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  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

Patient Totals and Demographics

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

Total Patients

18500 18000 17500 17000 16500 16000 15500 2001 2002 2003 2004 2005 Total Users Medical Services

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

Patients by Age and Gender

2005 13% 47% 7% Pediatric (<15yo)* Geriatric (>64)* Women's Health (ages 15-44)* Other 33%

* Groups noted as target populations by UDS

Patients by Race and Ethnicity

2005 White 34% Black 32% Hispanic 33%

Patients by Diagnosis

Prenatal Patients

Age

<15 15-19 20-24

2002

0 31 51 25-44 >44 50 1

Total Patients 133 2003

0 43 44 51 0

138 2004*

0 17 41 50 0

108

* Did not report less than 2 prenatal visits

2005*

0 10 24 39 0

73 Totals

0 101 160 190 1

452

2005 Prenatal Patients by Race

Total Patients 34% 32% Black Latino White Asian Unreported 14 % Prenatal Patients 1% 7 % 14 % 33% 6 4 %

Prenatal Care

53% Age of Patients 14% 33% 15-19 yo 20-24 yo 25-44 yo 36% Entry to Prenatal Care 9% First Trimester Second Trimester Third Trimester 55%

Delivery, Postpartum, and Infant Utilization Users who delivered during the year BW 1501-2500g** BW>2500g Postpartum Care Newborn visit *Less than 2 visits not reported *No BW <1501g 2002 2003 31% 5% 0% 0% 31% 5% 20% 5% 21% 2% 2004*

2005*

13%

59%

1% 12% 9% 6%

4% 41% 15% 25%

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

Visits by Primary Diagnosis**

9000 8000 7000 6000 5000 4000 3000 2000 1000 0 HTN DM Depression* STDs

*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

2001 2002 2003 2004 2005

Patients with Primary Diagnosis**

3500 3000 2500 2000 1500 1000 500 0 HTN DM Depression* STDs

*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

2001 2002 2003 2004 2005

Preventive Service Visits**

6000 5000 4000 3000 2000 1000 0 Contraceptive Management Pap Smear Child Health*

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

2001 2002 2003 2004 2005

Preventive Service Patients**

4000 3500 3000 2500 2000 1500 1000 500 0 Contraceptive Management Pap Smear Well Child Visits*

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

2001 2002 2003 2004 2005

Productivity, Charges, Collections, and Adjustments

Medical Team Productivity

6000 5000 4000 3000 2000 1000 0 4C's Texas Urban Large 2003* 2004 2005

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

Dental Team Productivity

3000 2500 2000 1500 1000 500 0 4C's TX Urban Large

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

2003 2004 2005

Medical Cost Per Visit*

$117 120 100 80 60 40 20 0 $90 $105 4C's Texas Urban Large $109 2003 2004 2005

Medical Cost Total Medical Service Costs - Lab/Xray Per Visit= Total Medical Service Visits - Nursing * Includes Psychiatry

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 Medical Care Accrued Medical Costs 2,253,023 Facility/ administrati on 1,636,833 Totals 3,889,856 Other Clinical 1,550,386 893,972 2,444,358 Enabling Totals 255,156 4,058,565 129,938 2,660,743 385,094 6,719,308

Medical Vs. Administrative Costs

6000000 5000000 4000000 3000000 2000000 1000000 0 Medical Overhead

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

2001 2002 2003 2004* 2005*

Laboratory and Pharmacy Costs

900000 800000 700000 600000 500000 400000 300000 200000 100000 0 Lab/Xray Pharmacy

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)

2001 2002 2003 2004 2005

Proportion of Payors 100 90 80 70 60 50 40 30 20 10 0 0 3 2 6 4Cs 88 1 7 7 Texas 25 59 3 10 6 Urban 38 43 2 14 7 Large 37 39 CHIP Private Insurance Medicare Medicaid Unisured

Proportion of Payors 2001-2005

90 80 70 60 50 40 30 20 10 0 Uninsured Medicaid Medicare Private Insurance 2001 2002 2003 2004 2005

2005 Collections by Payor

Medicaid (28%) Medicare (17%) Other Public Insurance (9%) Private Insurance (1%) Self Pay (45%)

Medicaid Patients

1400 1200 1000 800 600 400 200 0

Number of 4C’s pts with Medicaid by year

2001 2002 2003 2004 2005

Bad Debt as % of Self Pay Charges

2500000 2000000 1500000 1000000 500000 0 Bad Debt

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

2001 2002 2003 2004 2005

Self Pay Collection Rate

25% 20% 15% 10% 5% 0% 4C's Texas

Self Pay Collection Rate =

Urban Large

Amount Collected Full Charges

2003 2004 2005

Surplus/Deficit as % Total Cost

20% 15% 10% 5% 0% 2001 2002 2003 2004 2005* -5%

Surplus/ Deficit = (Total Amount Collected + Total Revenue) – Total Accrued Costs incl.Overhead

Total Accrued Costs including Overhead * 2005 does not really reflect a deficit but a transfer of excess funds

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

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

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

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