U1.00 PATIENT DEMOGRAPHICS |
U1.10 Target Populations |
U1.11 % Pediatric (<15 years old) |
23% |
28% |
29% |
27% |
29% |
22% |
17% |
24% |
32% |
U1.12 % Geriatric (age 65 and over) |
8% |
7% |
5% |
9% |
7% |
8% |
4% |
6% |
10% |
U1.13 % Women's health (age 15 - 44) |
27% |
29% |
30% |
27% |
29% |
28% |
23% |
27% |
32% |
U1.20 Gender Split
by Age Group |
U1.21 % total patients who are female |
56% |
59% |
60% |
59% |
60% |
57% |
55% |
59% |
62% |
U1.22 % patients under 15 who are female |
49% |
50% |
50% |
50% |
50% |
50% |
49% |
50% |
51% |
U1.23 % patients 15 - 44 who are female |
60% |
65% |
66% |
64% |
66% |
61% |
58% |
63% |
69% |
U1.24 % patients 45 - 64 who are female |
54% |
59% |
58% |
60% |
60% |
56% |
55% |
59% |
64% |
U1.25 % patients 65 and over who are
female |
60% |
61% |
63% |
60% |
62% |
59% |
57% |
61% |
66% |
U1.30 Race/Ethnicity/Language |
U1.31 % Asian/Pacific Islander* |
6% |
4% |
5% |
3% |
4% |
3% |
0% |
1% |
2% |
U1.32 % Black / African American* |
16% |
28% |
38% |
15% |
28% |
26% |
1% |
11% |
47% |
U1.33 % Native American / Alaskan Native* |
0% |
1% |
1% |
2% |
1% |
3% |
0% |
0% |
1% |
U1.34 % Hispanic or Latino* |
26% |
34% |
36% |
31% |
37% |
21% |
2% |
13% |
45% |
U1.35 % White* |
71% |
62% |
50% |
77% |
61% |
66% |
38% |
74% |
95% |
U1.36 % with Linguistic Barrier |
28% |
27% |
29% |
24% |
30% |
16% |
1% |
9% |
32% |
U1.40 Income/Insurance |
U1.41 % <= 100% Poverty * |
62% |
70% |
73% |
66% |
71% |
68% |
56% |
69% |
82% |
U1.42 % <= 200% Poverty * |
89% |
91% |
93% |
89% |
92% |
91% |
88% |
96% |
98% |
U1.43 % Uninsured |
24% |
39% |
41% |
36% |
38% |
43% |
25% |
38% |
55% |
U1.44 % with Medicaid coverage |
40% |
35% |
39% |
30% |
37% |
29% |
18% |
29% |
42% |
U1.45 % with Medicare coverage |
10% |
8% |
6% |
10% |
7% |
8% |
4% |
7% |
12% |
U1.46 % with Other Public Ins. coverage |
4% |
3% |
3% |
2% |
3% |
2% |
0% |
0% |
2% |
U1.47 % with Private Ins. coverage |
23% |
15% |
11% |
21% |
15% |
18% |
6% |
14% |
26% |
U1.48 % CHIP enrolled (M'aid or Oth.Pub.) |
3% |
2% |
3% |
2% |
3% |
2% |
0% |
0% |
2% |
U2.0 CLINICAL INFORMATION |
U2.10 Service Patient
to population ratios |
U2.11 % of patients tested for HIV |
2.52% |
3.14% |
4.14% |
1.87% |
3.15% |
3.10% |
0.00% |
0.70% |
3.47% |
U2.12 Mammograms per female patients
45+ years |
12.99% |
10.08% |
11.43% |
8.67% |
11.25% |
6.30% |
0.00% |
0.00% |
9.43% |
U2.13 Pap smears per female patients
15+ years |
21.34% |
21.75% |
23.30% |
19.77% |
22.85% |
17.81% |
10.52% |
16.97% |
24.88% |
U2.14 Family planning per female patients
15-44 yrs |
18.37% |
20.82% |
22.71% |
18.12% |
21.68% |
17.52% |
5.83% |
12.17% |
20.81% |
U2.15 Well child patients per patients
< 12 years |
67.95% |
57.82% |
62.99% |
50.70% |
60.25% |
45.95% |
30.56% |
49.28% |
67.61% |
U2.20 Diagnosis Patient
to population ratios |
U2.21 Hypertension per patient 20+ years |
13.95% |
15.48% |
14.64% |
16.52% |
15.38% |
15.80% |
10.03% |
14.22% |
19.94% |
U2.22 Symptomatic HIV per total medical
patients |
0.56% |
0.44% |
0.65% |
0.18% |
0.42% |
0.49% |
0.00% |
0.03% |
0.23% |
U2.23 Asymptomatic HIV per total medical
patients |
0.17% |
0.18% |
0.26% |
0.08% |
0.16% |
0.24% |
0.00% |
0.00% |
0.02% |
U2.24 Asthma per total medical patients |
4.35% |
3.37% |
3.77% |
2.88% |
3.45% |
3.09% |
1.95% |
2.79% |
3.94% |
U2.25 Diabetes per total medical patients |
7.25% |
7.24% |
6.98% |
7.56% |
7.13% |
7.64% |
5.20% |
6.96% |
9.09% |
U2.30 Visits per
year for patients with specific diagnoses |
U2.31 Asthma |
1.79 |
1.76 |
1.79 |
1.72 |
1.80 |
1.62 |
1.40 |
1.55 |
1.75 |
U2.32 Hypertension |
2.23 |
2.30 |
2.39 |
2.21 |
2.34 |
2.19 |
1.80 |
2.06 |
2.39 |
U2.33 Diabetes |
3.48 |
3.12 |
3.21 |
3.02 |
3.18 |
2.92 |
2.37 |
2.78 |
3.41 |
U2.34 Otitis Media |
1.44 |
1.46 |
1.45 |
1.47 |
1.46 |
1.42 |
1.24 |
1.33 |
1.46 |
U2.35 Mental disorders |
3.64 |
2.92 |
3.06 |
2.77 |
2.91 |
2.95 |
1.48 |
1.83 |
2.63 |
U2.40 Proportion
of Medical Encounters by Diagnosis ³ |
U2.41 % Asthma encounters |
2.21% |
1.89% |
2.16% |
1.56% |
1.94% |
1.68% |
1.05% |
1.44% |
2.10% |
U2.42 % Hypertension encounters |
7.37% |
8.31% |
8.21% |
8.44% |
7.98% |
9.69% |
5.05% |
7.94% |
12.12% |
U2.43 % Diabetes encounters |
7.15% |
7.18% |
7.17% |
7.19% |
7.10% |
7.49% |
4.94% |
6.65% |
9.24% |
U2.50 Perinatal Care |
U2.51 % Prenatal teen patients (<
20 yrs) |
14.59% |
18.21% |
18.12% |
18.36% |
18.20% |
18.26% |
13.72% |
18.31% |
23.25% |
U2.52 % Newborns Below Normal Birthweight |
6.56% |
7.76% |
7.97% |
7.40% |
7.74% |
7.89% |
3.83% |
6.28% |
10.12% |
U2.53 % Late Entry Into Prenatal Care |
27.72% |
35.80% |
36.29% |
34.94% |
35.90% |
35.11% |
21.79% |
32.27% |
42.80% |
U3.0 STAFFING RATIOS
AND PRODUCTIVITY |
U3.10 Support Ratios |
U3.11 Direct medical support |
1.68 |
1.72 |
1.75 |
1.67 |
1.77 |
1.54 |
1.26 |
1.60 |
2.00 |
U3.12 Direct dental support ratio |
0.94 |
1.37 |
1.34 |
1.41 |
1.44 |
1.18 |
0.89 |
1.21 |
1.66 |
U3.13 "Patient support" ratio |
1.23 |
1.23 |
1.17 |
1.31 |
1.28 |
1.08 |
0.77 |
1.17 |
1.53 |
U3.20 Medical Productivity
and Patient Panel Size |
U3.21 Family Practice Productivity |
3,397 |
3,830 |
3,778 |
3,881 |
3,943 |
3,488 |
2,979 |
3,682 |
4,289 |
U3.22 General Practice Productivity |
4,460 |
4,078 |
3,678 |
4,290 |
4,309 |
3,384 |
2,767 |
3,920 |
4,715 |
U3.23 Internal Medicine Productivity |
3,383 |
3,755 |
3,669 |
3,944 |
3,850 |
3,322 |
2,843 |
3,605 |
4,287 |
U3.24 Ob/Gyn Productivity |
3,006 |
3,616 |
3,531 |
3,776 |
3,642 |
3,335 |
2,566 |
3,429 |
4,546 |
U3.25 Pediatric Productivity |
3,559 |
3,937 |
3,814 |
4,206 |
4,019 |
3,373 |
2,927 |
3,678 |
4,363 |
U3.26 Overall Physician Productivity
(excl. spec. phys.) |
3,405 |
3,826 |
3,732 |
3,953 |
3,921 |
3,433 |
3,039 |
3,638 |
4,208 |
U3.27 NP/PA/CNM Productivity |
2,477 |
2,868 |
2,696 |
3,071 |
2,998 |
2,533 |
2,223 |
2,775 |
3,380 |
U3.271 NP Productivity |
2,364 |
2,811 |
2,647 |
3,020 |
2,953 |
2,503 |
2,105 |
2,739 |
3,375 |
U3.272 PA Productivity |
2,832 |
3,062 |
2,898 |
3,198 |
3,224 |
2,603 |
2,190 |
2,860 |
3,646 |
U3.273 CNM Productivity |
2,372 |
2,491 |
2,462 |
2,578 |
2,494 |
2,469 |
1,891 |
2,579 |
3,198 |
U3.28 Medical Team Productivity |
3,796 |
4,248 |
4,086 |
4,463 |
4,336 |
3,921 |
3,568 |
4,205 |
4,737 |
U3.281 Medical Team Productivity Ratio |
0.88 |
1.00 |
0.97 |
1.04 |
1.03 |
0.89 |
0.82 |
0.96 |
1.10 |
U3.29 Medical Patients per Provider
FTE |
865 |
1,101 |
1,078 |
1,130 |
1,126 |
1,013 |
895 |
1,097 |
1,324 |
U3.30 Dental Productivity
and Patient Panel Size |
U3.31 Dentist Productivity |
2,605 |
2,669 |
2,623 |
2,735 |
2,741 |
2,442 |
1,967 |
2,439 |
3,040 |
U3.32 Dental Hygenist Productivity |
1,588 |
1,341 |
1,438 |
1,235 |
1,385 |
1,243 |
881 |
1,300 |
1,703 |
U3.33 Dental Team Productivity |
2,743 |
2,671 |
2,659 |
2,686 |
2,746 |
2,450 |
1,987 |
2,491 |
2,995 |
U3.34 Dental Patients per Provider FTE |
836 |
964 |
980 |
943 |
999 |
867 |
705 |
903 |
1,226 |
U3.40 Mental Health
Productivity and Patient Panel Size |
U3.41 Case Manager Productivity |
747 |
884 |
854 |
965 |
883 |
888 |
281 |
685 |
1,306 |
U3.42 Education Specialist Productivity |
582 |
862 |
763 |
1,043 |
876 |
805 |
223 |
604 |
1,215 |
U3.43 Psychiatrist Productivity |
2,341 |
2,651 |
2,449 |
3,087 |
2,836 |
2,102 |
1,201 |
2,020 |
3,000 |
U3.44 Other Licensed Mental Health Providers
Productivity |
951 |
952 |
933 |
980 |
1,025 |
801 |
580 |
862 |
1,204 |
U3.45 Other Mental Health Staff Productivity |
588 |
641 |
578 |
750 |
676 |
553 |
84 |
510 |
935 |
U3.46 Licensed Mental Health Team Productivity |
1,095 |
1,206 |
1,188 |
1,233 |
1,319 |
957 |
657 |
1,008 |
1,450 |
U3.47 Mental Health Patients per Provider
FTE |
157.56 |
194.23 |
199.05 |
186.48 |
211.42 |
154.78 |
124.86 |
219.38 |
396.45 |
U4.0 UTILIZATION
RATES |
U4.10 Medical Encounters per Medical
Patient ³ |
3.52 |
3.15 |
3.12 |
3.18 |
3.19 |
2.98 |
2.54 |
3.02 |
3.50 |
U4.20 Dental Encounters per Dental Patient |
2.64 |
2.39 |
2.37 |
2.41 |
2.40 |
2.36 |
1.80 |
2.24 |
2.68 |
U4.30 Mental Health Encounters Per MH
Patient |
6.25 |
5.19 |
4.87 |
5.75 |
5.15 |
5.33 |
2.42 |
3.71 |
5.72 |
U4.40 Substance Abuse Encounters Per
SA Patient |
7.75 |
10.74 |
11.42 |
7.21 |
9.40 |
12.83 |
2.50 |
5.55 |
10.04 |
U4.50 Enabling Encounters per Enab.
Patient |
2.99 |
2.89 |
3.00 |
2.69 |
2.83 |
3.08 |
1.60 |
2.50 |
3.80 |
U5.0 COSTS |
U5.10 Costs by cost
center |
U5.11 Administration % of Total Cost |
24% |
25% |
26% |
25% |
25% |
27% |
22% |
27% |
32% |
U5.12 Facility % of Total Cost |
7% |
7% |
8% |
7% |
7% |
7% |
5% |
7% |
9% |
U5.13 Medical (loaded) as % of total
cost |
58% |
64% |
62% |
67% |
65% |
61% |
56% |
67% |
79% |
U5.14 Dental (loaded) as % of total
cost |
11% |
11% |
10% |
11% |
10% |
12% |
1% |
9% |
17% |
U5.15 Pharmacy (loaded) as % of total
cost |
6% |
7% |
7% |
8% |
8% |
6% |
1% |
3% |
8% |
U5.16 Lab/X-ray (loaded) as % of total
cost |
3% |
5% |
4% |
5% |
5% |
4% |
1% |
3% |
6% |
U5.17 Mental/Addictive (loaded) as %
of total cost |
7% |
5% |
5% |
4% |
4% |
7% |
0% |
2% |
6% |
U5.18 Enabling (loaded) as % of total
cost |
8% |
9% |
10% |
6% |
8% |
10% |
3% |
6% |
11% |
U5.19 Pharmaceuticals as a % of total
cost |
4% |
4% |
3% |
5% |
4% |
4% |
0% |
2% |
4% |
U5.20 Costs per patient |
U5.21 Medical Cost per Medical Patient
³ |
$507 |
$386 |
$404 |
$365 |
$386 |
$387 |
$296 |
$362 |
$472 |
U5.22 Dental Cost per Dental Patient |
$364 |
$344 |
$339 |
$351 |
$339 |
$362 |
$245 |
$343 |
$454 |
U5.23 Total Cost per Total Patient |
$765 |
$562 |
$597 |
$517 |
$560 |
$568 |
$405 |
$504 |
$652 |
U5.30 Costs per encounter |
U5.31 Medical cost per medical encounter
³ |
$144 |
$123 |
$129 |
$115 |
$121 |
$130 |
$103 |
$121 |
$146 |
U5.32 Dental Cost per dental encounter |
$138 |
$144 |
$143 |
$146 |
$141 |
$153 |
$117 |
$149 |
$194 |
U5.33 Pharmacy Cost per medical encounter
³ |
$17 |
$15 |
$15 |
$15 |
$15 |
$14 |
$1 |
$6 |
$17 |
U5.34 Lab & X-ray Cost per medical
encounter ³ |
$8 |
$9 |
$10 |
$9 |
$9 |
$9 |
$2 |
$7 |
$13 |
U5.35 Pharmaceutical cost per medical
encounter |
$10 |
$8 |
$8 |
$9 |
$8 |
$9 |
$1 |
$3 |
$9 |
U6.0 MANAGED CARE |
U6.10 Managed Care
Surplus/Deficit as % Expenses |
U6.11 Medicaid MC Surplus/Deficit % |
-1% |
7% |
8% |
5% |
9% |
-2% |
-17% |
-1% |
16% |
U6.12 Medicare MC Surplus/Deficit % |
-3% |
-2% |
-4% |
5% |
5% |
-44% |
-57% |
-27% |
8% |
U6.13 Other Public MC Surplus/Deficit
% |
-21% |
-11% |
-10% |
-12% |
-9% |
-23% |
-49% |
-29% |
-5% |
U6.14 Private MC Surplus/Deficit % |
-18% |
-31% |
-36% |
-12% |
-31% |
-27% |
-50% |
-31% |
-7% |
U6.15 Total MC Surplus/Deficit % |
-6% |
2% |
2% |
3% |
4% |
-7% |
-21% |
-5% |
12% |
U6.20 Average Capitated
Member Month Revenue |
U6.21 Medicaid PMPM |
$26 |
$24 |
$23 |
$26 |
$23 |
$26 |
$14 |
$18 |
$25 |
U6.22 Medicare PMPM |
$42 |
$118 |
$143 |
$58 |
$123 |
$29 |
$27 |
$35 |
$55 |
U6.23 Other Public PMPM |
$35 |
$25 |
$23 |
$29 |
$25 |
$19 |
$12 |
$18 |
$24 |
U6.24 Private Insurance PMPM |
$26 |
$22 |
$20 |
$27 |
$21 |
$26 |
$10 |
$13 |
$21 |
U6.30 Total Encounters per Member Year |
4.21 |
3.92 |
3.87 |
4.03 |
3.96 |
3.70 |
2.71 |
3.53 |
4.89 |
U7.0 CHARGES, COLLECTIONS
AND ADJUSTMENTS |
U7.10 Income by Source |
U7.11 % Income from Patient Service |
56% |
59% |
57% |
63% |
62% |
47% |
37% |
53% |
67% |
U7.12 % Income from BPHC |
12% |
19% |
17% |
21% |
17% |
25% |
14% |
23% |
36% |
U7.13 % Income from other sources |
33% |
22% |
27% |
16% |
21% |
27% |
8% |
17% |
30% |
U7.20 Managed Care
Participation |
U7.21 % Non-Managed Care Charges |
72% |
78% |
73% |
85% |
76% |
85% |
73% |
93% |
100% |
U7.22 % Capitated Managed Care Charges |
5% |
10% |
12% |
6% |
11% |
5% |
0% |
0% |
6% |
U7.23 % Fee-for-Service Managed Care
Charges |
23% |
13% |
15% |
9% |
14% |
9% |
0% |
1% |
16% |
U7.30 Other Ratios |
U7.31 Average Charge per Unduplicated
Patient |
$724 |
$554 |
$595 |
$502 |
$575 |
$476 |
$331 |
$454 |
$580 |
U7.32 Average Charge per Billable Encounter
¹ |
$190 |
$167 |
$181 |
$149 |
$170 |
$152 |
$116 |
$142 |
$173 |
U7.33 Ratio of Charges to Reimbursable
Costs ¹ |
119% |
114% |
120% |
107% |
119% |
99% |
82% |
101% |
120% |
U7.34 Average 330 Grant $ per Medical
Patient |
$109 |
$121 |
$116 |
$126 |
$107 |
$174 |
$89 |
$135 |
$210 |
U7.35 Ratio of Donations to Total Costs |
1% |
3% |
3% |
3% |
3% |
4% |
0% |
0% |
4% |
U7.40 Collection
Rate |
U7.41 % Medicaid Charges Collected |
75% |
85% |
81% |
94% |
85% |
84% |
69% |
87% |
105% |
U7.42 % Medicare Charges Collected |
71% |
68% |
64% |
73% |
68% |
69% |
51% |
69% |
88% |
U7.43 % Other Public Charges Collected |
56% |
66% |
65% |
67% |
67% |
59% |
39% |
57% |
76% |
U7.44 % Private Insurance Charges Collected |
62% |
57% |
52% |
62% |
56% |
61% |
41% |
56% |
70% |
U7.45 % Self Pay Charges Collected |
19% |
22% |
17% |
31% |
22% |
23% |
14% |
24% |
36% |
U7.46 % Overall Charges Collected |
59% |
60% |
57% |
66% |
61% |
57% |
45% |
59% |
72% |
U7.47 % Collections from Retroactive
Payments |
7% |
15% |
18% |
11% |
16% |
12% |
0% |
3% |
17% |
U7.50 Adjustments |
U7.51 Sliding Discounts as % of self
pay charges |
72% |
66% |
71% |
58% |
66% |
66% |
49% |
64% |
76% |
U7.52 Bad Debt as % of self pay charges |
8% |
9% |
10% |
9% |
10% |
8% |
2% |
6% |
13% |
U7.53 Allowances as % of insured charges |
27% |
20% |
23% |
16% |
20% |
19% |
5% |
16% |
29% |
U7.60 Indigent Care Income as % of self
pay chgs. |
34% |
13% |
15% |
9% |
13% |
12% |
0% |
0% |
10% |
U7.70 Surplus/Deficit as % Total Cost
² |
1% |
1% |
0% |
2% |
1% |
1% |
-4% |
1% |
7% |
U7.80 Payor Mix (%
of Charges) |
U7.81 % patient charges from Medicaid |
44% |
44% |
48% |
37% |
46% |
36% |
20% |
35% |
51% |
U7.82 % patient charges from Medicare |
10% |
9% |
7% |
12% |
9% |
10% |
4% |
8% |
13% |
U7.83 % patient charges from Other Public |
6% |
4% |
5% |
3% |
4% |
3% |
0% |
0% |
3% |
U7.84 % patient charges from Private
Insurance |
18% |
13% |
10% |
18% |
13% |
15% |
4% |
10% |
20% |
U7.85 % patient charges from Self Pay |
22% |
30% |
30% |
30% |
29% |
35% |
21% |
33% |
50% |