who Reports Which Tables

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2014 Changes

• Table 4:

– Line 26: Total number of patients who live in public housing

• Table 6A:

– New Line 1‐2a: Newly diagnosed with HIV – Look‐alikes will report this table for the first time

• Table 6B:

– Tobacco use assessment and cessation intervention measures have been combined into one measure, line 14a, “Tobacco Use Screening and Cessation Intervention” – New measure, line 20: Newly Identified HIV Cases and Follow‐Up – New measure, line 21: Patients Screened for Depression and Follow‐Up – Prenatal care tracking for women referred for prenatal care services

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2014 Changes Continued

• Table 7:

– Categories of HbA1c “less than 7%” and “7% ‐ <8%” have been combined into a single category of “less than 8%” – Outcomes for women referred for prenatal care services at centers which do not provider prenatal care

• Table 9D:

– Look‐alikes will report all elements of this table

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2015 Proposed Changes

• Table 4:

– New line 9a: Dually Eligible (Medicare and Medicaid) » this is a subset of line 9 (Medicare). Dually eligible patients will be reported on both line 9 and 9a.

• Tables 6A, 6B, and 7:

– Use of ICD‐10 coding begins October 1, 2015 » Use ICD‐9 for services from January 1 through September 30 » Use ICD‐10 from October 1 through December 31

• Table 7:

– The detail for reporting diabetic HbA1c will be further reduced. In 2015, health centers will only report those patients with HbA1c “greater than 9% or No Test During Year” (Column 3f)

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THE TABLES:

Key Definitions and Step by Step Instructions

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Who Counts: Patient Defined

• An individual who has one or more visits reported
• n Table 5 during the calendar year is considered

a “patient.”

– Medical, dental, behavioral health, vision, other professional and selected enabling services

• Whenever “patients” are counted, it must be an

unduplicated count.

• Each patient is counted once and only once regardless
• f the number or scope of visits.
• But they may be counted in each category of “patient”

that they fall in

• E.g., could be 1 medical patient and 1 dental patient

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ZIP CODE TABLE:

Patients by ZIP Code and Insurance

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Patients by ZIP Code

• Report all ZIP codes with 11 or more patients

– Combine the rest as “other zip codes”

• Patients in each ZIP code are reported by their primary

medical insurance

– This is the third party MEDICAL insurance that would be billed first if the patient had a medical visit – Must be reported for ALL patients including those patients who are not being seen for medical services – There is no unknown insurance category

• Totals must tie to total patients on Table 3A and insured patients
• n Table 4

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Patients by ZIP Code Continued

• Additional instructions for Special Populations

– Homeless: Use ZIP code of location where patient receives services if no better data exist. – Agricultural: Use ZIP code of the temporary housing they

• ccupy when patient is in the area.

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TABLES 3A AND 3B:

Patient Demographics

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Table 3A: Patients by Age & Gender

• Report total patients by age

and gender

• Age is calculated as of June 30
• Count each patient once and
• nly once
• Total on line 39 is used for

unduplicated patient count – totals from ZIP Code, table 3B, income of table 4, and insurance of table 4 must equal this number

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Table 3B: Patients by Hispanic or Latino Ethnicity/Race/Language

• Use Column B if patient

does not indicate “Latino” or “Hispanic.”

• Use Line 6 only if patient

chooses two or more listed races.

– “More than one” shouldn’t be a choice – don’t report Latino + a race as “more than one race”

• Use unreported, Line 7 if

no race was specified.

• Total must equal Table

3A.

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Table 3B: Patients by Language

• Report all patients who would best be served

in a language other than English including:

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

• ther than English is used
• This is the only UDS cell that may be

estimated.

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TABLE 4:

More Demographic Data

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Table 4: Patients by Income – Lines 1 ‐ 6

• Report income as of your most recent assessment.

– Income may be self‐reported if permitted by your policy – May report using a method different than that used for your sliding discount system

• Income must be current (obtained within the last year)

– otherwise report as unknown.

• Total on Line 6 must equal total on table 3A.

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Table 4: Patients by Medical Insurance – Lines 7 ‐ 12

• Report principal third party insurance for medical

care (even if patient is not a medical patient)

• Insurance is reported as of the last visit

– Even if insurance source did not pay for the visit – Total on Line 12 must equal total on Table 3A and line 6 on Table 4 – Total for each insurance type must equal totals on ZIP code table

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Table 4: Medical Insurance Reporting Categories

• None/Uninsured, line 7 – patients with no

insurance: may include patients whose services are reimbursed through grant, contract or uncompensated care funds

• Medicaid, lines 8a, 8b, 8 – report all Medicaid

patients including those in managed care programs run by commercial insurers

• Medicare, line 9 – report all Medicare patients

including Medicare Advantage and Medi‐Medi patients

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Table 4: Insurance Categories Continued

• CHIP, line 8b or 10b ‐ handled differently from state to state:

– If provided through Medicaid it is reported on Line 8b (CHIP Medicaid) – If provided through a commercial carrier outside of Medicaid it is reported on Line 10b (Other Public CHIP) – do not report as Private

• Other Public, lines 10a, 10b, 10 – Public coverage for patients

with a broad set of benefits

– Do not include family planning, breast and cervical programs, EPSDT, etc.

• Private Insurance, line 11 – Commercial coverage for patients

including Tricare, Trigon, Public Employees Insurance, etc.

• Note: Workers Comp is

not medical insurance

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Table 4: Managed Care Utilization – Lines 13a, b, c

• Completed ONLY by health centers with capitated

and/or FFS managed care (HMO) contracts.

– Patient is assigned to health center or their provider(s) – Patient MUST go to health center for listed primary care services – Do not count Primary Care Case Management patients or patients capitated for non‐medical service only (dental, mental health, etc.) – Do not count if medical is primary care only with no specialty or inpatient

• A member month is 1 member enrolled for 1 month. Report the

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

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

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Table 4: Target Populations – Lines 14 ‐ 26

• 330(g) MHC Grantees – provide separate totals for migratory and for seasonal

agricultural workers on Lines 14 and 15 – others report total Line 16

• 330(h) HCH Grantees ‐ report patient’s shelter arrangement as of first visit in 2014

(where they were housed the prior night) – others report total Line 23

• Patients seen at school based clinic locations are reported on Line 24
• Veteran is an individual who completed service in the Uniformed Services of the US
• 2014 Change: Report the total number of patients who live in public housing on

Line 26

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All health centers must report total number of targeted patients (if any)

• n Lines 16, 23, 24, 25,

and 26 even if they do not have targeted funding

Table 4: Agricultural Workers Defined – Lines 14 ‐ 16

• An agricultural worker is an individual whose PRINCIPAL employment is in

agriculture on a SEASONAL BASIS, who has been so employed within the last 24 months, and/or their dependents.

– Line 14: “Migratory” Workers who establish temporary home(s) for such employment. – Line 15: “Seasonal” Workers who do not live away from home.

• For both categories of workers, the term agriculture means farming in all its

branches as defined by the OMB‐developed NAICS, and includes seasonal workers included in the following codes and all sub‐codes within: 111, 112, 1151, and 1152.

• Health centers who do not have 330(g) funds report Line 16 – Total – only
• Agriculture means farming, including:

– Cultivation and tillage of the soil – The production, cultivation, growing, and harvesting of any commodity grown on, or in the land, or as an adjunct to or part of a commodity grown on or in the land; and – Any practice (including preparation and processing for market and delivery to storage or to market or to carrier for transportation to market) performed by a farmer or on a farm incident to or in conjunction with the above – Fisheries

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Table 4: Homeless Defined – Lines 17 ‐ 23

• A homeless patient is any person known to be homeless at the time
• f any service or who was housed but eligible because of having

been a homeless patient within 12 months of the service date.

• Health centers with no 330(h) funds report only Line 23 – total
• Shelter arrangements (at the first visit of the year):
• Shelter – homeless shelter
• Transitional – So designated, participate in cost, time usually limited
• Street – includes living outdoors, in a car, in an encampment, in

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

• “Doubled up” must be temporary and unstable
• Other – SROs, motels, currently housed previously homeless
• Persons who spent the prior night incarcerated, in an institutional

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

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Table 4: School‐Based Clinics and Veterans, Lines 24 and 25

• Line 24: School‐Based Clinics
• Patients who are seen at school‐based clinics,

including any clinic so identified on Forms 5B or 5C

• May be sited on or next to schools
• May or may not accept non‐students
• Line 25: Veterans
• Persons who have completed service in the

Uniformed Services of the United States

• Does not include active members of the military or Guard
• Does not include veterans of other nations

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Table 4: New Line 26 – Public Housing Patients

• Required of all health centers, not just 330(i)

PHPC grantees.

• Developments (large, multi‐unit) created or

managed for low income residents with public funds and/or support.

– Excludes housing supported only by Section 8 scattered site vouchers

• Use of patient address is acceptable to identify

the population.

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TABLES 5 AND 5A:

Staffing, Tenure, and Utilization

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Table 5: Staffing & Utilization

• Column A – Staff full‐

time equivalents (FTEs) reported by position

• Column B – Clinic visits

reported by provider type

• Column C – Patients

reported by service type

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Table 5, Column A: Categories

• f Staff
• Report all staff providing in‐scope services

– Include employees, contracted staff, residents, and volunteers – Do not include paid referral provider FTEs

• Report based on work performed, not job title

– A single person can be allocated across multiple categories

• E.g., MA works as lab tech one day a week: 80% MA, 20% lab tech
• Medical director’s corporate time (only) can be allocated to non‐clinical;

do not allocate “administrative time” of other providers

– Other Professional, Line 22, includes chiropractic, acupuncture, PT, OT, nutrition, podiatry, etc. – Other Related, Line 29a, includes non‐health care program staff (e.g., WIC, childcare, housing, fitness, job training, etc.) – See Appendix A in Reporting Manual for staffing categories

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Calculating FTEs for Staff

• FTE is actual for the year, not as of last day

– 1.0 FTE is the equivalent of one person working full‐time (as defined by health center) for one year

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

education, “admin time” etc.

• FTEs = Yearly paid hours divided by total hours for

position:

• E.g., 40 hour week = 2080 yearly hours; 35 hour week = 1820

– Calculate FTE for persons working part‐time or part‐year (E.g., 6 months full‐time = 0.50 FTE, 9 months half‐time = 0.375 FTE )

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Calculating FTEs for Hourly Work

• Who: Volunteers, locums, residents, on‐call providers, etc. who do

not receive paid‐time‐off (PTO) benefits

• How:
• 1. Calculate the number of leave hours and subtract from full‐

time hours for the comparable position

• E.g., Staff provider receives 160 hours vacation, 96 hours sick, 40 hours

continuing education, 80 hours holidays, 1704 hours worked

• 2. Calculate number of hours person being evaluated actually

works

• E.g., Volunteer provider worked 30 days @ 8 hours = 240 hours
• 3. Calculate and report FTE
• E.g., hours worked (240) divided by position FTE work hours (1704) =

.14 FTE (240/1704 = 0.1408)

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Table 5, Column B: Visit Defined

• A visit is:
• Face to face, one to one interaction between a patient

and a provider

• Exception: Group visits and telemedicine is permitted for

mental health and substance abuse visits

• No group health education or group medical visits.
• Medical, dental, vision, and some mental health staff

must be licensed

• Other disciplines must be credentialed by the health center
• The service must be charted
• The provider must be acting independently
• The provider must be using professional judgment

unique to their training and education

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Visit Defined Continued

• Only one visit per patient per provider type per day

– Exception: two different providers at two different sites

• Only one visit per provider per patient per day

regardless of the number of services provided

• DO COUNT paid referral visits when following current

patients in a nursing home, hospital, or at home

• DO NOT COUNT immunization only, lab only, dental

fluoride, mass screenings, health fairs, outreach or pharmacy visits

• Count visits provided by both paid and volunteer staff

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Table 5, Column C: Patients by Service Category Defined

• Total number of patients of that type of service seen

during the year

• A patient may be counted only once in each category

regardless of the number of visits

• Patients provided with multiple types of service must

be counted in each category

– e.g. A patient may counted as both a medical and a dental patient.

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Table 5A: Tenure for Selected Health Center Staff Defined

• Reports only on providers and key management staff
• Starting point will be last year’s work sheet

– Delete staff who have left and add new staff – Include persons working on last day of the year and those who have the day off, but are scheduled to return – Head count as of December 31 in consecutive months in current position (months will be over 12 if the person has had the position for more than one year) – Do not count paid referral providers or individuals who may work many days but do not have a regular schedule

• Data reported:

– are generally available in Personnel or Human Resource (HR) employment records – may be measured in a form differently than the way seniority information is stated – Should be available January 1 – Table can be done well in advance of the submission date

10/15/2014 22

Table 5A: Tenure

• Report all individuals who

work at the health center

– Full time, part‐time, part‐ year, contract, NHSC – Locums, volunteers, on‐call, residents

• Report combined tenure

– In months (not FTE) – As of last work day of year – By job title

• Same categories / lines as T5
• NOTE: It is almost impossible to have

Column B = Column A and impossible for B<A or D<C.

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Who to include in Census

• Include
• Those who worked in scope on December 31st
• Or who worked before then and were

scheduled to return to work in the new year

• Clinical staff:

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

44

• Key non‐clinical staff:

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

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Tenure for Full and Part Time Staff – Column A

• Regular employees and persons on regular

contracts who are employed at the time of the census are each counted as 1 in Column A.

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

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Tenure for Other Service Provider Arrangements – Column C

• Volunteers, locums, on‐call providers,

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

– Regardless of how much time they work if they are considered to be a part of the regular staff they are counted. Some examples include:

• Specialists who are usually present at least once each

month or quarter

• Primary care providers present during a specific season

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Tenure Months – Columns B and D

• Months are calculated from the date the person was

most recently hired into that position.

– Continuous months from the start date through December

• f the reporting year

– Rounded up to the closest whole number

• E.g., Pediatrician hired 8/1/03, promoted to CMO on 9/15/11, and

serves in both roles ‐ Count 137 months as pediatrician and 40 months as CMO

• E.g., COO is hired 11/10/89, promoted to Deputy Director 7/12/98

and then promoted to CEO 6/22/14, retaining the obligations of the Deputy Director ‐ Count 7 months as CEO only

• E.g., CEO hired 5/15/11 to fill the role of CIO, CFO, and CEO –Count

44 months as CEO, 44 months as CFO, 44 as CIO

TABLES 6A, 6B, AND 7:

Diagnoses and Services Provided; Quality of Care Indicators

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Clinical Profile Tables

• Clinical care

– Table 6A: Selected diagnoses and services

• Also completed by look‐alikes effective CY 2014
• Also completed for each additional non‐CHC funding stream

– Table 6B: Quality of care indicators – Table 7: Health outcomes and disparities

• EHR Capabilities and Quality Recognition

– Series of questions on health information technology (HIT) capabilities, including EHR interoperability, and incentives for the Meaningful Use of certified EHR technology.

• Includes the implementation of EHR, certification of systems, how

widely adopted the system is throughout the health center and its providers, and national and/or state quality recognition (accreditation

• r PCMH)

– Not a numbered table – at end of the EHB entry

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TABLE 6A:

Diagnoses and Services

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Table 6A: Diagnoses and Services

• Lines 1‐20d: Selected

diagnoses

– Report all diagnoses, not just primary diagnosis – New Line: 1‐2a Newly diagnosed HIV

• Lines 21‐34: Selected

services

• Uses ICD‐9, CPT, or ADA

codes

51

Diagnoses: Column A, lines 1‐20d

• Reports on the number of visits which

reported the selected diagnosis

– Each row has a name (e.g. diabetes), but is defined by one or more ICD‐9 codes as listed on the table and in the reporting manual

• Some codes are intentionally excluded, such as the code

for gestational diabetes

– Each visit with the unique diagnosis identified is counted – If patients have more than one reportable diagnoses during a visit, each is counted

• E.g., hypertension and diabetes and obesity

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Services: Column A, lines 21‐34

• Reports on the number of visits which

reported one or more of the selected services

– Each row has a name (e.g., childhood immunizations) but is defined by one or more CPT (or ICD‐9) codes or – in the case

• f dental services – ADA codes
• Some codes are intentionally excluded, such as the codes for some

surgically related procedures

– Each visit with the service provided is counted – If patients have more than one reportable service during a visit, each is counted

• E.g., Pap test and contraceptive services

– But not multiple services in the same category at one visit

• E.g., an DPT and an MMR at the same visit

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Patients by Diagnosis and Service: Column B

• Report the unduplicated number of patients who

had a specific diagnosis or received one or more

• f the selected services

– Count a patient once and only once on each line where a visit was counted.

• e.g., a patient who is seen five times for hypertension will be

counted as one patient in column B

– A patient may have a diagnosis and a service on the same day

• e.g., a patient seen for their diabetes and provided with a flu

shot would both be counted on this table.

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Table 6A: New Line 1‐2a Newly Diagnosed with HIV

• Persons first diagnosed with HIV during the twelve

months from 10/1/13 through 9/30/14

– Count only individuals who had never been diagnosed in any setting prior to a visit with your provider – Do not count:

• Persons who had been previously diagnosed but who were being

seen for the first time at your health center

• Were diagnosed elsewhere and referred to you for treatment
• Had a (positive) reactive initial screening test, but not a positive

supplemental test (unless you also referred them for the supplemental test and intend to provide treatment)

– ICD codes will not identify initial HIV diagnosis ‐ this will need to be identified from alternate EHR or other systems

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TABLE 6B:

Quality of Care Indicators

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Process Measures

• “Process

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

57

• Access to prenatal care (first prenatal

visit in 1st trimester)

• Childhood immunizations
• Cervical cancer screening
• Child and adolescent weight screening

& counseling

• Adult weight screening & follow‐up
• Tobacco use assessment and cessation

intervention

• Asthma drug therapy
• Cholesterol treatment (lipid therapy

for coronary artery disease patients)

• Heart attack/stroke treatment (aspirin

therapy for ischemic vascular disease patients)

• Colorectal cancer screening
• Depression screening and follow‐up
• HIV linkage to care

Section A, lines 1‐6: Prenatal Patients by Age Changes for 2014

• Report all patients, who received

prenatal care and all patients who test positive for pregnancy and were referred for obstetrical care during the year, by age category.

– Report all women served regardless of whether they delivered, including women whose only service in 2014 was their delivery – Include women who were referred for prenatal care, transferred, or were “risked out” – Do not include patients who may have had tests, vitamins, assessments or education, but did not have their initial clinical visit with the clinic’s obstetrical provider – Do not include women who went to another provider

• n their own or who left without a referral

58

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Section B, lines 7‐9: Access to Prenatal Care

• Trimester of entry into prenatal care

– For all patients reported in Section A, indicate what trimester they began care and whether it was with the health center or another provider – Entry into prenatal care occurs when the patient has had a visit with a physician or non‐physician provider at the health center or with a referral provider who initiates prenatal care with a complete physical exam (i.e., not a pregnancy test, nurse assessment, etc.)

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Section C, line 10: Childhood Immunizations

• Column A: Universe ‐ All children who

– turned 2 years and 364 days in 2014 (born on 1/1/11 ‐ 12/31/11) AND – who had at least one medical visit in 2014 AND – were first ever seen prior to their 3rd birthday

• This is the “catch‐up” schedule. Technically – asks

about children who were immunized before they turned 3.

– CDC / AAP still recommends immunization by age 2

No exclusions

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Childhood Immunizations

• Column B: Universe or sample of 70 patients
• Column C: Meeting measurement standard: Number of

children in Column B who, by their 3rd birthday are fully compliant for each disease listed on the next slide. A child is fully complaint if they had (1) received vaccine, or (2) shown evidence of the disease or (3) shown a contraindication for vaccine.

61

Required Vaccines

• Fully compliant means meeting measurement

standard for each of 11 diseases normally vaccinated against with:

– 4 DTP/DTaP, – 3 IPV, – 1 MMR, – 3 Hib, – 3 Hepatitis B, – 1 VZV (Varicella), – 4 Pneumococcal conjugate

• HepA, rotavirus and influenza were removed from reporting in

2013, but CDC / AAP still recommends these vaccines

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10/15/2014 32

Assessing Child Immunization Measurement Standard

• Notes in the medical record indicating that the patient

received the immunization “at delivery” or “in the hospital” may be counted as evidence of meeting the measurement standard.

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

does not list the date of each immunization and the name

• f the provider does not constitute sufficient evidence of

meeting the measurement standard.

• Good faith efforts to get a child immunized which

nonetheless fail do not meet the performance measurement including:

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

63

Section D, line 11: Cervical Cancer Screening

• Column A: Universe ‐ All women

– aged 24 – 64 (born 1/1/50 – 12/31/90) AND – with at least one medical visit in a health center clinic during the reporting year AND – who were first seen before age 65 excluding women with hysterectomy

64

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Cervical Cancer Screening

• Column B: Universe or sample of 70 patients
• Column C: Meeting the measurement standard:

Number of patients in Column B who:

– received one or more Pap tests in a three year period from 2012 through 2014 or – received one or more Pap tests in a five year period from 2010 through 2014 and was 30 years of age or older at the time of her last Pap test and chose to have a Pap test and an HPV test done simultaneously.

65

Assessing Cervical Cancer Measurement Standard

• Medical records must include a copy of the test result (your

lab or another lab) or include an evidence based entry which includes the provider, test date and result, which is not based

• n patient self report
• A note that “patient was referred” or “patient reported

receiving pap test” does not meet the performance standard.

• Good faith efforts to get the patient tested do not meet the

measurement standard.

• Performance measurement is not met even if she:

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

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Section E, line 12:Child & Adolescent Weight Assessment & Counseling

• Column A: Universe ‐ All children and adolescents

– From aged 3 through 17 on December 31st (born 1/1/97 – 12/31/11) AND – with at least one medical visit in a health center clinic during the reporting year AND – were first seen before age 17 excluding pregnant adolescents

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Child and Adolescent Weight Screening

• Column B: Universe or sample of 70 patients
• Column C: Meeting the Measurement Standard:

Number of patients in Column B who

– had their BMI percentile recorded during 2014 AND – had documented counseling on nutrition (not just diet) AND – had documented counseling on activity (not just exercise)

68 68

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Assessing Child & Adolescent Weight Screening Measurement Standard

• Just recording that a well child visit was done

does not meet the requirement

• All three criteria: BMI percentile, counseling
• n nutrition, and counseling on physical

activity must be documented

69

Section F, line 13: Adult Weight Screening and Follow Up

• Column A: Universe ‐ All adults:

– aged 18 and older on December 31st (born on or before 12/31/1996) AND – with at least one medical visit in a health center clinic during the reporting year AND – last seen after they turned 18 Excluding pregnant women and terminally ill patients

• Column B: Universe or sample of 70 patients

70

10/15/2014 36

Adult Weight Screening and Follow Up

• Column C: Meeting the Measurement Standard:

Number of patients in Column B who

– had their BMI recorded at their last visit or within 6 months of that visit AND – had a follow‐up plan documented if they were

• under age 65 and BMI was < 18.5 OR ≥ 25 or
• age 65 or older and BMI was < 23 OR ≥ 30

71

Assessing Adult Weight Measurement Standard

• Just recording height and weight is not

adequate – BMI must be visible in chart or on template

• Include in Column C as meeting the

measurement standard, adults:

– with BMI in ‘normal’ range – with BMI outside the normal range who have documented a followup plan

72

10/15/2014 37

Section G, line 14a:Tobacco Use Screening & Cessation Intervention: 2014 Change

• Column A: Universe ‐ All adults

– aged 18 and older on December 31st (born on or before 12/31/1996)

AND

– who have been seen at least twice (ever) in the practice for medical care AND – with at least one medical visit in a health center clinic during the reporting year AND – last seen after they turned 18

No exclusions

73

Tobacco Use Screening and Cessation Intervention

• Column B: Universe or sample of 70 patients
• Column C: Meeting the Measurement Standard:

Number of patients in Column B who

– were queried about their tobacco use one or more times by any provider (e.g. dental, vision) during their last visit or within 24 months of their last visit AND – If found to be a tobacco user:

• Received tobacco cessation services or
• Received an order for a smoking cessation medication

(prescription or OTC) or

• Were found to be on (using) a smoking cessation agent

74

10/15/2014 38

Assessing Tobacco Use Screening & Cessation Measurement Standard

• Note that universe will not be the same as adult

weight universe because of the two‐visit criteria

• All adults meeting the criteria are included in the

universe, not just tobacco users.

• Include in Column C as meeting the measurement

standard, adults who were: – screened and found not to be tobacco users – tobacco users with intervention charted

75

Section H, line 16: Asthma Treatment

• Column A: Universe ‐ Patients aged 5 through 40:

– Initially diagnosed with persistent asthma AND – born between 1/1/74 and 12/31/09 AND – last seen while between ages 5 through 40 AND – seen at least twice (ever) in the practice AND – had at least one medical visit in a health center clinic during the reporting year excluding patients with allergic reaction to asthma medications and those diagnosed with intermittent asthma

76

10/15/2014 39

Asthma Treatment

• Column B: Universe or sample of 70 patients
• Column C: Meeting the Measurement

Standard: Patients reported in Column B who

– received or had a prescription for inhaled corticosteroids or – received or had a prescription for an approved alternative medication or – were on medication

77

Assessing Asthma Treatment Measurement Standard

• The diagnosis of asthma (ICD‐9 493.x) is not sufficient

to define the universe. Only those with persistent asthma are to be included.

• CPT Category II codes or EHR template choices can be

used to code severity; no ICD‐9 codes do so.

• Appendix C in the Reporting Manual describes

sampling techniques that can be used to identify persistent asthmatics if no other codes are available.

78

10/15/2014 40

Section I, line 17: Cholesterol Treatment (Lipid Therapy for CAD Patients)

• Column A: Universe ‐ All adults:

– with an active diagnosis of CAD or had a myocardial infarction (MI) or had cardiac surgery AND – aged 18 and older on December 31st (born on or before 12/31/1996) AND – last seen after they turned 18 AND – seen at least twice (ever) for medical care AND – had at least one medical visit in a health center clinic during the reporting year Excludes individuals whose last LDL lab test was <130 mg/dL or with an allergy to or a history of adverse

• utcomes from or intolerance to LDL lowering

medications.

79

Cholesterol Treatment

• Column B: Universe or sample of 70 patients
• Column C: Meeting the Measurement

Standard: Patients reported in Column B who received a prescription for, were provided with, or were taking lipid lowering medications

80

10/15/2014 41

Section J, line 18: Heart Attack/Stroke Treatment (Aspirin Therapy for IVD Patients)

• Column A: Universe ‐ All adults:

– with an active diagnosis of IVD during 2013 or 2014 OR had been discharged after AMI or CABG or PTCA during 2013

AND

– aged 18 and older on December 31st (born on or before 12/31/1996) AND – last seen after they turned 18 AND – had at least one medical visit in a health center clinic during the reporting year No exclusions

81

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

Heart Attack/Stroke Treatment

• Column B: Universe or sample of 70 patients
• Column C: Meeting the Measurement

Standard: Patients reported in Column B who had documentation of aspirin or another anti‐ thrombotic medication being prescribed, dispensed, or used

82

10/15/2014 42

Section K, line 19: Colorectal Cancer Screening

• Column A: Universe ‐ Patients aged 51 through 74

– born between 1/1/40 and 12/31/63 AND – had at least one medical visit in a health center clinic during the reporting year Excluding patients who have had colorectal cancer or colectomy

83

Colorectal Cancer Screening

• Column B: Universe or sample of 70 patients
• Column C: Meeting the Measurement Standard:

Patients reported in Column B who had documentation

• f appropriate colorectal cancer screening:

– Colonoscopy conducted during reporting year or previous 9 years OR – Flexible sigmoidoscopy conducted during reporting year or previous 4 years OR – Fecal occult blood test (FOBT), including the fecal immunochemical (FIT) test, during the reporting year

84

10/15/2014 43

Section L, line 20: HIV Linkage to Care: New Measure

• Column A: Universe – All patients, regardless of age:

– diagnosed for the first time ever with HIV between 10/1/13 and 9/30/14 AND – who had at least one medical visit during the reporting year No exclusions

85

HIV Linkage to Care

• Column B: Universe or sample of 70 patients
• Column C: Meeting the Measurement Standard:

Patients reported in Column B who, within 90 days of the visit where they tested positive for HIV had:

– A medical visit with a health center provider who initiates treatment for HIV or – A visit with a referral resource who initiates treatment for HIV

86

10/15/2014 44

Assessing HIV Linkage to Care Measurement Standard

• Neither a referral nor a patient going to a referral

source for the confirmatory testing meets the measurement standard. Actual treatment at the referral source must have begun.

• There is no code for newly diagnosed HIV patients.

Health centers should develop alternative methods for tracking within the EHR or medical record.

• A newly diagnosed HIV patent must be confirmed by

a positive supplemental, not an initial, reactive test.

87

Section M, line 21: Depression Screening and Follow‐up: New Measure

• Column A: Universe ‐ Patients age 12 or older

– born on or before 12/31/02 AND – had at least one medical visit during the reporting year Excluding persons with active diagnosis of depression or bipolar disorder or who are currently receiving on‐going treatment for depression.

88

10/15/2014 45

Depression Screening and Follow‐up

• Column B: Universe or sample of 70 patients
• Column C: Meeting the Measurement Standard:

Patients reported in Column B who had a standardized depression screening test during the measurement year that:

– was negative OR – was positive and who have a follow‐up plan documented

89

Assessing Depression Screening & Follow‐Up Measurement Standard

• All patients age 12 and older are expected to be

screened for depression.

• Include in Column C as meeting the measurement

standard, patients age 12 and older: – with a negative screening result – with a positive screening who have a documented followup plan

90

10/15/2014 46

TABLE 7:

Health Outcomes and Disparities

91

Intermediate Outcome Measures

• Low birth weight
• Hypertensive patients with

controlled blood pressure < 140/90)

• Diabetes patients with

controlled blood sugar HbA1c <=9%)

“Intermediate

• utcome measures”: If

this measurable intermediate outcome is improved, then later negative health

• utcomes will be less

likely.

92

10/15/2014 47

Table 7: Disparities Format

Hispanic/Latino 1a Asian 1b1 Native Hawaiian 1b2 Other Pacific Islander 1c Black/African American 1d American Indian/Alaska Native 1e White 1f More than One Race 1g Unreported/Refused to Report Race Subtotal Hispanic/Latino Non‐Hispanic/Latino 2a Asian 2b1 Native Hawaiian 2b2 Other Pacific Islander 2c Black/African American 2d American Indian/Alaska Native 2e White 2f More than One Race 2g Unreported/Refused to Report Race Subtotal Non‐Hispanic/Latino Unreported/Refused to Report Ethnicity h Unreported/Refused to Report Race and Ethnicity i Total

• All outcome data are

reported in a matrix to show ethnicity and race.

• Latino patients are

reported in section 1.

• Patients who report race

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

• Patients who report

neither race nor ethnicity are reported as Unreported in section 3.

93

Table 7: Column Format

• Columns 1a, 2a, and 3a: Universe requires totals of:

– 1a: women who delivered – 2a: hypertensive patients – 3a: diabetic patients

• Universe must be used for reporting on delivery and

birth data (columns 1a‐1d).

• Columns 2b and 3b: For diabetes and hypertension

report on:

– The universe of patients meeting criteria (number in columns 2a and 3a) OR – 70 randomly selected patients – May use different method for each – Random sample is across total, not 70 for each race or ethnicity

94

10/15/2014 48

HIV Pregnancy and Deliveries by Health Center Clinicians

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

clinic, regardless of whether or not the health center provided them with or referred them for prenatal services

• Line 2: Total number of deliveries performed

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

95 HIV Positive Pregnant Women Blank 2 Deliveries Performed by Health Center’s Providers Blank

Section A: Low Birth Weight: Change for 2014

• All Health Centers must report the outcomes for all

pregnant medical patients who were provided any of the following required services:

– no prenatal care, but were referred for prenatal care, AS WELL AS – full perinatal services through delivery – some or all prenatal care and then referred for delivery – some prenatal care and then referred out for late prenatal care and delivery – some prenatal care and then transferred because of risk status Women who decline referral are not included.

• Requires reporting on tracking of patients by Health

Centers who never reported in the past.

96

10/15/2014 49

Section A: Low Birth Weight

• Column 1a: All women who were in the

health center’s prenatal program OR who were referred for care who were known to have delivered during the year, even if the delivery was done by another provider

– Column 1a need not / will not / should not equal the sum

• f columns 1b + 1c + 1d except by coincidence
• Columns 1b – 1d: Live births, by weight, born during

the year to prenatal care patients and referred women, regardless of who performed the delivery.

• Includes multiples

97

Prenatal Care Patients Who Delivered During the Year

(1a) Live Births: <1500 grams (1b) Live Births: 1500‐ 2499 grams (1c) Live Births: ≥ 2500 grams (1d)

Assessing Low Birth Weight Measurement Standard

• Race and Ethnicity reporting:
• Column 1a: Patients who delivered
• Indicate the race and ethnicity of the woman delivering
• Columns 1b, 1c, 1d: Children by birthweight
• Indicate the race and ethnicity of the child(ren) born
• Race and ethnicity of the child need not be that of

the mother.

• Unlike other measures, here the larger the

number of children born with low birth weight, the poorer the outcome.

98

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Section B: Blood Pressure Control

• Column 2a: Universe ‐ Patients aged 18 to 85

– diagnosed with hypertension prior to 6/30/14 AND – born between 1/1/30 and 12/31/96 AND – seen at least twice during the reporting year for any medical service Excluding pregnant women and patients with end stage renal disease

99

Total Hypertensive Patients (2a) Charts Sampled or EHR Total (2b) Patients with HTN Controlled (2c)

Blood Pressure Control

• Column 2b: Universe or sample of 70 patients
• Column 2c: Meeting the Measurement

Standard: Patients reported in Column 2b whose most recent blood pressure is less than 140/90

100

Total Hypertensive Patients (2a) Charts Sampled or EHR Total (2b) Patients with HTN Controlled (2c)

10/15/2014 51

Assessing Blood Pressure Control Measurement Standard

• Patients with no documented blood pressure during

the reporting year are not reported, and do not meet the measurement standard.

• It does not matter if hypertension was treated during

the measurement year or is currently being treated. The notation of hypertension may appear during or prior to 2014.

101

Section C: Diabetes Control

• Column 3a: Universe ‐ Patients aged 18 to 75

– diagnosed with diabetes AND – were born between 1/1/40 and 12/31/96 AND – were seen at least twice during the reporting year for any medical service Excluding those with only a diagnosis of gestational diabetes or steroid‐induced diabetes.

102

Total Patients with Diabetes (3a) Charts Sampled or EHR Total (3b) Patients with HbA1c <8% (3d1) Patients with 8% ≤ HbA1c ≤ 9% (3e) Patients with HbA1c >9%

• r No Test

During Year (3f)

10/15/2014 52

Diabetes Control: Change for 2014

• Column 3b: Universe or sample of 70 patients
• Columns 3d1‐3f: Test Results: Patients reported in Column

3b whose last HBA1c during the reporting year is in the given range

– No test during the reporting year does not meet the measurement standard and is reported in Column 3f – Change for 2014: Number of categories for HbA1c has been reduced. Columns 3c (<7%) and 3d (7% ≤ HbA1c < 8%) have been eliminated. All patients with HbA1c < 8% will be reported in column 3d1

• Performance measurement remains unchanged

103

Total Patients with Diabetes (3a) Charts Sampled or EHR Total (3b) Patients with HbA1c <8% (3d1) Patients with 8% ≤ HbA1c ≤ 9% (3e) Patients with HbA1c >9%

• r No Test

During Year (3f)

104

Available Webinars

Introduction to UDS Clinical Measures

Presented On: October 20, 2014 from 2:00 – 4:30 EST Objectives: Review clinical performance measures (Table 6B and 7) and discuss strategies for accurate data collection and reporting Recorded sessions are available at http://bphc.hrsa.gov/healthcenterdatastatistics/reporting/index.html

UDS Sampling Methods

Presented On: November 6, 2014 from 1:30 – 3 EST Objectives: Review purpose of random sample and correct methods for generating random sample and chart substitutions Recorded sessions are available at http://bphc.hrsa.gov/healthcenterdatastatistics/reporting/index.html

10/15/2014 53

TABLES 8A, 9D, AND 9E:

Financial Profile

105

Financial Profile Tables

• Cost of delivering services and sources and

amounts of income

– Table 8A: Financial costs – Table 9D: Income from patient services – Table 9E: Other revenues

106

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TABLE 8A:

Financial Costs

107

Table 8A: Financial Costs

• Reports accrued costs
• Requires allocation of

facility and non‐clinical services to other centers

• Excludes bad debt
• Includes depreciation
• Reports donated (“in‐kind”)

costs only on line 18 – after the subtotal on line 17 which is used for all cost calculations.

108

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Table 8A and Table 5 Crosswalk

FTEs Reported on Table 5, Line: Have costs reported

• n Table 8A, Line:

1‐12: Medical providers and clinical support staff 1: Medical Staff 13‐14: Lab and X‐Ray 2: Lab and X‐Ray 16‐18: Dental 5: Dental 20a‐20c: Mental Health 6: Mental Health 21: Substance Abuse 7: Substance Abuse 22: Other Professional (e.g., nutritionists, podiatrists, etc.) 9: Other Professional 22a‐22c: Vision Services 9a: Vision 23: Pharmacy 8a: Pharmacy 24‐28: Enabling (e.g., case management, outreach, eligibility, etc.) 11a‐11g: Enabling 29a: Other programs/services (i.e., non‐health related services including WIC, job training, housing, child care, etc.) 12: Other related Services 30a‐30c and 32: Non‐clinical Support Services and Patient Support (e.g., corporate, intake, medical records, billing, fiscal, and IT staff) 15: Non‐clinical Support Services 31: Facility (e.g., security, maintenance, janitorial staff, etc.) 14: Facility

109

Table 8A: Lines 1 ‐ 10

• Line 1: Medical care costs include:

– Medical staff salaries and benefits – Staff dedicated to EHR and QI activities – Staff on contract and contracted visits – Excludes ophthalmologists and psychiatrists

• Line 2: All medical (not dental) lab and x‐ray costs including

supplies, lab staff, referral labs, radiologists, etc.

• Line 3: All other direct medical costs including provider

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

• Lines 5, 6, 7, 9, & 9a: Other clinical services costs

– Personnel (hired or contracted) and all “other” direct expenses for (5) dental, (6) mental health, (7) substance abuse, 9 (other professional), and (9a) vision

110

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Table 8A: Lines 8a and 8b

• Pharmacy Costs

– Line 8b ‐ costs of pharmaceuticals, only – Line 8a ‐ all other pharmacy costs including MIS, staff, equipment, non‐pharmaceutical supplies, etc.

• If you cannot separate non‐drug cost from total cost ‐ report all costs on

line 8b

• All pharmacy overhead is on Line 8a, Column B
• Note: Do not include donated pharmaceuticals on either line. This is shown on

line 18.

111

Table 8A: Lines 11a ‐ 12

• Line 11a‐11g: Enabling

― Personnel (hired or

contracted), their expenses, and all other direct enabling costs

• Line 12: Other program related

costs

– Include costs associated with staff reported on Table 5 Line 29a, as well as other related direct expenses for non‐health‐care services such as:

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

– Include any “pass through” funds here

112

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Table 8A: Lines 14 – 15 Non‐Clinical Support and Facility

• Line 14: Facility costs include rent or depreciation, mortgage

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

– No CIP or FIP costs, but include appropriate depreciation

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

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

113

Allocation of Facility

• Facility

– Allocate each building separately

• Captures differences in costs per building such as

improvements, donated space, etc.

– Allocate based on proportion of square footage utilized by each cost center or based on better data, if available – Include allocation to “non‐clinical support” for administration’s facility costs

114

10/15/2014 58

Allocation of Non‐Clinical Support

• Non‐clinical support staff and costs

– Allocate based on actual use

• Allocating billing to cost centers that bill, front desk costs to

those services that use the front desk staff for check in, etc.

– Alternative: straight line method, using the proportion of total costs to each service category excluding all non‐clinical support and facility costs – Can use both methods

– First, do specific allocations based on use – Then, allocate remaining overhead based on straight line

115

TABLE 9D:

Patient Related Revenue

116

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Table 9D: Patient Related Revenue

• Reports on a cash basis
• 2014 charges and cash

income for patient services are reported by payor: Medicaid, Medicare, Other Public, Private and Self‐Pay

• Look‐alikes now complete all

parts of this table, including retros and managed care

117

Charges

• Full Charges ‐ Column A:

– Undiscounted, unadjusted charges for services based

• n fee schedule; charges should cover costs

– Include all charges (medical, dental, pharmacy, mental health, etc.). – Do not include “charges” where no collection is attempted or expected such as charges for enabling services, donated pharmaceuticals, or free vaccines.

118

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Collections

• Collections ‐ Column B:

– Report all payments for health services including capitation payments, payments from patients, third party insurance, FQHC reconciliations, wrap‐around payments, and contract payments (e.g., payments from schools, jails) received during the year. – Report by payor. – Do not include “meaningful use” payments.

119 119 120

Adjustments – Retroactive Payments

• Retroactive payments, etc. – Columns c1‐c4:

Note: c1 – c4 are included in Column B, but do not equal Column B – Columns (c1) and (c2): reconciliation payments for FQHC or CHIP‐RA settlements (c1 from current year, c2 from prior year) – Column (c3): “Other Retroactive Payments” including risk pools, incentives, PFP, withholds and court ordered payments – Column (c4): amounts which are returned to third party (report as positive number)

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Adjustments – Allowances

• Allowances ‐ Column D:

– Reductions in payment by a third party based on a contract – Allowances do not include disallowances:

• non‐payment for services that are not covered by the third party
• r that are rejected by the third party
• deductibles or co‐payments that are due from the patient and not

paid by a third party

– Reduce allowances by any amounts of subsequent FQHC payments (reconciliations in Columns c1, c2 or c3) – For capitated plans, Column D = Column A – Column B

121 121

Adjustments – Sliding Discounts

• Sliding Discounts – Column E:

– A reduction in the amount charged (paid or owed) for services rendered which:

• is based solely on the patient’s documented income

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

• may be applied to insured patients’ co‐payments,

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

• May not be applied to past due amounts

– Available on Self Pay, line 13 only

122

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Adjustments – Bad Debt

• Bad Debt – Column F:

– Amounts owed by patients 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

payor bad debt

• Do not report as a “cost” on Table 8A

– Bad debt can never be changed to a sliding discount – Available on Self Pay, line 13 only

123

Payors: Medicaid and Medicare

• Lines 1 ‐ 3: Medicaid

– All routine Medicaid – EPSDT – under any name – Medicaid part of Medi‐Medi or crossovers – CHIP, if paid through Medicaid – May also include fees for other state programs which are paid by the Medicaid intermediary

• Lines 4 ‐ 6: Medicare

– All routine Medicare – Medicare Advantage – Medicare portion of Medi‐Medi or crossovers

124

10/15/2014 63

125

Payors: Other Public and Private

• Lines 7 ‐ 9: Other Public

– State or other public insurance programs – Non‐Medicaid CHIP programs – State‐based programs which cover a specific service or disease (i.e., BCCCP, Title X, Title V, TB) – Does not include indigent care programs – NOTE: Patients who benefit from services paid for by “other public payers” are not necessarily counted as “other public insurance” on Table 4

• Lines 10 ‐ 12: Private

– Private and commercial insurance – Medi‐gap programs, Tricare, Workers Comp. etc. – Contracts with schools, jails, head start, etc. – NOTE: Patients benefiting from private contracts may not be insured in these categories on Table 4

126

Payment Types Reported

• Each of the four third‐party payor

categories has three payment types:

– Fee‐for‐service: Payment for each charge (or global fee) on the charge slip, encounter form, or bill – Managed care capitated: Payments for each month the patient is enrolled in the program. In public programs, includes reconciliations to some prospective payment system (PPS) rates – Managed care fee‐for‐service: Patient is assigned to doctor or clinic, but payment is only made when a charge is reported. Reconciliation to PPS rates occur in some public programs.

10/15/2014 64

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

127

Reclassify Charges

• It is essential to reclassify charges which are

unpaid in whole or in part, not including allowances:

– 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, or Other Public)

• Add to charges on line for self pay or the secondary (tertiary,

etc.) payor

• Show collections of these amounts on the appropriate line

128

10/15/2014 65

TABLE 9E:

Other Revenues

129

Table 9E: Other Revenues

• Report only non‐patient

service income

• Cash basis – amount

received/drawn down during the year

• Report “last party” to

handle funds before you received them

• Do not include:

– Capital received as loan – Patient‐related revenue, including pharmaceuticals – Value of donated services, supplies, or facilities – Donated “community value”

130

10/15/2014 66

Federal Grants: Lines 1 ‐ 3

• Line 1: BPHC Grant drawdowns

– Report all funds received directly from BPHC regardless of their end use. – Include funds received from BPHC and passed through to another agency.

• If you do not report activity for grant, report as cost on Table 8A, Line 12
• Line 2: Ryan White Part C HIV Early Intervention

– Report Part C funds only. – Usually, Part A is reported on line 7, Local, Part B is reported on line 6, State, and SPRANS grants on line 3, Other Federal.

• Line 3: Other Federal Grants

– Report funds received from Federal government grants management system. – Do not report Ryan White – especially part A or part B – here unless you are an entity that receives the funds directly. – Do not include IHS funds for compacted and contracted services received by a tribe and passed through to the clinic.

131

Other Government Grants: Lines 3a, 4a, 6, and 7

• Line 3a: Medicare and Medicaid EHR Incentive

Payments for Eligible Providers

– Payments made directly to providers and turned over to the health center are also recorded here

• Line 4a: ARRA – CIP and FIP drawdowns – will be zero

for almost everyone submitting

• Line 6: State Grants ‐ and ‐ Line 7: Local Grants

– Do not include grant funds which pay for units of service

132

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Other Revenue Sources – Lines 6a, 8, and 10

• 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, or on a flat fee per visit, but not fee‐for‐service

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

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

• Do not include state insurance plans
• IHS PL 93‐638 Compact funds allocated to the health center are

reported here. Private contracts with tribes are to be reported as Private, on Table 9D.

• Line 8: Foundation / Private Grants
• Line 10: Other Revenues

– Contributions, fund raising income, rents, sales, patient record fees, pharmacy sales to the public (i.e., non‐health center patients), etc.

133

ASSISTANCE AND STRATEGIES FOR SUCCESSFUL REPORTING

134

10/15/2014 68

CY 2013 Review Results

• Nearly all health centers required at least one round of

changes, with the highest frequency of changes being 7 times.

• On average, most tables were changed by a quarter of health

centers.

• Nearly half the health centers (avg. 45%) changed data on

Tables 5, 6B, and 9D.

135

0% 10% 20% 30% 40% 50% ZIP Code 3A 3B 4 5 5A 6A 6B 7 8A 9D 9E Table

% of Health Centers with Data Changes by Table in CY 2013

Available Assistance

• Regional in‐person trainings
• On‐line training modules, manual, fact sheets, webinars, and other TA

materials available:

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

• PALs

– PAL 2014‐01: Approved Uniform Data System Changes for Calendar Year 2014 http://bphc.hrsa.gov/policiesregulations/policies/pal201401.html – PAL 2014‐02: 2014 Uniform Data System Reporting Changes for Look‐Alikes http://bphc.hrsa.gov/policiesregulations/policies/pdfs/pal201402.pdf

• Telephone and email support line for reporting questions and use of UDS

data: 866‐UDS‐HELP or udshelp330@bphcdata.net

• Technical support from a UDS Reviewer to review submission
• Primary Care Associations/Primary Care Offices
• EHB Support (see handout)

– HRSA Call Center for EHB access and roles: 877‐464‐4772 – BPHC Help Desk for EHB system issues: 301‐443‐7356

136

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Strategies for Success Reporting

• Work as a team – tables are inter‐related
• Adhere to definitions and instructions ‐ Refer to the

manual, fact sheets, and other resources

• Check your data before submitting

– Refer to last years reviewer’s letter emailed to the UDS Preparer/Contact – Address edits in EHB by correcting or providing explanations that demonstrate your understanding.

• That does not mean typing “number is correct” for every questioned
• item. If it is correct, tell us how you verified the data.

– Check data trends – Compare data to benchmarks – Report on time, but do not submit incomplete reports

• Work with your reviewer

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Thank you for attending this training and for all of your hard work to provide comprehensive and accurate data to BPHC!

Ongoing questions can be addressed to UDSHelp330@BPHCDATA.NET 866‐UDS‐HELP