2012 UDS Reporting Enhancements For Reports Due on February 15, 2013 - PowerPoint PPT Presentation

2012 UDS Reporting Enhancements For Reports Due on February 15, 2013 HRSA Bureau of Primary Health Care

Overview of Today’s Presentation  Today’s presentation is designed to review the three tables that will be changed for 2012 data submission on February 15, 2013 • A new table (Table 5A) will permit grantees and BPHC to demonstrate tenure / continuity of key staff • Reporting patients and diagnoses regardless of primacy on Table 6A • Three new clinical measures • Revised data on EHRs and Quality Recognition at health centers 2

3 Health Center Program Quality Priorities

Health Center Program Quality Priorities  Implementation of QA/QI Systems  Adoption and Meaningful Use of EHRs  Patient Centered Medical Home Recognition  Improving Clinical Outcomes 4

5 Background and Overview of the 2012 Changes

Background and Overview 2012 UDS Changes  The 2012 UDS Changes were vetted in the same way as earlier measures • Published initially as PAL 2012-01 on October 7 and revised as PAL 2012-03 • Subsequently announced in Federal Register • Comments and recommendations solicited from health centers, PCAs, PCOs, and the general public • Comments were reviewed and modified package was approved by OMB in February 2012 • Introduced in the 2011-12 UDS Training 6

Objectives for Today’s Presentation  Today’s presentation is designed to help grantees understand • Where these new measures have come from and why they are being added • What the new measures are • How to complete and submit data on Tables 5A, 6A, 6B, and the addendum to the 2012 UDS 7

8 Tenure for Key Staff Table 5A (New)

Overview 2012 UDS Tenure for Key Staff Table  Data will describe the health center clinical and non- clinical professionals that comprise the key health center workforce • Based on categories already in use in the UDS and in the grant application process • Will permit a display of total workforce rather than FTEs which often blend multiple individuals into a single FTE • Will permit a display of the average tenure of key health center staff 9

Overview Table 5A: Tenure for Key Staff  Data to be presented are generally available in health center Personnel or Human Resource employment records  No new data over and above that needed for HR management should be necessary • May measure TENURE in a form that is different than way the health center states SENIORITY information • HR information will probably need to be reviewed and compiled for this measure • Virtually all of the work can be done well in advance of the 2012 submission date – in fact much can be done now  Data will be submitted in the 2012 UDS 10

Data Elements Key Clinical and Non-Clinical Staff  Workforce and tenure data will be collected for all clinical providers and for key senior administrative staff  Key clinical staff  Key non-clinical staff • CEO / Executive Director • Physicians • Mid-level medical providers • CFO / Fiscal Officer • Dental providers • CIO • Mental Health providers • CMO / Medical Director • Vision providers  Line numbers remain the same as those used for Table 5 for all clinical staff 11

Data Elements: Rows Key Clinical and Non-Clinical Staff 1 Family Physicians 16 Dentist 2 General Practitioners 17 Dental Hygienist 3 Internists 20a1 Psychiatrist 4 ObGyn 20a2 Licensed Psychologist 5 Pediatricians 20a3 LCSW 7 Other Specialty MDs 20a4 Other Licensed MH 9a Nurse Practitioners 22a Ophthalmologist 9b Physician Assistants 22b Optometrist 10 Certified Midwives 30a1 CEO 11 Nurses 30a2 CMO 30a3 CFO 30a4 CIO 12

Data Elements: Column (a) Full and Part Time Staff  For each of the positions listed how many full and part time individuals ( not FTEs) were on the health center’s staff on December 31st • One full time physician working the entire year = 1 • One full time physician who started July 10 = 1 • One part time physician working entire year = 1 • One contract physician working on site = 1 • One physician working full time until 12/25 = 0 • One off-site referral physician paid by visit = 0 • One NHSC assignee starting 9/1 = 1 • One CMO / ObGyn = 1 on each line 13

Data Elements: Column (b) Full and Part Time Staff  Total months worked in this position: • Count from the first day of month of hire: • CEO was hired 9/25/10 - Count 27 months (9/10 – 12/12) • Tenure begins with most recent hiring: • Doctor X was a Loan Repayor from 1/1/02 to 12/31/05, left for a position out of state, but came back to the center on 7/1/09 - Count 42 months (7/09 – 12/12) • Count only time in the current position (by line number): • Employee starts work 4/22/93; earns an LVN license, and is promoted from medical assistant to LVN 6/15/98 - Count 171 months (6/98 – 12/12) 14

Data Elements: Column (b) Full and Part Time Staff  If employee works in two positions simultaneously report time in each using start date for each • Pediatrician is hired 8/1/2002 and promoted to CMO on 9/15/2010 - Count 125 months as pediatrician (8/02 – 12/12) and 28 months as CMO (9/10 – 12/12) • Chief Operations Officer is hired 11/10/88, Promoted to Deputy Director 7/12/97 and then promoted to CEO 6/22/12, retaining the obligations of the Deputy Director - Count 7 months as CEO [Deputy Director is not a reported position] • After downsizing, a new CEO of a small agency is hired 5/15/10 to fill the role of CIO and CFO as well as CEO, and is so reported in their application - Count 32 months as CEO, 32 months as CFO and 32 months as CIO 15

Data Elements: Column (c-d) Locum, On-Call, etc.  Health centers make use of a wide variety of clinical and non-clinical personnel under arrangements other than full- or part-time staff  Some of these individuals are in place for an extended period of time, while others may be present for very limited or intermittent times  Eligible individuals are reported in columns c and d 16

Data Elements: Column (c-d) Locum, On-Call, etc.  Common arrangements include • Locum tenens: Individuals who are hired through an agency and generally not an employee of the center, agency pays salary and benefits • On-call providers: Individuals who are hired by the Center on an as-needed basis, may or may not receive benefits • Volunteers: Unpaid clinical or non-clinical persons • Residents / interns / trainees: Individuals in a training program, may or may not be paid • Count only if they have a license – all medical residents; some mental health trainees 17

Data Elements: Column (c-d) Locum, On-Call, etc.  Common arrangements include • Administrative consultants: used when a full time person is not available or cannot be afforded, especially in CFO or CIO, but also CMO and CEO  Report on Table 5A if • They were working on December 31st • They had a continuing schedule of work which included dates prior to and after 12/31  Continuous months worked for each of these individuals will be equal to or greater than 1, but generally not a large number 18

Data Elements: Column (c-d) Locum, On-Call, etc.  Common arrangements include individuals who are used: • for a day or far longer • as replacements when regular staff are absent due to vacation, CME, FMLA, disability, etc. • in lieu of regular staff when positions are not filled • to provide a clinical or non-clinical service which could otherwise not be afforded • as part of a training program 19

20 Table Table

Table 6A – Modified: Selected Diagnoses and Services Rendered 21

Background and Overview The Problem with “Primary”  Primary diagnosis is no longer seen as a critical bench mark for health centers  Primary diagnosis is thought to under-state the morbidity of center patients with multiple diagnoses  Certain important diagnoses are thought to be seriously understated because they do not appear as “primary” • Mental health • Behavioral health including overeating • Substance use including tobacco and alcohol 22

2012 Change Sections Affected  Table 6A includes diagnostic data as well as data on services rendered to clinic patients • The first 26 lines (with line numbers from 1 to 20d and changes made over time) deal with diagnoses • The next 22 lines (lines 21 through 34) report on services rendered • Only the diagnostic lines – through line 20d – are being altered 23

2012 Change Column (a) Simple Change to Visits Counted  When patients are seen, the provider (and only the provider) identifies not only a primary diagnosis, but as many as eight other secondary and lower level diagnoses  Effective January 1, 2012, all diagnoses at a medical visit will be reported on Table 6A • Only for those diagnoses on lines 1 through 20d • Does not include diagnoses on the “problem list” which are not addressed during the visit 24

2012 Change Column (a) Examples  Some common clinical examples: • Patient is seen for hypertension and diabetes. Both are counted as visits in column a. • Hypertensive diabetic patient is also overweight and smokes, but neither is addressed in the visit. Only hypertension and diabetes visits are counted. • Hypertensive patient comes in because of an asthma attack and asthma and smoking are addressed. Asthma and smoking are counted, hypertension is not. 25