any chc - sample multi-year trend report access and financial measures budget access to primary care
TRANSCRIPT
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Any CHC - Sample Multi-yearTREND REPORT
Access and Financial Measures
Budget
Access to Primary Care
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Number of Patients/Users - PM#1
Measures Access to Health Care
The number of patients utilizing services is a significant indicator of a health center’s effort to meet the health care needs of its community, as well as an important indicator of the health center’s market penetration.
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Any CHC Number of Unduplicated Patients
18,020
15,009
18,870
17,638
15,126
12,000
14,000
16,000
18,000
20,000
2003 2004 2005 2006 2007
Total Patients
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Any CHC Patients - Gender Breakdown
37%
41%38%38%
41%
59%
62%62%63%
59%
30%
35%
40%
45%
50%
55%
60%
65%
70%
2003 2004 2005 2006 2007
Males Females
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Any CHC Patients - Age Breakdown
23%28%
23%26%26%
77%77%
74%74%72%
0%
20%
40%
60%
80%
100%
2003 2004 2005 2006 2007
Children 19 Years of Age and Under
Adults Over 19 Years of Age
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Any CHC Patients - Ethnicity Breakdown
0.5% 0.4%0.5%0.5% 0.4%
16%14%
30%
34%
16%
0.1% 0.1%0.1% 0.1% 0.1%
29%
40%38%
25%
37%
21%
20%
13% 15%16%
4%
12%
48%
40%
46%
0%
10%
20%
30%
40%
50%
60%
2003 2004 2005 2006 2007
Asian/Pacific Islander N - 4% U - 4% Black/African American N - 23% U - 31%Am Indian/Alaska Native N - 1% U - 1% White N - 37% U - 24%Hispanic or Latino N - 36% U - 39% Ethnicity Not Reported
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Any CHC Patients - Medical Service
17,257
15,009
18,743
17,638
15,126
12,000
14,000
16,000
18,000
20,000
2003 2004 2005 2006 2007
Total Medical Patients
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Any CHC Patients - Other Service Types
1,503
47
23991
15
611
424
746
501
269
1,223
870983
1,418
1,104
0
500
1000
1500
2000
2003 2004 2005 2006 2007
Total Dental Patients Total Mental Health Patients
Total Enabling Services Patients
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Average Number of Visits Per UserMeasures Practice Quality, Comprehensive Care, and Acuity
Calculation:Total Provider Medical Encounters
(physicians and mid-levels only)
- divided by -
Total Medical Users (Patients)
The Measure is Calculated in the Same Manner for Each Type of Service Provided by a Health Center
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Any CHC - Average Number of Visits Per User
2.97
3.023.223.23
3.00
2.84
1.89
1.47
2.13
2.33 2.40
1.701.89
2.41
1.30
3.24
3.60
2.87
3.26
4.23
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
2003 2004 2005 2006 2007
Medical - N - 3.18 U - 3.14 Dental - N - 2.41 U - 2.41 Mental Health - N - 4.93 U - 4.90 Enabling Services - N - 2.80 U - 2.98
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Any CHC - Patient Mix by Payer Type
51.6%50.5%
46.3%45.4%
45.1%
23.1%23.9%28.2%
30.5%
23.6%
14.0%14.5%
15.0% 15.6% 14.6%
0.0%0.0%0.0%0.0% 0.0%
11.4%11.0%9.9%
9.2%
16.8%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
2003 2004 2005 2006 2007
Uninsured Users N - 39% U - 41%Medicaid Users N - 35% U - 39%Medicare Users N - 8% U - 6%Other Public Users N - 2% U - 3%Private Insurance Users N - 16% U - 11%
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Any CHC - Patient Mix by Payer Type
9,3049,530
8,171
6,8646,774
4,1554,513
4,9764,608
3,5382,515
2,1692,266
2,750 2,755
0000 0
2,0462,0721,741
1,388
2,528
0
2,000
4,000
6,000
8,000
10,000
2003 2004 2005 2006 2007
Uninsured Users N - 39% U - 41%Medicaid Users N - 35% U - 39%Medicare Users N - 8% U - 6%Other Public Users N - 2% U - 3%Private Insurance Users N - 16% U - 11%
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Any CHC Patient Income Level
35.0%
27.7%
34.3% 37.0% 39.2%
13.4%
14.5%
13.9% 13.4%13.8%
2.4%2.1%2.5%3.0% 3.2%
0.9%
1.2%
0.6% 0.9%
1.4%
47.4%
54.4%
49.1%46.4% 42.3%
0%
10%
20%
30%
40%
50%
60%
2003 2004 2005 2006 2007
Percent with Income: 100% and Below FPL Percent with Income: 101% to 150% of FPL Percent with Income: 151% to 200% of FPL Percent with Income: Over 200% of FPL Percent with Income: Unkonwn
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Any CHC - Number of Patients
Contributing Factors:
CF1:
CF2:
CF3:
CF4:
CF5:
CF6:
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Restricting Factors:
RF1:
RF2:
RF3:
RF4:
RF5:
RF6:
Any CHC - Number of Patients
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Performance Improvement Options: PIO1
PIO2
PIO3
PIO4
PIO5
Any CHC - Number of Patients
Next StepsNext Steps
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Current RatioMeasures Financial Liquidity
Minimum of 1.0 - with 2.0 preferred
Calculation:
Current Assets / Current LiabilitiesSource: Month End and Year End Balance Sheet - One of the Routine
Financial Statements.
The Balance Sheet is a snapshot of the financial position of the organization at the point in time (date) of
the Financial Statement.
All activities of the health center (What people do) impacts the Current Ratio:
Increased Encounters = Increased Revenue = Improved Profitability = Increase in the Current Ratio
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Current AssetsCash or Readily Converted to Cash
Cash
Net Patient Services Accounts Receivable
Grants and Contracts Receivable
Prepaid Expenses (rent, insurance, etc.)
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Current LiabilitiesExpenses /Obligations Due in One Year Time
Accounts PayableAccrued Expenses (payroll taxes/withholdings, uncompensated
absences, etc.)
Capital Leases - Current Portion
Lines of Credit
Notes/Mortgage Payable - Current Portion
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Any CHC Current Ratio
1.69
3.00
2.27
1.86
1.42
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
2004 2005 2006 2007 2008
Current Ratio BPHC Minimum BPHC Preferred
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Any CHC Balance Sheet Data
Description
Prior Year Audit
Jan 31, 2004
Prior Year Audit
Jan 31, 2005
Prior Year Audit
Jan 31, 2006
Prior Year Audit
Jan 31, 2007
UNAUDITED Jan 31, 2008 (12 months)
Percent Change
2004 to 2008Variance
2004 to 2008
Cash 182,980$ 284,891$ 333,982$ 918,327$ 678,979$ 271.1% 495,999$ Patient Accounts Receivable - Net 736,069$ 1,237,990$ 1,341,604$ 997,654$ 1,501,358$ 104.0% 765,289$ Grants and Contracts Receivable 34,897$ -$ 57,258$ -$ 264,633$ 658.3% 229,736$ Accounts Receivable - Other 143,439$ 143,300$ 234,596$ 231,288$ 128,815$ -10.2% (14,624)$ Other Current Assets 202,297$ 215,841$ 252,430$ 266,634$ 280,379$ 38.6% 78,082$ Total Current Assets 1,299,682$ 1,882,022$ 2,219,870$ 2,413,903$ 2,854,164$ 119.6% 1,554,482$ Accounts Payable 105,072$ 120,309$ 283,020$ 459,152$ 720,815$ 586.0% 615,743$ Accrued Payroll and Related Expenses 337,021$ 304,145$ 411,554$ 466,270$ 562,052$ 66.8% 225,031$ Deferred Revenue 59,303$ 60,167$ 57,705$ 134,405$ 382,780$ 545.5% 323,477$ Other Accrued Liabilities 47,009$ 19,633$ 28,971$ 30,287$ 2,487$ -94.7% (44,522)$ Line of Credit & Short-term Notes -$ -$ -$ 131,066$ 131,066$ #DIV/0! 131,066$ Current Portion - Long-term Debt & Cap Leases 219,260$ 123,708$ 196,668$ 78,708$ 209,774$ -4.3% (9,486)$ Total Current Liabilities 767,665$ 627,962$ 977,918$ 1,299,888$ 2,008,974$ 161.7% 1,241,309$ Current Ratio (CA/CL) 1.69 3.00 2.27 1.86 1.42 -16.1% -0.27 Working Capital (CA-CL) 532,017$ 1,254,060$ 1,241,952$ 1,114,015$ 845,190$ 58.9% 313,173$
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Total Net AssetsNet Worth
Calculation:
Total Assets (Audited Balance Sheet) - Minus -
Total Liabilities (Audited Balance Sheet)
The difference between what the organization owns minus the debts the organization owes. Negative Net Assets is an indication of severe financial
weakness and raises the question of financial viability.
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Any CHC - Total Net Assets
$2,312,196
$3,094,507$3,238,584
$3,853,603
$4,368,766
$2,000,000
$3,000,000
$4,000,000
$5,000,000
2004 2005 2006 2007 2008
Total Net Assets
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Debt Management RatioMeasures the Debt Load - Percent of Debt to Total Assets
Calculation:
Total Liabilities (Audited Balance Sheet) - Divided by -
Total Assets (Audited Balance Sheet)
The target is a Debt Management Ratio below 0.50 (or less than 50% of Total Assets tied up in Debt). A Debt Management Ratio in excess of 1.0 is an indication of excessive debt load and is an indicator that the organization’s financial viability is
in question.
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Any CHC - Debt Management Ratio
0.320.26
0.24
0.19
0.3
0
0.25
0.5
0.75
1
2004 2005 2006 2007 2008
Debt Management Ratio Maximum Target
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Increase/(Decrease) in Net AssetsMeasures Financial Results from Operations
Calculation:
Total Operating Revenues (Audited Stmt of Activities) - Minus -
Total Operating Expenses (Audited Stmt Activities)
Donated Capital Assets increase Net Assets but are not included in order to evaluate the results from operations only.
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Any CHC - Increase/Decrease in Net Assets
$233,200 $63,282
$825,178
$73,405 ($211,082)($2,000,000)
$1,000,000
$4,000,000
$7,000,000
$10,000,000
$13,000,000
$16,000,000
2004 2005 2006 2007 2008
Total Revenues Total Expenses
Increase/Decrease in Net Assets - Operating Incr/Decr in Net Assets - w/Cap Grants & Non-Op
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Net Patient Services RevenueMeasures Amount of Revenue Derived from Patient Services
Calculation:Total Patient Services Revenue (per Audit)
Net of Adjustments for Contractual Allowances, Discounts, Bad Debt, and Reserve for Doubtful Accounts
Patient Services Revenue is an important resource for covering the costs of providing services.
These revenues should increase over time due to inflation and more importantly due to growth in
the number of patients served annually.
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Any CHC - Net Patient Services Revenue
$8,042,489
$7,692,353
$6,312,193
$6,201,508
$4,798,203$4,543,650
$7,097,036
$6,350,500
$4,954,801
$3,950,774
$3,000,000
$4,000,000
$5,000,000
$6,000,000
$7,000,000
$8,000,000
$9,000,000
2004 2005 2006 2007 2008
Net Patient Services Revenue - Audit (Accrual)Net Patient Services Receipts Collected UDS (Cash)
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Any CHC - Federal 330 Grants & Other Sources of Revenue
$1,658,927
$1,828,127$1,993,240
$2,375,679
$2,765,861$3,595,469
$4,485,696$4,770,549
$6,116,399$6,461,881
$1,000,000
$2,000,000
$3,000,000
$4,000,000
$5,000,000
$6,000,000
$7,000,000
$8,000,000
2004 2005 2006 2007 2008
Grant - Federal 330 Health Center Cluster - CHC and HCH
Other Sources of Revenue
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Any CHC - Percent of Patient Services and Other Non-Federal 330 Sources of Revenue
23.1%
24.9% 25.1%27.1%
25.5%
57.2% 57.0% 55.7% 55.4%
58.0%
15%
25%
35%
45%
55%
65%
75%
2004 2005 2006 2007 2008
Other Non-Federal CHC Sources of RevenueNet Patient Services Revenue
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Percent of Income from BPHC ReceiptsMeasures Efficiency in Establishing Other Sources of Income
Calculation:
BPHC Health Center Cluster Grant Funds
- divided by -
Total Annual Income from All Sources
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Any CHC - Percent of Income from BPHC Receipts
17%
19%19%
21%21%
10%
15%
20%
25%
2003 2004 2005 2006 2007
Percent of Income from BPHC% BPHC Receipts - National Average 2006 - 19%% BPHC Receipts - Rural Average 2006 - 17%
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Percent Change: Net Patient Services Revenue compared to
Net Patient Accounts ReceivableMeasures Effectiveness of Patient Services Revenue Accounting Procedures
Calculation:Percent Change in Net Patient Revenues (Audits Year to Year)
Compared toPercent Change in Net Patient Services Accounts Receivable
The trend lines should be a mirror image if accounting procedures for patient services revenue are effective. Fluctuations and
crossing trend lines is an indication of the need for accounting/audit adjustments to bring amounts in line with
realizable values (collectible amounts).
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Any CHC - Percent Change: Net Patient Revenues compared to Net Patient Accounts Receivable
38%
29%
2%
22%
5%
52%
68%
8%
-26%
50%
-40%
-20%
0%
20%
40%
60%
80%
2004 2005 2006 2007 2008
Percent Change in Net Patient Revenues
Percent Change in Net Patient Accounts Receivable
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COLLECTION RATE(Percent of Gross Charges Collected)
Measures Efficiency in Collecting Patient Services Revenue
Calculation:
Total Charges Collected (Table 9-D, Col. 3, Line 14)
- divided by -
Total Gross Charges (Table 9-D, Col. 2, Line 14)
The Calculation can be done for each payer type using the same formula - subtotal for each payer type from Table 9-D.
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Any CHC Percent of Gross Charges Collected
53%58%48%53%
57%
107%
149%
84%
101%109%99%
78%
71%75%
77%
94%
96%
79%
0%0%
85%78%
63%58%
82%
22%27%27%28%29%
0%
20%
40%
60%
80%
100%
120%
140%
160%
2003 2004 2005 2006 2007
Total N 62% U 59% Medicaid N 88% U 84%Medicare N 69% U 65% Other Public N 69% U 67%Private Ins N 59% U 52% Self-Pay N 23% U 18%
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Issues that Affect the Collection Rate:
Fee Schedule
Patient Mix by Financial Payer Class
Patient Registration Practices
Billing and Collection Policies and Procedures
Provider Coding Norms
FQHC (Prospective Payment) Rate
FQHC Rate Setting & Settlement Policies & Procedures
Degree of Medicaid and Other Managed Care
Sliding Fee Discount Minimum
Sliding Fee Discount Policies and Procedures
Contractual Agreements with Health Plans
Staffing Level, Skills, & Training of Billing & Collection Office
Data Systems
Reporting Capabilities and Monitoring Activities
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Average Charge Per Billable EncounterMeasures Effectiveness of Fee Schedule and Coding Practices
Calculation:
Total Gross Charges (for the period)
- divided by -
Total Billable Encounters (for the period)
Includes medical (physicians + mid-levels), dental, & mental health services
Data is obtained from the UDS Report - Tables 5 and 9-D
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Any CHC Average Charge Per Billable Encounter
$237
$193$190
$172
$140
$125
$150
$175
$200
$225
$250
2003 2004 2005 2006 2007
Average Charge per Billable EncounterNational Average 2006 - $156Urbanl Average 2006 - $170
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Average Collection Per Billable EncounterMeasures Effectiveness of Billing and Collection Efforts
Calculation:
Total Charges Collected (for the period)
- divided by -
Total Billable Encounters (for the period)
Includes medical (physicians + mid-levels), dental, & mental health services
Data is obtained from the UDS Report - Tables 5 and 9-D
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Any CHC Average Collection Per Billable Encounter
$125
$111
$91$91
$80
$50
$75
$100
$125
$150
2003 2004 2005 2006 2007
Average Collection per Billable Encounter
National Average 2006 - $96
South Carolina Average 2006 - $82
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Patient Payer MixMeasures Distribution of Patients by Financial Class
Calculation:
Patient Users - Each Financial Class (UDS Table 4) - Divided By -
Total Patient Users (UDS Table 4)
Due to significant differences in the average revenue received per encounter by Third Party Payers and Self-Pay Patients the
Patient Payer Mix has a significant impact on revenue potential, collection rates, and profitability.
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Any CHC - Patient Mix by Payer Type
51.6%50.5%
46.3%45.4%
45.1%
23.1%23.9%28.2%
30.5%
23.6%
14.0%14.5%
15.0% 15.6% 14.6%
0.0%0.0%0.0%0.0% 0.0%
11.4%11.0%9.9%
9.2%
16.8%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
2003 2004 2005 2006 2007
Uninsured Users N - 39% U - 41%Medicaid Users N - 35% U - 39%Medicare Users N - 8% U - 6%Other Public Users N - 2% U - 3%Private Insurance Users N - 16% U - 11%
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Any CHC - Patient Mix by Payer Type
9,3049,530
8,171
6,8646,774
4,1554,513
4,9764,608
3,5382,515
2,1692,266
2,750 2,755
0000 0
2,0462,0721,741
1,388
2,528
0
2,000
4,000
6,000
8,000
10,000
2003 2004 2005 2006 2007
Uninsured Users N - 39% U - 41%Medicaid Users N - 35% U - 39%Medicare Users N - 8% U - 6%Other Public Users N - 2% U - 3%Private Insurance Users N - 16% U - 11%
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Provider Team ProductivityMeasures Provider/Practice Efficiency
Medical Team Calculation:Total Provider Medical Encounters
(physicians and mid-levels only)
- divided by -
Physician FTEs + 50% of Mid-Level FTEs
The Dental Team Productivity is Calculated in the Same Manner with Hygienists at 50% of the FTE Value
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Any CHC - Medical Provider Team Productivity
4,258
4,4424,654
4,012
4,468
3,9314,084
3,3423,815 3,612
3,033
3,129
2,994
3,048 3,084
1,132
1,2061,221
1,076
994
0
1,500
3,000
4,500
6,000
2003 2004 2005 2006 2007
Medical Provider Team Productivity - N - 4280 U - 4183
Average Provider Productivity - Medical - Physicians Only - N - 3868 U - 3789
Average Provider Productivity - Medical - Mid-Levels Only - N - 2921 U - 2769
Medical Users Per Provider FTE - N - 1109 U - 1096
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Any CHC - Dental Provider Team Productivity
2,526
1,458
13,400
3,500
1,000
771
9,100
1,500
470889
0
2,500
5,000
7,500
10,000
12,500
15,000
2003 2004 2005 2006 2007
Dental Provider Team Productivity - N - 2716 U - 2715
Dental Users Per Provider FTE - N - 975 U - 985
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Factors that Impact Provider Team Productivity Hours of Operation for Each Site Capacity of Each Site – Number of Exam Rooms, Number of Provider FTEs, Parking,
Space for Support Staff, and Patient Waiting Area Provider Staffing Level versus Patient Demand for Each Site – including fluctuations in
patient demand Medical/Dental Support and Patient Support Staff by Site Total Hours Providers are Scheduled to See Patients Face-to-Face – daily/weekly/annually
(incorporate personnel leave benefits, training, regular meetings into analysis of hours) Patient Scheduling Practices – including number scheduled per hour per provider, number
of days out that patient appointments can be made (90 to 120 days), unanticipated provider absence (cancel or transfer appointed patients to another provider that day), degree of walk-ins, timing of walk-ins, use of same day appointments, no show rate, how no show rate and walk-ins are factored into scheduling practices, etc.
Closures for Holidays, Weather-related Events, etc. Provider Turnover by Site – When, Number of FTEs, Period of Vacancy or Overlap, etc. Start-up Activity of a New Site or Expanding Capacity Telephone System Functionality – number of lines, number of staff answering lines,
number of staff that can make appointments Patient Registration Practices – time it takes to process Patient Wait and Cycle Time at each pass-off and from beginning to end of office visit
(patient satisfaction) Volume of New Patients versus Existing Patients Facility Layout by Site – does it facilitate patient flow or hinder it?
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Average Number of Visits Per UserMeasures Practice Quality, Comprehensive Care, and Acuity
Calculation:Total Provider Medical Encounters
(physicians and mid-levels only)
- divided by -
Total Medical Users (Patients)
The Measure is Calculated in the Same Manner for Each Type of Service Provided by a Health Center
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Any CHC - Average Number of Visits Per User
2.97
3.023.223.23
3.00
2.84
1.89
1.47
2.13
2.33 2.40
1.701.89
2.41
1.30
3.24
3.60
2.87
3.26
4.23
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
2003 2004 2005 2006 2007
Medical - N - 3.18 U - 3.14 Dental - N - 2.41 U - 2.41 Mental Health - N - 4.93 U - 4.90 Enabling Services - N - 2.80 U - 2.98
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Any CHC - Support Staff Ratios
2.2
1.58
1.9
2.162.03
1.42
1.48
1.681.89
1.75
1.33
0 0 0
1.61
0.0
0.5
1.0
1.5
2.0
2.5
2003 2004 2005 2006 2007
Direct Medical Support Ratio N - 1.70 U - 1.74 Patient Support Ratio N - 1.26 U - 1.22 Dental Support Staff Ratio N 1.39 U 1.36
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Uncompensated Care RatioMeasures Efficient Use of BPHC Grant Funds
Calculation:
Sliding Fee Discounts + Medicaid Contractual
Adjustments (only if aggregate amount reduces gross charges)
- divided by -
BPHC Health Center Cluster Grant Funds
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Any CHC Uncompensated Care Ratio
224%
170%165%159%
148%
100%
125%
150%
175%
200%
225%
250%
2003 2004 2005 2006 2007
Uncompensated Care to BPHC Receipts Ratio
UCR National Average 2006 - 140%
UCR Urban Average 2006 - 177%
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Factors Impacting the Uncompensated Care Ratio Fee Schedule/Charge Master - Are Fees in Line with Market/National Norms? Set for All Services
Provider Coding Norms - Based on National Benchmarks/Under-coding
Sliding Fee Discount Policies and Procedures
Sliding Fee Discount Minimums - How do they compare with neighboring CHCs/National?
Sliding Fee for Ancillary Services - All Inclusive versus Separate Minimum?
Sliding Fee for Underinsured - Co-Pays and Deductibles?
Policy on Failure to Pay - How is the Patient Handled? Bad Debt Write-off?
Signage on Availability of Sliding Fee - How do Patients Know?
Methods Used to Inform Community About Discounted Services
Patient Registration Practices - How is the Application Process Handled?
FQHC (Prospective Payment) Rate
FQHC Rate Setting & Settlement Policies & Procedures
Amount of BPHC Health Center Cluster Grants
Patient Mix by Financial Payer Class - Sliding Fee (by category) and Medicaid
Billing and Collection Policies and Procedures
Staffing Level, Skills, & Training of Front Desk, Patient Reps, Billing & Collections
Data Systems - Is the data captured? How
Reporting Capabilities and Monitoring Activities
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Percent of Administrative & Facility CostsMeasures Operating Efficiency for Overhead Costs
Calculations:
Total Administration Costs (Table 8-A, Col. (a), Line 15)
- divided by -
Total Accrued Costs (Table 8-A, Col. (c), Line 17)
Total Facility Costs (Table 8-A, Col. (a), Line 14)
- divided by -
Total Accrued Costs (Table 8-A, Col. (c), Line 17)
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Any CHC Percent of Admin & Facility Costs
24%23%
22%22%
23%
7%
8%
7%7%
8%
37%
36%
38%
40%
39%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
2003 2004 2005 2006 2007
Administrative Cost Percentage - Nat. Avg. 25% U- 26%Facility Cost Percentage - Nat. Avg. 7% U - 8%Administrative and Facility Percent of Total FTEs - N - 40%
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Any CHC - Current Ratio
Contributing Factors:
CF1:
CF2:
CF3:
CF4:
CF5:
CF6:
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Restricting Factors:
RF1:
RF2:
RF3:
RF4:
RF5:
RF6:
Any CHC - Current Ratio
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Performance Improvement Options:
PIO1
PIO2
PIO3
PIO4
PIO5
Any CHC - Current RatioNext StepsNext Steps