Uniform Data System (UDS) Report 2005: Comparisons and Trends

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

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

3. Patient Totals and Demographics

4. 2005 Statistics • 2005 total patients • 17,519 • Receiving medical services • 16,818 • Prenatal patients • 73

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

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

7. 2005 Black 32% White34% Hispanic 33%

8. Patients by Diagnosis

9. Prenatal Patients * Did not report less than 2 prenatal visits

10. 2005 Prenatal Patients by Race Total Patients Prenatal Patients 32% 34% 33%

11. Prenatal Care

12. Delivery, Postpartum, and Infant Utilization *Less than 2 visits not reported *No BW <1501g

13. 2005 Enrollment of Prenatal Care Users in WIC • Prenatal care users: 78% • Infants: 49% • Postpartum care users: 49%

14. Visits by Primary Diagnosis** *2001-2003 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

15. Patients with Primary Diagnosis** *2001-2003 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

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

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

18. Productivity, Charges, Collections, and Adjustments

19. Medical Team Productivity 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

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

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

22. 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

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

24. 2005 Medical /Administrative Costs

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

26. 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)

27. Proportion of Payors

28. Proportion of Payors 2001-2005

29. 2005 Collections by Payor

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

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

32. Self Pay Collection Rate Self Pay Amount Collected Collection Rate = Full Charges

33. 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

34. Findings • Total number of patients have decreased • 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 • Medical team productivity increased and is significantly high compared to state and national CHC averages

35. Findings • 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 • Number of Medicaid patients has decreased since 2003 • Collection rate continues to be low for self payers compared to standard set by state • Bad debt continues to increase

36. Limitations • 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 • Current system has inability to accurately assess utilization by health conditions diagnosed and coded

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