General Instructions

This section describes submission requirements including who submits UDS reports, when and where to submit UDS data, and how data are submitted.

WHO SUBMITS REPORTS AND REPORTING PERIODS

Reports should be submitted directly by the BPHC grantee.  The grantee is the direct recipient of one or more BPHC grants.  All grantees who are funded before October 1 of the year are expected to report.  Grantees must report activity for the entire calendar year, even if they were funded, in whole or in part, for less than the full year.  Grantees who are funded for the first time after October 1 of the year and who have had no other BPHC funds during the year do not report. 

DUE DATES AND REVISIONS TO REPORTS

Initial submissions of all UDS reports for CY 2008 will be due by March 2, 2009.    

Beginning with the 2008 UDS Report, grantees will no longer be able to revise their data after data has been finalized in June, 2009. 

HOW AND WHERE TO SUBMIT DATA

Starting with CY2008 UDS, reporting submission will be on-line making use of a web based data collection system that is completely integrated with the HRSA Electronic Handbooks (EHBs).  BPHC users will use the EHB user name and password to log into the EHB in order to complete their UDS submission.  BPHC users will be able to submit the UDS report data using standard web browsers through a Section 508 compliant user interface. The system will present users with electronic forms that will clearly communicate what is required and will guide the users in completing their reports.

Usability features such as those that pre-fill data from prior year reports based on business rules will prevent redundant data entry while other features such as calendar controls to enter date will speed up the data entry process. Users will be able to work on the forms in part, save them online and return to complete them later in a collaborative manner. The approach will allow grantees to distribute the data entry burden amongst multiple users if required. Business rules that check for quantitative and qualitative edit checks will be applied to ensure that the data submitted meets the legislative and programmatic requirements.

The users will be provided with a summary of what is complete and what is incomplete along with links to jump to the appropriate sections to fix the identified incomplete parts.

DEFINITIONS OF ENCOUNTERS, PROVIDERS, PATIENTS AND FTES

This section provides definitions which are critical for consistent reporting of UDS data across grantees.  

ENCOUNTERS

Encounter definitions are needed both to determine who is counted as a patient (Tables 3A, 3B, 4, 6A, 6B and 7) and to report encounters by type of provider staff (Table 5).  Encounters are defined as documented, face-to-face contacts between a patient and a provider who exercises independent professional judgment in the provision of services to the patient. To be included as an encounter, services rendered must be documented in a chart in the possession of the grantee.  Appendix A provides a list of health center personnel and the usual status of each as a provider or non-provider for purposes of UDS reporting.  Encounters which are provided by contractors, and paid for by the grantee, such as Migrant Voucher encounters or out-patient or in-patient specialty care associated with an at-risk managed care contract, are considered to be encounters to be counted on the UDS to the extent that they meet all other criteria.  In these instances, a summary of the encounter may appear in the grantee’s charts.

Further elaborations of the definitions and criteria for defining and reporting encounters are included below.

1.  To meet the criterion for "independent professional judgment," the provider must be acting on his/her own when serving the patient and not assisting another provider.  For example, a nurse assisting a physician during a physical examination by taking vital signs, taking a history or drawing a blood sample is not credited with a separate encounter.  Independent judgment implies the use of the professional skills associated with the profession of the individual being credited with the encounter and unique to that provider or other similarly or more intensively trained providers.

2.  To meet the criterion for "documentation," the service (and associated patient information) must be recorded in written or electronic form.  The patient record does not have to be a full and complete health record in order to meet this criterion.  For example, if an individual receives services on an emergency basis and these services are documented, the documentation criterion is met even though some portions of the health record are not completed.  Screenings at health fairs, immunization drives for children or the elderly and similar public health efforts do not result in encounters regardless of the level of documentation.

3.  When a behavioral health provider renders services to several patients simultaneously, the provider can be credited with an encounter for each person only if the provision of services is noted in each person's health record.  Such visits are limited to behavioral health services.  Examples of such non-medical "group encounters" include: family therapy or counseling sessions and group mental health counseling during which several people receive services and the services are noted in each person's health record.  In such situations, each patient is normally billed for the service.  Medical visits must be provided on an individual basis.  Patient education or health education classes (e.g., smoking cessation) are not credited as encounters.

4.  An encounter may take place in the health center or at any other site or location in which project-supported activities are carried out.  Examples of other sites and locations include mobile vans, hospitals, patients' homes, schools, nursing homes, homeless shelters, and extended care facilities.  Encounters also include contacts with patients who are hospitalized, where health center medical staff member(s) follow the patient during the hospital stay as physician of record or where they provide consultation to the physician of record.  A reporting entity may not count more than one inpatient encounter per patient per day.

5.  Such services as drawing blood, collecting urine specimens, performing laboratory tests, taking X-rays, giving immunizations or other injections, and filling/dispensing prescriptions do not constitute encounters, regardless of the level or quantity of supportive services. 

6.  Under certain circumstances a patient may have more than one encounter with the health center in a day.  The number of encounters per service delivery location per day is limited as follows.  Each patient may have, at a maximum:

- One medical encounter (physician, nurse practitioner, physicians assistant, certified nurse midwife, or nurse).

- One dental encounter (dentist or hygienist).

- One “other health” encounter for each type of “other health” provider (nutritionist, podiatrist, speech therapist, acupuncturist, optometrist, etc.).

- One enabling service encounter for each type of enabling provider (case management or health education).

- One mental health encounter.

- One substance abuse encounter.

If multiple medical providers deliver multiple services on a single day (e.g., an Ob-Gyn provides prenatal care and in Internist treats hypertension) only one of these encounters may be counted on the UDS.  While some third party payors may recognize these as billable, only one of them is countable.  The decision as to which provider gets credit for the visit on the UDS is up to the grantee.  Internally, the grantee may follow any protocol it wishes in terms of crediting providers with encounters.

7.  A provider may be credited with no more than one encounter with a given patient in a single day, regardless of the types or number of services provided.   

8.  The encounter criteria are not met in the following circumstances:

- When a provider participates in a community meeting or group session that is not designed to provide clinical services.  Examples of such activities include information sessions for prospective patients, health presentations to community groups (high school classes, PTA, etc.), and information presentations about available health services at the center.

- When the only health service provided is part of a large-scale effort, such as a mass immunization program, screening program, or community-wide service program (e.g., a health fair).

- When a provider is primarily conducting outreach and/or group education sessions, not providing direct services.

- When the only services provided are lab tests, x-rays, immunizations or other injections, TB tests or readings and/or prescription refills.

- Services performed under the auspices of a WIC program or a WIC contract.

Further definitions of encounters for different provider types follow:

PHYSICIAN ENCOUNTER– An encounter between a physician and a patient. 

NURSE PRACTITIONER ENCOUNTER– An encounter between a Nurse Practitioner and a patient in which the practitioner acts as an independent provider.

PHYSICIAN ASSISTANT ENCOUNTER– An encounter between a Physician Assistant and a patient in which the practitioner acts as an independent provider.

CERTIFIED NURSE MIDWIFE ENCOUNTER– An encounter between a Certified Nurse Midwife and a patient in which the practitioner acts as an independent provider.

NURSE ENCOUNTER (MEDICAL) – An encounter between an R.N., L.V.N. or L.P.N. and a patient in which the nurse acts as an independent provider of medical services exercising independent judgment, such as in a triage encounter.  Services which meet this criteria may be provided under standing orders of a physician, under specific instructions from a previous visit, or under the general supervision of a physician or Nurse Practitioner/Physicians Assistant/Certified Nurse Midwife (NP/PA/CNM) who has no direct contact with the patient during the visit, but must still meet the requirement of exercising independent professional judgment.  (Note that some states prohibit an LVN or an LPN to exercise independent judgment, in which case no encounters would be counted for them.  Note also that, under no circumstances are services provided by Medical Assistants or other non-nursing personnel counted as nursing visits.)

DENTAL SERVICES ENCOUNTER– An encounter between a dentist or dental hygienist and a patient for the purpose of prevention, assessment, or treatment of a dental problem, including restoration.  Note: A dental hygienist is credited with an encounter only when s/he provides a service independently, not jointly with a dentist.  Two encounters may not be generated during a patient's visit to the dental clinic in one day, regardless of the number of clinicians who provide services or the volume of service (number of procedures) provided.

MENTAL HEALTH ENCOUNTER– An encounter between a licensed mental health provider (psychiatrist, psychologist, LCSW, and certain other Masters Prepared mental health providers licensed by specific states,) or an unlicensed mental health provider credentialed by the center, and a patient, during which mental health services (i.e., services of a psychiatric, psychological, psychosocial, or crisis intervention nature) are provided.

SUBSTANCE ABUSE ENCOUNTER– An encounter between a substance abuse provider (e.g., a mental health provider or a credentialed substance abuse counselor, rehabilitation therapist, psychologist) and a patient during which alcohol or drug abuse services (i.e., assessment and diagnosis, treatment, aftercare) are provided.

OTHER PROFESSIONAL ENCOUNTER– An encounter between a provider, other than those listed above and a patient during which other forms of health services are provided.  Examples are provided in Appendix A.

CASE MANAGEMENT ENCOUNTER – An encounter between a case management provider and a patient during which services are provided that assist patients in the management of their health and social needs, including patient needs assessments, the establishment of service plans, and the maintenance of referral, tracking, and follow-up systems.  These must be face to face with the patient.  Third party interactions on behalf of a patient are not counted in case management encounters.

HEALTH EDUCATION ENCOUNTER– A one-on-one encounter between a health education provider and a patient in which the services rendered are of an educational nature relating to health matters and appropriate use of health services (e.g., family planning, HIV, nutrition, parenting, and specific diseases).  Participants in health education classes are not considered to have had encounters.  Some individuals trained as pharmacists now work as health educators and perform health education work.  They should be classified as health educators and have those services counted as health education encounters.  This does not include the normal education that is a required part of the dispensing of any medicine in a pharmacy.

PROVIDER

A provider is the individual who assumes primary responsibility for assessing the patient and documenting services in the patient's record.  Providers include only individuals who exercise independent judgment as to the services rendered to the patient during an encounter.  Only one provider who exercises independent judgment is credited with the encounter, even when two or more providers are present and participate.  If two or more providers of the same type divide up the services for a patient (e.g., a family practitioner and a pediatrician both seeing a child) only one may be credited with an encounter.  Where health center staff are following a patient in the hospital, the primary responsible center staff person in attendance during the encounter is the provider (and is credited with an encounter), even if other staff from the health center and/or hospital are present.  (Appendix A provides a listing of personnel.  Only personnel designated as a “provider” can generate encounters for purposes of UDS reporting.)

Providers may be employees of the health center, contracted or volunteers.  Contract providers who are part of the scope of the approved grant-funded program and who are paid by the center with grant funds or program income, serve center patients and document their services in the center's records, are considered providers.  (A discharge summary or similar document in the medical record will meet this criteria.)  Also, contract providers paid for specific visits or services with grant funds or program income, who report patient encounters to the direct recipient of a BPHC grant (e.g., under a migrant voucher program or contractors with homeless grantees) are considered providers and their activities are to be reported by the direct recipient of the BPHC grant.  Since there is no time basis in their report, no FTE is reported for such individuals.  Volunteer providers who serve center patients and document their services in the center's records, are also considered providers.

PATIENT

Patients are individuals who have at least one encounter during the year, as defined above.  The term “patient” is not limited to recipients of medical or dental services; the term is used universally to describe all persons provided UDS-countable encounters.

The Universal Report includes all individuals who have at least one encounter during the year within the scope of activities supported by any BPHC grant covered by the UDS.  In any given category (e.g. medical, dental, enabling, etc.) in the Universal Report, each patient is counted once and only once, even if s/he received more than one type of service or receives services supported by more than one BPHC grant.  For each Grant Report, patients include individuals who have at least one encounter during the year within the scope of project activities supported by the specific BPHC grant.  A patient counted in any cell on a Grant Report is also included in the same cell on the Universal Report. 

Persons who only receive services from large-scale efforts such as immunization programs, screening programs, and health fairs are not counted as patients.  Persons whose only service from the grantee is a part of the WIC program are not counted as patients.

Centers see many individuals who do not become patients as defined by and counted in the UDS process.  “Patients”, as defined for the UDS, never include individuals who have such limited contacts with the grantee, whether or not documented on an individual basis.  These include, but are not limited to, persons whose only contact is:

-  When a provider participates in a community meeting or group session that is not designed to provide clinical services.  Examples of such activities include information sessions for prospective patients, health presentations to community groups (high school classes, PTA, etc.), and information presentations about available health services at the center.

-  When the only health service provided is part of a large-scale effort, such as an immunization program, screening program, or community-wide service program (e.g., a health fair).

-  When a provider is primarily conducting outreach and/or group education sessions, not providing direct services.

-  When the only services provided are lab tests, x-rays, immunizations or other injections, TB tests or readings, and/or filling or refilling a prescription.

-  Services performed under the auspices of a WIC program or a WIC contract.

FULL-TIME EQUIVALENT EMPLOYEE

A full-time equivalent (FTE) of 1.0 means that the person worked full-time for one year.  Each agency defines the number of hours for “full-time” work.  For example, if a physician is hired full-time and works 36 hours per week, she is a 1.0 FTE.  The full-time equivalent is based on employment contracts for clinicians and exempt employees; FTE is calculated based on paid hours for non-exempt employees. FTEs are adjusted for part-time work or for part-year employment.   In an organization that has a 40 hour work week (2080 hours/year), a person who works 20 hours per week (i.e., 50% time) is reported as “0.5 FTE.”  In some organizations different positions have different time expectations. Positions with different time expectations, especially clinicians, should be calculated on whatever they have as a base for that position.  Thus, if physicians work 36 hours per week, this would be considered 1.0 FTE, and an 18 hour per week physician would be considered as 0.5 FTE, regardless of whether other employees work 40 hours weeks.  FTE is also based on the number of months the employee works.  An employee who works full time for four months out of the year would be reported as “0.33 FTE” (4 months/12 months).  

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.  Individuals who are paid by the grantee on a fee-for-service basis only and do not have specific assigned hours, are not counted in the calculation of FTEs since there is no basis for determining their hours.