Table 5 - Staffing and Utilization

This table provides a profile of grantee staff, the number of encounters they render and the number of patients served. Unlike Tables 3 and 4, where an unduplicated count of patients is reported, Column C of Table 5 is designed to report the number of unduplicated patients within each of six major service categories: medical, dental, mental health, substance abuse, other professional services, and enabling. The staffing information in Table 5 is designed to be compatible with approaches used to describe staff for financial/cost reporting, while ensuring adequate detail on staff categories for program planning and evaluation purposes. (NOTE: Staffing data are not reported on the Grant Report tables.)

For the Universal Report, all staff, all encounters and all patients are reported in Columns A, B and C. For the Grant Reports, only Columns B and C are to be completed. (Column A will appear “grayed out” in the computer version and printouts of the Grant Report tables.) Every eligible encounter must be counted on the Universal Report including all those reported in the Grant Reports. Grant Reports provide data on patients supported by funds which are within the scope of one of the non-CHC grants and the encounters which they had during the year. This includes all encounters supported with either grant or non-grant funds. Note that no cell in a Grant Report may contain a number larger than the corresponding cell in the Universal Report.

Instructions for Completing Table 5 - Column a - FTE

This table includes FTE staffing information on all individuals who work in programs and activities that are within the scope of the project for all of the programs covered by UDS. (The FTE column is completed only on the Universal Report. Staff are not separated according to the different BPHC funding streams.) All staff are to be reported in terms of annual Full-Time Equivalents (FTEs). A person who works 20 hours per week (i.e., 50 percent time) is reported as “0.5 FTE.” (This example is based on a 40 hour work week. Positions with less than a 40 hour base, especially clinicians, should be calculated on whatever they have as a base for that position. Agencies which have a 35 hour work week would consider 17.5 hours worked to be 0.5 FTE, etc.) Similarly, an employee who works 4 months out of the year would be reported as “0.33 FTE” (4 months/12 months). (See page 9 of this Manual for detailed instructions on calculating FTEs).

Staff may provide services on behalf of the grantee on a regularly scheduled basis under many different arrangements including, but not limited to: salaried full-time, salaried part-time, hourly wages, National Health Service Corps assignment, under contract, or donated time. Thus, FTEs reported on Table 5 Column A include paid staff, volunteers, contracted personnel (paid based on worked hours), residents and preceptors. Individuals who are paid by the grantee on a fee-for-service basis only are not counted in the FTE column since there is no basis for determining their hours.

All staff time is to be allocated by function among the major service categories listed. For example, a full-time nurse who works solely in the provision of direct medical services would be counted as 1.0 FTE on Line 11 (Nurses). If that nurse provided case management services for 10 hours per week, and provided medical care services for the other 30 hours per week, time would be allocated 0.25 FTE case manager (Line 24) and 0.75 FTE nurse (Line 11). Do not, however, attempt to parse out the components of an interaction. The nurse who vitals a patient who they then place in the exam room, and later provide instructions on wound care, for example, would not have a portion of the time counted as “health education” – it is all a part of nursing.

An individual who is hired as a full-time clinician must be counted as 1.0 FTE regardless of the number of “direct patient care” or “face-to-face hours” they provide. Providers who have released time to compensate for on-call hours or who receive leave for continuing education or other reasons are still considered full-time if this is how they were hired. The time spent by providers doing “administrative” work such as charting, reviewing labs, filling or renewing prescriptions, returning phone calls, arranging for referrals, participating in QI activities, supervising nurses etc. is counted as part of their overall medical care services time. The one exception to this rule is when a Medical Director is engaged in corporate administrative activities, in which case time can be allocated to administration. Corporate administration does not, however, include clinical administrative activities such as supervising the clinical staff, chairing or attending clinical meetings, writing clinical protocols, etc.

Personnel by Major Service Category – Staff are distributed into categories that reflect the types of services they provide. Major service categories include: medical care services, dental services, mental health services, substance abuse services, other professional health services, pharmacy services, enabling services, other program related services, and administration and facility. Whenever possible, the contents of major service categories have been defined to be consistent with definitions used by Medicare. The following summarizes the personnel categories; a detailed list appears in Appendix A.

·         Medical Care Services (Lines 1 – 15)

-               Physicians - M.D.s and D.O.s, except psychiatrists, pathologists and radiologists. Naturopaths and Chiropractors are not counted here.

-               Nurse Practitioners

-               Physician Assistants

-               Certified Nurse Midwives

-               Nurses - registered nurses, licensed practical and vocational nurses, home health and visiting nurses, clinical nurse specialists, and public health nurses

-               Laboratory Personnel - pathologists, medical technologists, laboratory technicians and assistants, phlebotomists

-               X-ray Personnel - radiologists, X-ray technologists, and X-ray technicians

-               Other Medical Personnel - medical assistants, nurses aides, and all other personnel providing services in conjunction with services provided by a physician, nurse practitioner, physician assistant, certified nurse midwife, or nurse. Medical records and patient support staff are not reported here.

·         Dental Services (Lines 16 – 19)

-               Dentists - general practitioners, oral surgeons, periodontists, and pediodontists

-               Dental Hygienists

-               Other Dental Personnel - dental assistants, aides, and technicians

·         Mental Health Services (Lines 20a, a1, a2, b, c and 20)

-                Psychiatrists (Line 20a)

-                Licensed Clinical Psychologists (Line 20a-1)

-                Licensed Clinical Social Workers (Line 20a-2)

- Other licensed mental health providers, including psychiatric nurses, psychiatric social workers, family therapists, and other licensed Masters Degree prepared clinicians.

- Other mental health staff, including unlicensed individuals providing counseling, treatment or support services related to mental health professionals.

·         Substance Abuse Services (Line 21) - Psychiatric nurses, psychiatric social workers, mental health nurses, clinical psychologists, clinical social workers, and family therapists and other individuals providing counseling and/or treatment services related to substance abuse.

·         All Other Professional Health Services (Line 22) - Occupational and physical therapists, nutritionists, podiatrists, optometrists, naturopaths, chiropractors, acupuncturists and other staff professionals providing health services. Note: WIC nutritionists and other professionals working in WIC programs are reported on Line 29a, Other Programs and Services Staff. (A more complete list is included in Appendix A.) There is a “specify” box that must be completed. Explain the specific other professional health services included.

·         Pharmacy Services (Line 23) Pharmacists (including clinical pharmacists), pharmacist assistants and others supporting pharmaceutical services. Note that effective 2006, the time (and cost) of individuals spending all or part of their time in assisting patients to apply for free drugs from pharmaceutical companies are to be classified as “other enabling workers”, on line 28.

·         Enabling Services (Lines 24 - 29)

-               Case Managers - staff who provide services to aid patients in the management of their health and social needs, including assessment of patient medical and/or social services needs, and maintenance of referral, tracking and follow-up systems. Case managers may provide eligibility assistance, if performed in the context of other case management functions. Staff may include nurses, social workers and other professional staff.

-               Patient and Community Education Specialists - health educators, family planning, HIV specialists, and others who provide information about health conditions and guidance about appropriate use of health services that are not otherwise classified under outreach.

-               Outreach Workers - individuals conducting case finding, education or other services to identify potential clients and/or facilitate access/referral of clients to available services.

-               Eligibility Assistance Workers - all staff providing assistance in securing access to available health, social service, pharmacy and other assistance programs, including Medicaid, WIC, SSI, food stamps, TANF, and related assistance programs.

-               Personnel Performing Other Enabling Service Activities - all other staff performing services as enabling services,not described above.

-               Interpretation Staff - Staff whose full time or dedicated time is devoted to translation and/or interpretation services. DO NOT INCLUDE that portion of the time of a nurse, medical assistant or other support staff who provides interpretation or translation during the course of their other activities.

·         Other Programs and Related Services Staff (Line 29a)

Some grantees, especially “umbrella agencies,” operate programs which, while within their scope of service, are not directly a part of their medical or social health services. These include WIC programs, job training programs, head start or early head start programs, shelters, housing programs, etc. The staff for these programs are reported under Other Programs and Related Services. The cost of these programs are reported on Table 8A on line 12. There is a “specify” field that must be used to describe what these staff are doing.

·         Administration and Facility (Lines 30 - 33)

-               Management and Support Staff – (Line 30a) - Staff providing management and administrative office support for health center operations within the scope of the grant, not including the Chief Financial Officer or the Chief Medical Officer.

-               Fiscal and Billing Staff – (Line 30b) - Staff performing fiscal and accounting functions in support of health center operations within scope of the grant, including the Chief Financial Officer, and staff performing billing functions for services performed within the scope of the grant.

-               IT Staff – (Line 30c) - Technical information technology and information systems staff supporting the maintenance and operation of the computing systems that support clinical and administrative functions performed within the scope of the grant.

-               Facility – (Line 31) - staff with facility support and maintenance responsibilities, including custodians, housekeeping staff, security staff, and other maintenance staff.

-               Patient Services Support Staff – (Line 32) - intake staff and medical/patient records.

Note: The Administration and Facility category for this report is more comprehensive than that used in some other program definitions and includes all personnel working in a BPHC-supported program, whether that individual's salary was supported by the BPHC grant or other funds included in the scope of project.

Note also: Tables 8has data relating to cost centers. Staff classifications should be consistent with classifications on other tables. The staffing on Table 5 is routinely compared to the costs on Table 8A during the editing process. If there is a reason why such a comparison would look strange (e.g., volunteers on Table 5 resulting in no cost on Table 8A) be sure to include an explanatory note on Table 8A.

Instructions for completing Table 5 Column b (encounters) and Column c (Patients)

Encounters (Column B) – An encounter is a documented, face-to-face contact between a patient and a provider who exercises independent professional judgment in the provision of services to the individual. (See General Instructions for further details on the definition of encounters). Grantees are to report encounters during the reporting period rendered by staff identified in column a, regardless of whether the staff are salaried or contracted based on time worked. No encounters are reported for personnel who are not “providers who exercise independent professional judgment” within the meaning of the definition above. In addition, the BPHC had chosen not to require reporting grantees to report on encounters for certain other classes of staff, even if the do exercise professional judgment. In Column B, the cells applicable to these staff (e.g., laboratory, transportation, outreach, pharmacy etc.) are blocked out.

Encounters that are purchased from non-staff providers on a fee-for-service basis are also counted in this column, even though no corresponding FTEs are included in Column A. To be counted, the service must meet the following criteria:

1)      the service was provided to a patient of the Grantee by a provider that is not part of the grantee's staff (neither salaried nor contracted on the basis of time worked),

2)      the service was paid for in full by the grantee, and

3)      the service otherwise meets the above definition of an encounter.

This category does not include unpaid referrals, or referrals where only nominal amounts are paid, or referrals for services that would otherwise not be counted as encounters.

Patients (Column C) – A patient is an individual who has at least one encounter during the reporting year. Report the number of patients for each of the six separate services listed below. Within each category, an individual can only be counted once as a patient. A person who receives multiple types of services should be counted once (and only once) for each service.

For example, a person receiving only medical services is reported once (as a medical patient) regardless of the number of encounters made. A person receiving medical, dental and enabling services is reported once as a medical patient (Line 15), once as a dental patient (Line 19) and once as an enabling patient (Line 29), but is counted only once on each appropriate line in column C, regardless of the number of visits reported in column B. An individual patient may be counted once (and only once) in each of the following categories:

·         Medical care services patients (Line 15)

·         Dental services patients (Line 19)

·         Mental health services patients (Line 20)

·         Substance abuse services patients (Line 21)

·         Patients of other professional services (Line 22)

·         Enabling services patients (Line 29)

If you show encounters in Column B for any of these six categories, you are required to show the unduplicated number of persons who received these encounters. Since patients must have at least one documented encounter, it is not possible for the number of patients to exceed the number of encounters. Also, individuals who only receive services for which no encounters are generated (e.g., laboratory, transportation, outreach) are not included in the patient count reported in Column C. For example, individuals who receive outreach or transportation services are not included in the total number of patients receiving enabling services in Column C; individuals who received flu shots but no other service are not counted as medical users, etc.

Questions and Answers for Table 5

1.      Are there changes to this table?
Yes. Several changes were made this year:

1. Line 1 now reads “Family Physicians” instead of “Family Practitioners”. This is a title change only and does not denote a new group of providers
2. Line 20a and 20b have been added for Licensed Clinical Psychologists and Licensed Clinical Social Workers. These individuals were previously counted on line 20b.
3. Line 20b no longer includes Licensed Clinical Psychologists and Licensed Clinical Social Workers.
4. Line 30, Administration has now been divided into lines 30a (Management and Support Staff), 30b (Fiscal and Billing staff) and 30c (Health IT staff.) All staff time formerly counted on line 30 which does not explicitly fit into lines 30b or 30c should be included in line 30a.
   
   

2.      Are the changes from prior years still in effect?
Yes. In 2007 Lines 10a and 27a were added and line 25 was renamed.

1. Line 10a “Total Midlevel Practitioners” sums the FTE for Nurse Practitioners (Line 9a), Physicians Assistants (Line 9b) and Certified Nurse Midwives (Line10), This row automatically calculates.
2. Line 27a “Eligibility Assistance Workers” reports FTEs for all staff providing assistance in securing access to available health, social service, pharmacy and other assistance programs, including Medicaid, WIC, SSI, food stamps, TANF, and related assistance programs. These FTEs were previously included on Line 28 Other Enabling.
3. Line 25 “Patient and Community Education Specialists” reports FTEs for both categories of health education staff. The FTEs corresponding with staff costs reported on Table 8B Lines 7 and 9 should be reported on Table 5 Line 25. Note that, while there is room to show encounters, only one-on-one patient education services are eligible to be counted.

3.      How do I count participants in a group session?

If you have group treatment sessions (e.g., for substance abuse or mental health) you must record the encounter in each participant’s chart and then record an encounter for each participant. If an encounter is not recorded in a participant’s chart, that participant may not be counted as a patient. No group medical encounters are counted on the UDS. Though in some instances they may be billable as counseling services, the UDS specifically does not count as encounters activities in such sessions.

4.      How do I report the FTEs for a clinician who regularly sees patients 75 percent of the time and covers after-hours call the remaining 25 percent of his/her time?

An individual who is hired as a full-time clinician must be counted as 1.0 FTE regardless of the number of “direct patient care” or “face-to-face hours” they provide. Providers who have released time to compensate for on-call hours or hours spent on clinical committees, or who receive leave for continuing education or other reasons are still considered full-time if this is how they were hired. The time spent by providers doing administrative work such as charting, reviewing labs, filling prescriptions, returning phone calls, arranging for referrals, etc. is not to be adjusted for. The one exception to this rule is when a Medical Director is engaged in corporate administrative activities, in which case time can be allocated to administration. This does not, however, include clinical administrative activities including chairing or attending meetings, supervising staff, and writing clinical protocols. Note that Uniform Government Services (UGS), the FQHC Medicare intermediary, has different definitions for full time providers. These UGS definitions are not to be used in reporting on the UDS,

5.      Is it appropriate for the total number of patients reported on Table 3A to be equal to the sum of the several types of patients on Table 5?

On Table 5, the grantee reports patients for each type of service, with the patient counted once for each type of service received. Thus a person who receives both medical and dental services would be counted once as a medical patient on Line 15 and once as a dental patient on Line 19. Because there are six different types of patients identified on Table 5, a patient who is counted only once on Table 3A may be counted up to six different places on Table 5.

Grantees which provide only medical services will report the same number of total patients on Table 3A as they do medical patients on Table 5 (Line 15). But where an agency has more than one type of patient (e.g., medical and dental or medical and enabling) the sum of the numbers in column c of Table 5 will never be the same as those on Table 3A.

6.      If I report case management services on Table 2 or costs for them on Tables 8A and 8B, do I have to report case managers on Table 5?

Yes. There should be a logical consistency between Table 5 and Tables 2 and 8A and 8B. If a grantee reports that case management services are provided by the grantee (i.e., Table 2, Column A is marked), one would expect to see case managers reported on Table 5. For example, if nurses also have case management duties, their time (FTEs) should be split.

7.      How are contracted providers and their activities reported on Table 5?

If the contracted provider is paid on the basis of time worked, the FTE is reported on Table 5 Column A as well as the encounters and patients receiving services from this provider. If the contracted provider is paid on a fee-for-service basis, no FTE is reported on Table 5 Column A but encounters and patients are reported.

8.      If a clinician provides mental health and substance abuse (behavioral health) services to the same patient during an encounter, how should this be counted?
Because “substance abuse” is also seen as a mental health diagnosis, it is permissible to count the encounter as mental health. Under no circumstances would it be counted as “one of each.” The provider will also need to be classified as mental health for this encounter as must be the cost of the provider on Table 8A.

9.      Do I count the time of residents?
Yes – they are licensed practitioners and their time is counted just like any other practitioner. Note, however, that most work shorter days because they are in educational sessions and often have more vacation time or other time than a normal practitioner. This would make them less than full time.

TABLE 5 – STAFFING AND UTILIZATION