Uniform Data System (UDS) Report 2005: Comparisons and Trends September 2006 Cassandra Arceneaux MD, MPH General Preventive Medicine Resident- UTMB

Objectives Identify demographics and total number of patients seen over past 5 years Identify demographics and total number of patients seen over past 5 years Compare medical productivity to other districts and previous years Compare medical productivity to other districts and previous years Compare costs by encounter and service Compare costs by encounter and service Discuss bad debt and adjustments Discuss bad debt and adjustments Review statistics by payor categories Review statistics by payor categories

Patient Totals and Demographics

2005 Statistics 2005 total patients 2005 total patients  17,519 Receiving medical services Receiving medical services  16,818 Prenatal patients Prenatal patients  73

Total Patients Total Pts. = Total users of all services Medical Services = No. of pts. using medical services

Patients by Age and Gender * Groups noted as target populations by UDS 2005

White 34% Black 32% Hispanic 33% 2005

Patients by Diagnosis

Prenatal Patients Age *2005*Totals < > Total Patients * Did not report less than 2 prenatal visits

2005 Prenatal Patients by Race 34% 32% 33% Total PatientsPrenatal Patients

Prenatal Care

Delivery, Postpartum, and Infant Utilization *2005* Users who delivered during the year 31%5%13%59% BW g** 0%0%1%4% BW>2500g31%5%12%41% Postpartum Care 20%5%9%15% Newborn visit 21%2%6%25% *Less than 2 visits not reported *No BW <1501g

2005 Enrollment of Prenatal Care Users in WIC Prenatal care users: 78% Prenatal care users: 78% Infants: 49% Infants: 49% Postpartum care users: 49% Postpartum care users: 49%

Visits by Primary Diagnosis** * values represent all mental disorders excluding drug and ETOH dependence; later part of 2004 first mental health counselor hired **some data limitations include accuracy of diagnosis and coding and what diagnosis was listed as primary

Patients with Primary Diagnosis** * values represent all mental disorders excluding drug and ETOH dependence; later part of 2004 first mental health counselor hired **some data limitations include accuracy of diagnosis and coding and what diagnosis was listed as primary

Preventive Service Visits** *up to age 11 **some data limitations include accuracy of diagnosis and coding and what diagnosis was listed as primary

Preventive Service Patients** *up to age 11 **some data limitations include accuracy of diagnosis and coding and what diagnosis was listed as primary

Productivity, Charges, Collections, and Adjustments

Medical Team Productivity Total visits for physicians and mid-levels (Total physician FTEs**)+ (Total Midlevel FTEs/2) *2003 Excludes Psychiatry **FTEs = Full Time Equivalent Hours or 2080 hrs Medical Team Productivity =

Dental Team Productivity Dental Team Total Visits for dentists and hygienists Productivity = Total dentist FTEs + hygienists FTEs

Medical Cost Per Visit* * Includes Psychiatry Medical Cost Total Medical Service Costs - Lab/Xray Per Visit= Total Medical Service Visits - Nursing $90 $105 $117 $109

Medical Costs (Definitions)  Costs for Medical Care  Medical Staff  Lab and X-Ray  Medical/Other Direct  Costs for Medical Services  Dental Health  Mental health  Substance Abuse  Pharmacy/Pharmaceuticals  Other Professional Costs  Costs for Enabling and other Program Related Services

Administrative Costs (Definition) Total Facility Costs +Total Administration Costs = Overhead

2005 Medical /Administrative Costs Services Accrued Medical Costs Facility/ administrati on Totals Medical Care 2,253,0231,636,8333,889,856 Other Clinical 1,550,386893,9722,444,358 Enabling255,156129,938385,094 Totals4,058,5652,660,7436,719,308

Medical Vs. Administrative Costs *STD fund and WIC fund moved from clinic into general fund; loss in providers

Laboratory and Pharmacy Costs Lab/X-ray Total Lab/X-ray Costs including Overhead Costs = Total Medical Visits – Nurse Visits Pharmacy (Accrued Cost of Pharmacy not including pharmaceuticals) + Costs = (Accrued cost of pharmaceuticals)

Proportion of Payors

Proportion of Payors

2005 Collections by Payor

Medicaid Patients Number of 4C’s pts with Medicaid by year

Bad Debt as % of Self Pay Charges Bad Self-Pay Bad Debt Write-off Debt = Self-Pay Charges

Self Pay Collection Rate Self PayAmount Collected Collection Rate = Full Charges

Surplus/Deficit as % Total Cost Surplus/(Total Amount Collected + Total Revenue) – Total Accrued Costs incl.Overhead Deficit = Total Accrued Costs including Overhead * 2005 does not really reflect a deficit but a transfer of excess funds reserved for Texas City renovations

Findings Total number of patients have decreased Total number of patients have decreased Due to limitations in coding we are unable to assess utilization trends by diagnosis Due to limitations in coding we are unable to assess utilization trends by diagnosis An apparent decrease in preventive visits and decline in visits for major diagnoses An apparent decrease in preventive visits and decline in visits for major diagnoses Medical team productivity increased and is significantly high compared to state and national CHC averages Medical team productivity increased and is significantly high compared to state and national CHC averages

Findings Medical cost per encounter remains less than state and national CHC averages Medical cost per encounter remains less than state and national CHC averages In 2005 the proportion of private insurance and Medicaid patients has increased compared to the uninsured In 2005 the proportion of private insurance and Medicaid patients has increased compared to the uninsured Number of Medicaid patients has decreased since 2003 Number of Medicaid patients has decreased since 2003 Collection rate continues to be low for self payers compared to standard set by state Collection rate continues to be low for self payers compared to standard set by state Bad debt continues to increase Bad debt continues to increase

Limitations There is a discrepancy between what the UDS reports and what the AS-400 shows There is a discrepancy between what the UDS reports and what the AS-400 shows UDS methods of calculation and reporting have changed since 2002 UDS methods of calculation and reporting have changed since 2002 Current system has inability to accurately assess utilization by health conditions diagnosed and coded Current system has inability to accurately assess utilization by health conditions diagnosed and coded

Opportunities Maintain provider productivity Maintain provider productivity Increase utilization rate among all clinic patients Increase utilization rate among all clinic patients Increase number of insured patients Increase number of insured patients Increase collections Increase collections EMR implementation will help to improve health data quality EMR implementation will help to improve health data quality