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:
- 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
- Line 20a and 20b have been added
for Licensed Clinical Psychologists
and Licensed Clinical Social Workers.
These individuals were previously
counted on line 20b.
- Line 20b no longer includes Licensed
Clinical Psychologists and Licensed
Clinical Social Workers.
- 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.
- 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.
- 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.
- 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.
Personnel by
Major Service Category |
FTEs
(
a ) |
Clinic
Encounters
(
b ) |
Patients
(
c ) |
1 |
Family Physicians |
|
|
|
2 |
General Practitioners |
|
|
|
3 |
Internists |
|
|
|
4 |
Obstetrician/Gynecologists |
|
|
|
5 |
Pediatricians |
|
|
|
6 |
|
|
|
|
7 |
Other Specialty
Physicians |
|
|
|
8 |
Total Physicians (Lines 1 – 7) |
|
|
|
9a |
Nurse Practitioners |
|
|
|
9b |
Physician Assistants |
|
|
|
10 |
Certified Nurse
Midwives |
|
|
|
10a |
Total Mid-Levels (Lines 9a - 10) |
|
|
|
11 |
Nurses |
|
|
|
12 |
Other Medical
personnel |
|
|
|
13 |
Laboratory personnel |
|
|
|
14 |
X-ray personnel |
|
|
|
15 |
Total Medical (Lines 8 + 10a through 14) |
|
|
|
16 |
Dentists |
|
|
|
17 |
Dental Hygienists |
|
|
|
18 |
Dental Assistants,
Aides, Techs |
|
|
|
19 |
Total Dental Services (Lines 16 – 18) |
|
|
|
20a |
Psychiatrists |
|
|
|
20a1 |
Licensed Clinical
Psychologists |
|
|
|
20a2 |
Licensed Clinical
Social Workers |
|
|
|
20b |
Other Licensed
Mental Health Providers |
|
|
|
20c |
Other Mental
Health Staff |
|
|
|
20 |
Mental Health (Lines 20a-c) |
|
|
|
21 |
Substance Abuse Services |
|
|
|
22 |
Other Professional Services |
|
|
|
23 |
Pharmacy Personnel |
|
|
|
24 |
Case Managers |
|
|
|
25 |
Patient / Community
Education Specialists |
|
|
|
26 |
Outreach Workers |
|
|
|
27 |
Transportation
Staff |
|
|
|
27a |
Eligibility
Assistance Workers |
|
|
|
27b |
Interpretation
Staff |
|
|
|
28 |
Other Enabling
Services |
|
|
|
29 |
Total Enabling Services (Lines 24-28) |
|
|
|
29a |
Other Programs / Services (specify___) |
|
|
|
30a |
Management and
Support Staff |
|
|
|
30b |
Fiscal and Billing
Staff |
|
|
|
30c |
IT Staff |
|
|
|
30 |
Total Administrative Staff (Lines 30a-30c) |
|
|
|
31 |
Facility Staff |
|
|
|
32 |
Patient Support
Staff |
|
|
|
33 |
Total Admin &
Facility (Lines
30 – 32) |
|
|
|
34 |
Total (Lines 15+19+20+21+22+23+29+29a+33) |
|
|
|
|