URBAN INDIAN HEALTH PROGRAM CY2013 1 Introducing the UDS Brief Introduction to UDS Available...

URBAN INDIAN HEALTH PROGRAMCY2013 2

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

Agenda


• Copy of the presentation slides• CY2013 UDS Manual, Tables, Fact

Sheets • Summary of CY2013 changes• UDS Feedback Report• UDS Reference Formula Guide

Reference Materials


Do you know?

(117,557 Patients, 51,646 AI/AN)• How many patients are served by the Urban Indian

Health Program?

• How many visits? (507,987)

• What % of patients are uninsured?(52%) on Medicaid?

(30%)

• What is the average cost per medical visit? ($230)

• Where can you get this information? (UIHP UDS for CY2012)

• How is this information used? (We’ll discuss in a few moments…)

• Why are we here today? (Accurate Reporting of the UDS Data)


2012 Program Impact

• 33 Programs serving 117,557

• Total Visits include Medical, Dental, MH, SA, Vision, Other Professional and Enabling Services

• Employees represent FTE- those employed greater


• 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)

What is the Uniform Data System (UDS)?


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

What is Reported Table(s)

Patients you serve Coversheet/Zip CodeTables 3A, 3B, 4

Staffing Mix Table 5

Types and quantities of services you provide

Tables 2, 5 and 6A

The care you deliver Tables 6A

Costs of providing services Table 8A

Revenue sources Tables 9D and 9E


TableUniversal 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

Universal and AI/AN Tables


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

Why is the UDS important?


• 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

Critical Dates in the UDS Process


• 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

Available Assistance


• Work as a Team• Refer to reporting manual, fact sheets

and support resources• Check your data before submitting

• Address all edits• Check data trends • Compare data to benchmarks• Refer to last year’s review questions

Strategies for Success: Submission


UDS Tables and Definitions


• Definitions of terms for consistent reporting

• Step-by-step instructions for table completionReference Manual and Quick Fact Sheets

• Interrelatedness of TablesTables cannot be completed accurately

without cross checking• How the data are / can be used for

program improvement

Each table will be reviewed for:


CY2013 Changes

Table CY2013

Coversheet,Zip Code, Table 2 No Change

3A, 3B No Change

4Table 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


General InformationProvides general information

on program including contacts, service locations and services


• 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

Cover Sheet


• Site name and address

• Year round/less than year round

• Full-time or part-time

• Location code • Medicaid

numbers (if site specific)

Service Delivery Site Locations


• For each service indicate if and how service is provided (3 methods of service)

• Check all cells that apply

• There is no “quantity” measure

Table 2: Services Offered and Delivery Methods


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

patients

Patient Profile


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

Patient Profile Tables

21


• 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

Who Counts: Patient Defined


• 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

Who counts as an American Indian/Alaska Native patient (AI/AN)?


Patients by Zip CodesZip Code Table


Patients by Zip Code

• Enter zip code and number of patients from each zip code

• Account for total patients by zip code

• Aggregate zip codes with 3 or less patients

• Combine the rest as ‘other zip codes’


Patients by Zip Code (continued)

Additional instructions for reporting zip codes for special populations:

• Homeless- Use zip code of location where patient receives services if no better data exists

• Seasonal/Migrant Workers-use zip code of the temporary housing they occupy when patient is in the area.


Patient DemographicsTables 3A and 3B


• 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.

Table 3A: Patients by Age & Gender (Universal and AI/AN)


Table 3B: Patients by Race and Ethnicity

• Patients self select except AI/AN (line 4a); 4b for “Other” AI/AN

• Use Column b (Non-Hispanic) if patient does not indicate “Latino” or “Hispanic”

• Use Line 6 only if patient chooses two or more listed races.– “More than one”

shouldn’t be a choice; don’t use for Latino + a Race


• Count each patient once and only once on Table 3BAI/AN Line 4a col d must = total

AI/AN patients reported on AI/AN Table 3A

Total on line 8 col d must = Total Patients by Zip Code Table and Age and Gender Table (Table 3A)

• If no known race and/or ethnicity, report on line 7

Table 3B: Patients by Race and Ethnicity


• 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

Table 3B: Patients by Language


Other Demographic Data: Income, Insurance, Managed Care, Veterans

Table 4


• Income• Insurance• Managed

care • Veterans

Table 4: Selected Patient Characteristics


• 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

Table 4: Patients by Income


• 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

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

Table 4: Patients by Medical Insurance


• 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

Table 4: Medical Insurance Reporting Categories


• CHIP: is handled differently from state to state:

• If provided through Medicaid is reported on line 8b

• If provided through a commercial carrier outside of Medicaid it is reported on Line 10b (Other Public- not private)

• OTHER PUBLIC: Public coverage for patients for a broad set of benefits- very uncommon

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

• PRIVATE INSURANCE• NOTE: Workers Comp is not medical

insurance

Table 4: Medical Insurance Reporting Categories (continued)


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.

Table 4: Managed Care Utilization & Veterans


• 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

Cross Table Issues


• 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

Uses of Patient Data


• How would you check the reasonableness of these numbers?

• Do they get your seal of approval?

Test Your Reviewer Skills 1


Table 5: Staffing and Utilization

Describes the types and quantities of services provided and staff who provide these services

FTEs, visits, and patients


• Col (a) – Staff full-time equivalents (FTEs) reported by position

• Col (b) – Clinic visits reported by provider type

• Col (c) – Patients reported by service

Table 5: Staffing and Utilization


• Include all workers providing services at approved sitesEmployees, 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).

Who is included as a Full-time Equivalent (FTE)?


• 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.)

How are FTEs calculated?


• 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

yearFull time doctor works 2080 hours less

vacation (160) holidays (96) and CME (40) hours = 1784

250 / 1784 = 0.14 FTE

How are FTEs calculated? (Continued)


• 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

Where are FTEs reported?


• 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

Where are FTEs reported? (Continued)


• Face to face, 1:1 between patient and providerExcept 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)

What is a Visit?


• 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

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, visitsPharmacy visits

What is a Visit? (continued)


• 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

What is a service patient?


• FTEs (Column a) are not reported on the AI/AN Table 5

• Report visits and services received by AI/AN patients

AI/AN Table 5


• 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

Cross Table Issues


• 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 visitCharge and collection per visit

Uses of Utilization and FTE Data


• How would you check the reasonableness of these numbers?



Table 6A: Clinical ProfileDescribes patients by selected

diagnoses and services received


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

Clinical Profile Table


60

• Lines 1-20e diagnoses regardless of primacy

• Lines 21-34 Selected Services

• Column (a) – Visits• Column (b) –

Patients

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

Table 6A: Selected Diagnoses and Services Rendered


• 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

Cross Table Issues


• 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)

Uses of Clinical Data


Financial ProfileDescribes cost and efficiency of

delivering services and sources and amounts of income


• Table 8A – Financial costs• Table 9D – Patient related

revenues• Table 9E – Other revenues

Grants, contracts, and other income not generated by patient services

Financial Profile Tables


Table 8A Financial Costs

Costs by Cost Center


• 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

Table 8A:Financial Costs


Cross Table Issues (continued)Table 8A and Table 5 “Crosswalk”


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.

Table 8A: Direct Costs


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

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.

FINANCIAL COSTS OF ENABLING AND OTHER PROGRAM RELATED SERVICES

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.Total Enabling Services Cost (Sum lines 11a through 11g)

12. Other Related Services (specify:________________)

13.TOTAL ENABLING AND OTHER SERVICES

(SUM LINES 11 AND 12)



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 CorporationsJob Training Child careShelters Fitness programsHead Start /Early Head StartAdult Day Health Care

• Include any “pass through” funds here



• 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.

Table 8A: Facility and Non-clinical


• 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

Allocation of Facility


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.

Allocation of Non-Clinical Support


• 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

serviceFor example, medical cost per medical visit or dental cost per dental patient, etc.

Cross Table Issues


• Cost per patient and per service patient

• Cost per service visit (e.g., medical, dental, etc.)

• % overhead costs (non-clinical support services and facility)

Uses of Cost Data


• How would you check the reasonableness of costs on T8A as they relate to staffing and visits on T5?


Table 5:

Table 8A:


Table 9D: Patient Related Revenues

Charges, collections and allowances by payor


• Cash Basis• Patient revenues are

reported by payor:Medicaid MedicareOther PublicSelf-Pay

Table 9D: Patient Related Revenue


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

Charges


• 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 payorDo not include cash “donations” (these

are reported on Table 9E)Do not include “meaningful use”

payments

Collections


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)

Adjustments


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

Allowances


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

Self-Pay Sliding Discounts


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

Bad Debt


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

Payors: Medicaid and Medicare


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.

Payors: Other Public and Private


Line 13: Self PayCharges 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

Payors: Self-Pay


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

Reclassify Charges


• 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)

Cross-Table Issues


• Average charge per visit• Payor mix• Charge to cost ratio

indication that fees cover costs

Uses of Revenue Data


Table 9E: Other RevenuesNon-patient-service income


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

loanPatient-related

revenueValue of donated

services, supplies, or facilities

Donated “community value”


• 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

Table 9E: IHS, Other Federal and State Grants


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

Table 9E: Non-FederalIndigent Care Programs


• 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 GrantsFunds received from foundations or private

organizations including money received from a contract with a tribe

• Line 10: Other RevenuesContributions, fund raising income, rents and

sales, patient record fees, etc.

Table 9E: Non-Federal Grants or Contracts


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.)

What NOT to include on Table 9E


• 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

Cross Table Issues


• 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

Uses of Revenue Data


Demonstration of Software

AccessData EntryValidationSubmissionReports


Using UDS for Decision Making

Interpreting the Feedback Report


• Too much information and not enough time!

• A Snapshot Approach – focus on a few high impact measures for initial review to identify

StrengthsPossible areas of improvement

Focusing Your Efforts


• 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?

Snapshot of Performance


Performance measures• Access

Describes patients you serve

• Quality of Care Utilization and GPRA

measures• Efficiency

Evaluates capacity• Financial Cost/Viability

Assesses costs and viability

Feedback Report


Evidence that program is serving priority populations:

• % Growth in patientsAI/AN patients% AI/AN of total patientsTotal patients% patients using medical

services• Patient demographics• Patients with financial, cultural

and linguistic barriers% Uninsured, Medicaid, other

public% < 200% FPL

Patient Profile


Evidence that program is delivering quality care:

GPRA Measures

Continuity of care

Prevalence rates

• 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)

Quality of Care


Evidence that program is operating a cost effective services delivery model:

• Growth in visits• Provider FTEs• Panel size

(patients/provider FTE)

• Visits per provider• Staff Ratios

Efficiency


• 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

Financial/Cost Viability

Evidence that program is financially viable:


• 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

UDS Reference Guide


% Pediatric: (T3A Lines 1-15, Col A+B) /(T3A L39 CA + T3A L39 CB)

T= Table + = add - = subtractL= Line * = multiply C=

Column / = divide

Calculations for Performance Measures


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)


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)

Averages


• 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

Identifying Strengths & Weaknesses


Priscilla DavisJohn Snow, Inc. (JSI)

UDS Helpline: 1-866-698-5976email: [email protected]: www.uihpdata.net

Contact Information

URBAN INDIAN HEALTH PROGRAM CY2013 1 Introducing the UDS Brief Introduction to UDS Available...

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