Uniform Data System (UDS) Report 2005:

Comparisons and Trends

September 2006September 2006

Cassandra Arceneaux MD, MPHCassandra Arceneaux MD, MPH

General Preventive Medicine General Preventive Medicine Resident- UTMBResident- UTMB

Objectives

Identify demographics and total number of Identify demographics and total number of patients seen over past 5 yearspatients seen over past 5 years

Compare medical productivity to other Compare medical productivity to other districts and previous yearsdistricts and previous years

Compare costs by encounter and service Compare costs by encounter and service Discuss bad debt and adjustmentsDiscuss bad debt and adjustments Review statistics by payor categoriesReview statistics by payor categories

Patient Totals and Demographics

2005 Statistics

2005 total patients2005 total patients 17,51917,519

Receiving medical servicesReceiving medical services 16,81816,818

Prenatal patientsPrenatal patients 7373

Total Patients

15500

16000

16500

17000

17500

18000

18500

Total Users Medical Services

20012002200320042005

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

Patients by Age and Gender

13%

7%

33%

47%

Pediatric (<15yo)*

Geriatric (>64)*

Women's Health (ages 15-44)*

Other

* Groups noted as target populations by UDS

2005

Patients by Race and Ethnicity

White 34%

Black 32%

Hispanic 33%

2005

Patients by Diagnosis

Prenatal Patients

AgeAge 20022002 20032003 2004*2004* 2005*2005* TotalsTotals

<15<15 00 00 00 00 00

15-1915-19 3131 4343 1717 1010 101101

20-2420-24 5151 4444 4141 2424 160160

25-4425-44 5050 5151 5050 3939 190190

>44>44 11 00 00 00 11

Total Total PatientsPatients

133133 138138 108108 7373 452452

* Did not report less than 2 prenatal visits

2005 Prenatal Patients by Race

BlackLatinoWhiteAsianUnreported

14%

64%

14%

7% 1%

34% 32%

33%

Total Patients Prenatal Patients

Prenatal Care

Age of Patients

14%

33%

53%

15-19 yo

20-24 yo

25-44 yo

Entry to Prenatal Care

55%36%

9% FirstTrimesterSecondTrimesterThirdTrimester

Delivery, Postpartum, and Infant Utilization

20022002 20032003 2004*2004* 2005*2005*

Users who delivered Users who delivered during the yearduring the year

31%31% 5%5% 13%13% 59%59%

BW 1501-2500g**BW 1501-2500g** 0%0% 0%0% 1%1% 4%4%

BW>2500gBW>2500g 31%31% 5%5% 12%12% 41%41%

Postpartum CarePostpartum Care 20%20% 5%5% 9%9% 15%15%

Newborn visitNewborn visit 21%21% 2%2% 6%6% 25%25%

*Less than 2 visits not reported

*No BW <1501g

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

Visits by Primary Diagnosis**

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

HTN DM Depression* STDs

20012002200320042005

*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

Patients with Primary Diagnosis**

0

500

1000

1500

2000

2500

3000

3500

HTN DM Depression* STDs

20012002200320042005

*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

Preventive Service Visits**

0

1000

2000

3000

4000

5000

6000

ContraceptiveManagement

Pap Smear Child Health*

20012002200320042005

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

Preventive Service Patients**

0

500

1000

1500

2000

2500

3000

3500

4000

ContraceptiveManagement

Pap Smear Well ChildVisits*

20012002200320042005

*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

0

1000

2000

3000

4000

5000

6000

4C's Texas Urban Large

2003*

2004

2005

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

0

500

1000

1500

2000

2500

3000

4C's TX Urban Large

200320042005

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

Medical Cost Per Visit*

0

20

40

60

80

100

120

4C's Texas Urban Large

200320042005

* 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 Costs for Medical Care

Medical StaffMedical Staff Lab and X-RayLab and X-Ray Medical/Other DirectMedical/Other Direct

Costs for Medical ServicesCosts for Medical Services Dental HealthDental Health Mental healthMental health Substance AbuseSubstance Abuse Pharmacy/PharmaceuticalsPharmacy/Pharmaceuticals Other Professional CostsOther Professional Costs

Costs for Enabling and other Program Related ServicesCosts for Enabling and other Program Related Services

Administrative Costs (Definition)

Total Facility Costs +Total Total Facility Costs +Total Administration Costs = OverheadAdministration Costs = Overhead

2005 Medical /Administrative CostsServicesServices Accrued Accrued

Medical CostsMedical CostsFacility/ Facility/ administratiadministrationon

TotalsTotals

Medical CareMedical Care 2,253,0232,253,023 1,636,8331,636,833 3,889,8563,889,856

Other ClinicalOther Clinical 1,550,3861,550,386 893,972893,972 2,444,3582,444,358

EnablingEnabling 255,156255,156 129,938129,938 385,094385,094

TotalsTotals 4,058,5654,058,565 2,660,7432,660,743 6,719,3086,719,308

Medical Vs. Administrative Costs

0

1000000

2000000

3000000

4000000

5000000

6000000

Medical Overhead

2001200220032004*2005*

*STD fund and WIC fund moved from clinic into general fund; loss in providers

Laboratory and Pharmacy Costs

0

100000

200000

300000

400000

500000

600000

700000

800000

900000

Lab/Xray Pharmacy

20012002200320042005

Lab/X-ray Total Lab/X-ray Costs including OverheadCosts = Total Medical Visits – Nurse Visits

Pharmacy (Accrued Cost of Pharmacy not including pharmaceuticals) + Costs = (Accrued cost of pharmaceuticals)

Proportion of Payors

0 1 3 237

1014

27 6 76

25

38 37

88

59

4339

0

10

20

30

40

50

60

70

80

90

100

4Cs Texas Urban Large

CHIP

Private Insurance

Medicare

Medicaid

Unisured

Proportion of Payors 2001-2005

0

10

20

3040

50

60

70

80

90

Uninsured Medicaid Medicare PrivateInsurance

20012002200320042005

2005 Collections by Payor

Medicaid (28%)

Medicare (17%)

Other PublicInsurance (9%)Private Insurance(1%)Self Pay (45%)

Medicaid Patients

0

200

400

600

800

1000

1200

1400

20012002200320042005

Number of 4C’s pts with Medicaid by year

Bad Debt as % of Self Pay Charges

0

500000

1000000

1500000

2000000

2500000

Bad Debt

20012002200320042005

Bad Self-Pay Bad Debt Write-offDebt = Self-Pay Charges

Self Pay Collection Rate

0%

5%

10%

15%

20%

25%

4C's Texas Urban Large

200320042005

Self Pay Amount CollectedCollection Rate = Full Charges

Surplus/Deficit as % Total Cost

-5%

0%

5%

10%

15%

20%

2001

2002

2003

2004

2005*

Surplus/ (Total Amount Collected + Total Revenue) – Total Accrued Costs incl.OverheadDeficit = 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 decreasedTotal number of patients have decreased Due to limitations in coding we are unable Due to limitations in coding we are unable

to assess utilization trends by diagnosisto assess utilization trends by diagnosis An apparent decrease in preventive visits An apparent decrease in preventive visits

and decline in visits for major diagnosesand decline in visits for major diagnoses Medical team productivity increased and is Medical team productivity increased and is

significantly high compared to state and significantly high compared to state and national CHC averagesnational CHC averages

Findings

Medical cost per encounter remains less than state Medical cost per encounter remains less than state and national CHC averagesand national CHC averages

In 2005 the proportion of private insurance and In 2005 the proportion of private insurance and Medicaid patients has increased compared to the Medicaid patients has increased compared to the uninsured uninsured

Number of Medicaid patients has decreased since Number of Medicaid patients has decreased since 20032003

Collection rate continues to be low for self payers Collection rate continues to be low for self payers compared to standard set by statecompared to standard set by state

Bad debt continues to increaseBad debt continues to increase

Limitations

There is a discrepancy between what the There is a discrepancy between what the UDS reports and what the AS-400 showsUDS reports and what the AS-400 shows

UDS methods of calculation and reporting UDS methods of calculation and reporting have changed since 2002have changed since 2002

Current system has inability to accurately Current system has inability to accurately assess utilization by health conditions assess utilization by health conditions diagnosed and codeddiagnosed and coded

Opportunities

Maintain provider productivityMaintain provider productivity Increase utilization rate among all clinic Increase utilization rate among all clinic

patientspatients Increase number of insured patientsIncrease number of insured patients Increase collectionsIncrease collections EMR implementation will help to improve EMR implementation will help to improve

health data qualityhealth data quality