2008 - 2009 BPHC Uniform Data System Training

1. 2008 - 2009 BPHC Uniform Data System Training

2. Objectives • The 2008 Basic UDS training is designed to ensure that participants will know: • Why the UDS is important • How and when to submit your UDS report • What is included in the UDS • How each table is accurately completed • What help is available to assist you

3. Your Handouts • Today’s agenda • Copy of the presentation slides • 2008 UDS Manual • Set of blank tables • National Roll-up tables for 2007 • Summary of 2007 UDS Data

4. Introduction to the UDS What is the UDS and why is it important?

5. The UDS: What is it? • The Uniform Data System (UDS) is a standardized reporting system that provides consistent information about the performance of BPHC funded grantees and programs including: • Community Health Centers • Migrant/Farmworker Health Centers • Health Care for the Homeless Centers • Public Housing Primary Care Centers

6. Information Included • The number and socio-demographic characteristics of people served • Types and quantities of services provided • Types of staff who provide these services • Enhanced clinical characteristics of patients • Cost and efficiency of delivering services • Sources and amounts of income

7. Importance of the UDS • The BPHC has been collecting data documenting health center performance since 1977 • Data are used to document the effectiveness of the BPHC programs to • The Office of Management and Budget (OMB) • Congress (Congressional Committees) • HRSA (BPHC and OPR) staff • PCAs, PCOs and other who “tell the story” • Researchers

8. Importance – cont. • Data are used to • Evaluate impact of BPHC programs on the nation • Guide BPHC support decisions • Provide data for HRSA-OPR Performance Review process • Support program development and improvement at the grantee level

9. SAC / BPR Use • BPHC has targeted clinical and financial UDS measures to be included in the SAC and BPR grant applications • For new clinical measures, 2008 data will serve as the baseline for reporting • NOTE: There are no established, normative, or standardized benchmarks! • Program monitoring will be facilitated through annual UDS reporting of required measures

10. BPHC Measures

11. Getting Help • Help and information is available year round (not just at submission time) through multiple mechanisms including: • These training programs • An annually revised UDS Manual • A telephone help line (866-UDS-HELP) • An on-line help site: (udshelp330@bphcdata.net)

12. Getting Started Who needs to report, how and when?

13. Who Reports • All grantees funded before October 1, 2008 (including New Starts) with one or more of the following BPHC grants: • 330(e): Community Health Center • 330(g): Farmworker Health Center • 330(h): Health Care for the Homeless • 330(i): Public Housing Primary Care Centers

14. What is Reported • All activity included in your current “scope of project” • Includes everything in your most recent grant application and budget, funded expansions and approved changes of scope • Excludes all out of scope services • Activity is reported for the period January 1, 2008 - December 31, 2008 • Regardless of when you were funded or first drew down funds

15. What Tables are Submitted • Agencies funded under only one BPHC funding authority complete only the “Universal” report • Agencies with multiple funding will also complete grant reports • An abbreviated report including only Tables 3A, 3B, 4, 5 and 6A • Covering only special populations programs

16. How and When to Report • UDS data will be entered through the HRSA “Electronic Handbook” (EHB) which will then be available for integration with other BPHC data • Demo of application on Day 2 • UDS report is due March 2 • Extra time provided this year because of new clinical reporting requirements • Will return to February 15th due date in 2010

17. Data Editing and Correction • Your report is assigned to an Editor who reviews the report for accuracy and completeness • Your Editor will contact you for corrections and/or clarification as necessary • Editor completes editing June 15, 2009 • No prior year revisions will be processed after September 1, 2008

18. Table by Table Instructions What is reported in each table:

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

20. Patient Profile Patients by Zip Code Table 3A – Patients by Age and Gender Table 3B – Patients by Race/Ethnicity/Language Table 4 – Other Patient Characteristics Income, insurance, special populations Provider and Utilization Profile Table 5 – Staffing and Utilization FTEs, encounters and patients Overview of the Tables

21. Clinical Profile Table 6A – Selected Diagnoses and Services Table 6B – Quality of Care Indicators Table 7 – Health Outcomes and Disparities Financial Profile Table 8A – Costs Accrued costs by cost center Table 9D – Patient related revenues Charges, collections, allowances and discounts by payor type Table 9E – Other revenues Grants, contracts and other non-patient related income Tables – continued

22. Patient Profile- Patients by Zip Code andTables 3A, 3B and 4 Characteristics of patients including origin, age and sex, race and ethnicity, language, income and insurance

23. Patients - Defined • Total Patients: Individuals who receive one or more documented encounter during the reporting year. (Encounters will be discussed when we get to Table 5!) • Grant Program Patient: An individual who receives one or more documented encounter supported by one of the special population grant programs (Homeless, Farm Worker, or Public Housing)

24. Complete contact information for person responsible for UDS submission Report number of patients by zip code for all patients Patients by Zip Code • Special treatment of Special Populations: • Homeless – use zip code of location where patient receives services • Migrant – use zip code of temporary housing they are using where patient receives services • Report all zip codes with more than 10 patients • Combine the rest as “other zip codes”

25. Report all patients who had any type of encounter reported on Table 5 during 2008 Age is calculated as of June 30 Count each person once and only once! Table 3A Patientsby Age & Gender

26. Total patients on Line 4 equals patients reported on line 11 and on Table 3A Line 39 Columns (a) and (b) Ethnicity is self reported by patients Table 3B: Patients by Ethnicity

27. Total patients on Line 11 equals patients on line 4 and patients on Table 3A Line 39 Columns (a) and (b) Race is self reported by patients; patients must have the option to select multiple races Report patients who code race as Latino on Line 10 Note change in line numbers and subtotal (Lines 5a-5) Table 3B: Patients by Race

28. Patients best served in a language other than English include: Bilingual persons not fluent in medical English Persons who are served by a bilingual provider Persons who receive interpretation services Persons using sign language Persons in PR or the Pacific where a language other than English is used This is the only UDS cell that may be estimated!! Table 3B: Patients by Language

29. Total Patients on Line 6 equals Table 3A Line 39 Columns (a) and (b) Use most recent income data including self-reported income Income must be based on data obtained from patient – otherwise report as unknown Table 4: Patients by Income

30. Total Patients on Line 12 equals Line 6 and Table 3A Line 39 Columns (a) and (b) Report principal 3rd party payor for medical care (even if patient is not a medical patient) Insurance is reported as of the last visit Table 4: Patients by Insurance

31. Include as “insurance” payors such as Medicaid, Medicare, Blue Cross, etc. which “belong” to the patient Programs such as family planning, BCEDP, immunization grants, TB control and most state and local safety net programs belong to the clinic – the patient may not take the benefit elsewhere; these patients are often uninsured Workers Comp is not medical insurance SCHIP is handled differently in each state: SCHIP which is provided through Medicaid is reported on Line 8a SCHIP which is provided through a commercial carrier is reported on Line 10a Some states have both: Report patients for combined programs on the appropriate line Table 4: Insurance

32. To be completed ONLY by health centers with managed care contracts A member month is defined as 1 member being enrolled for 1 month. Total member months equals the sum of the monthly enrollment for 12 months Member month information should be obtained from monthly enrollment lists supplied by managed care companies to their providers This information was previously reported on Table 9C Table 4: Managed Care Utilization

33. Table 4: Target Populations • Grantees receiving special populations funding must report additional information: • 330(g) MHC Grantees report migrant and seasonal farmworkers separately • 330(h) HCH Grantees - report type of shelter arrangement at the time of first visit in 2008 • Veteran is an individual who completed service in the Uniformed Services of the United States All grantees must report the total number of patients on Lines 16, 23, 24 and 25.

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

35. Table 5Staffing and Utilization Staff FTEs, patient visits/encounters and patients by service

36. Col (a) – Staff full-time equivalents (FTEs) reported by position Col (b) – Clinic encounters reported by position Col (c) – Patients reported by service type Table 5:Staffing & Utilization

37. Col (a): FTEs Defined • 1.0 “FTE” is defined as being the equivalent of one person working full-time for one year • Each agency defines the number of hours for “full-time” work • (e.g., if a physician is hired full-time and works 36 hours per week, she is 1.0 FTE) • FTEs are based on employment contracts for clinicians and exempt employees; FTE is calculated based on paid hours for non-exempt employees (e.g., 2080 hrs/yr) • FTEs are adjusted for part-time work or for part-year employment

38. Col (a): FTEs reported • Report FTEs on lines corresponding with work performed, not by job title • Include as FTEs: • Employees • Contract personnel (not paid by unit of service) • Volunteers based on hours worked • Residents based on hours worked • Do not reduce clinical FTEs for vacation, CME, meetings, holidays, etc. • Do not allocate a portion of MDs’ and midlevel practitioners’ time to non-clinical functions

39. Col (a): Changes • New positions added to Table 5 in 2008 • Line 20a1 LCP • Line 20a2 LCSW • Line 30a Management and Support Staff • Management team including CFO, secretaries, AAs, etc. • Line 30b Fiscal and Billing staff • Accounting and billing staff excluding CFO • Line 30c IT Staff • Enabling positions (lines 24 – 28) changed to conform with changes on Table 8A (inclusion of lines from 8B)

40. Col (b) Encounters Defined • To qualify: An encounter must be face to face between the patient and the provider • An exception is provided for behavioral health telemedicine • Medical and dental providers must be licensed • Mental health has lines for licensed and unlicensed • All others are credentialed by the center • The provider must be acting independently • The provider must be exercising professional judgment • Not all interactions require professional judgment • The service must be charted

41. Col (b) Encounters: Reported • Report encounters on lines corresponding with staff performing the service • Medical encounters are provided by physicians, mid-level practitioners and licensed nurses only • Dental encounters are provided by dentists and dental hygienists only • Include Encounters: • Provided by paid and volunteer staff • Provided by a third party and paid for in full by grantee, including managed care referrals or voucher program encounters. • Performed by staff rounding on patients in the hospital

42. Col (b) Encounters - Visits per day • One encounter per patient (user), per provider type, per day • One medical – One dental • One mental health – One substance abuse • One Health Education – One Case Management • One of each type of “Other Health” service • Exception: Two encounters of the same type with two different providers at two different locations may both be counted • (NOTE: This UDS rule is not consistent with the rules of each and everythird party payor)

43. Col (b) Encounters Defined – Visits per Provider • A provider counts only one encounter with a patient during a day regardless of the number of services provided to that patient • A pediatrician providing fluoride drops during a medical visit cannot count a dental encounter • Case managers frequently provide case management and health education – but there is just one encounter • Dentists may count only one visit, regardless of the number of teeth worked on

44. Col (b) Encounters -Interactions that are not encounters • “Group encounters” • Only mental health group counseling encounters may be counted – if and only if it is charted in each patient’s chart and each patient is charged • No medical group visits may be counted • Group health education interactions are not counted • Other uncounted interactions: • Health education classes • Community meetings • Health fairs or mass screenings • “Immunization clinics” or “immunization only” services • Lab tests or “lab only” visits, x-rays or x-ray only visits • Pharmacy visits, refills, “Clinical Pharmacist” services • Outreach which provides only information on services

45. Col (c) Patients • Service Patient: An individual who receives one or more documented “encounter” of any specific service type: – Medical – Dental – Mental Health – Substance Abuse – Enabling – Perinatal

46. Col (c) Patients • A patient should be counted once and only once in each category in which they receive services • Thus, the same individual must! be counted as both a medical patient and a dental patient if they used both services • But they would be counted only once in any given category regardless of the number of visits they had • The total of any combination of patient categories should not equal total patients on Tables 3A and 4 unless only one type of service is offered!

47. Table 5 - Grant Tables • Table 5 Grant Reports will include only visits (column b) and patients by service (column c) • FTEs are not reported on the grant report • All activity for grant report patients (those included on Tables 3A, 3B, and 4) is included on the Table 5 grant report, regardless of funding sources • e.g., a dental encounter for a public housing “patient” is included on the public housing Grant Table, regardless of the source of the funds which pay for the visit

48. Table 5 – Tips for Success • Tables 5, and 8A are closely related. All FTEs reported on Table 5 must be included in the same cost center on Tables 8A. Preparation of Tables 5 and 8A must be coordinated • Encounters and patients reported in any cell of the grant tables cannot exceed the number reported on the universal table • Review definitions of patients, encounters and FTE employees

49. Table 6ASelected Diagnoses and Services Rendered Patients and encounters for selected primary diagnoses and services

50. Lines 1-20d reports patient and encounters for selected primary diagnoses Diagnoses not typically reported as primary will likely appear underreported (e.g., SA and MH) Typically only a fraction of total encounters are recorded on this table Table 6A Col (a) – Diagnoses