any chc - sample multi-year trend report access and financial measures budget access to primary care

Any CHC - Sample Multi-yearTREND REPORT

Access and Financial Measures

Budget

Access to Primary Care

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.

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

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

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

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

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

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

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

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

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%

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%

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

Any CHC - Number of Patients

Contributing Factors:

CF1:

CF2:

CF3:

CF4:

CF5:

CF6:

Restricting Factors:

RF1:

RF2:

RF3:

RF4:

RF5:

RF6:

Any CHC - Number of Patients

Performance Improvement Options: PIO1

PIO2

PIO3

PIO4

PIO5

Any CHC - Number of Patients

Next StepsNext Steps

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

Current AssetsCash or Readily Converted to Cash

Cash

Net Patient Services Accounts Receivable

Grants and Contracts Receivable

Prepaid Expenses (rent, insurance, etc.)

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

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

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$

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.

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

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.

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

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.

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

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.

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)

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

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

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

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%

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).

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

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.

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%

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

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

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

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

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

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.

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%

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%

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

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

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

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?

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

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

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

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

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%

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

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)

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%

Any CHC - Current Ratio

Contributing Factors:

CF1:

CF2:

CF3:

CF4:

CF5:

CF6:

Restricting Factors:

RF1:

RF2:

RF3:

RF4:

RF5:

RF6:

Any CHC - Current Ratio

Performance Improvement Options:

PIO1

PIO2

PIO3

PIO4

PIO5

Any CHC - Current RatioNext StepsNext Steps