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The Health Center Program: Health Care and Business Plan Performance Measures

In order to support the provision of high quality patient care, HRSA-funded health centers are expected to have ongoing quality improvement/assessment programs that include clinical services and quality management.  To this end, the Health Center Program incorporates systems of quality assessment, quality improvement, and quality management that focus provider responsibilities on improving care processes and outcomes.

In concert with performance improvement initiatives within the broader health care community, the Health Center Program incorporates quality-related performance measures that place emphasis on health outcomes and demonstrate the value of care delivered by health centers.  These performance measures are selected to provide a balanced and comprehensive representation of health center services, clinically prevalent conditions among underserved communities, and the population across life cycles.  Their use is familiar to the majority of health center grantees that have extensive experience working to improve the quality of perinatal, chronic, and preventative care services. Further, the performance measures are aligned with those of national standard setting organizations, and are commonly used by Medicare, Medicaid, and health insurance/managed care organizations to assess quality performance.

The measures below are to be reported by all grantees in the Uniform Data System (UDS) for calendar year 2009, and are included in the Health Care and Business Plans for 2010  Service Area Competition (SAC) and Budget Period Renewal (BPR) grant opportunities.  They reflect the performance measures and specifications for the 2009 UDS. (These measures refine those reported in the 2008 UDS; the 2008 UDS Manual is available at http://bphc.hrsa.gov/uds/manual/default.htm.) The alignment of the performance measures across grant performance reporting (UDS) and the grant application (SAC and BPR) provides grantees with the opportunity to establish quality and performance goals for their organization and patient populations, and assess their progress toward these goals.  The alignment furthers HRSA’s objective to collect data in a way that minimizes grantee reporting burden, and helps document the value of the Health Center Program.

Outreach / Quality of Care

Percentage of pregnant women beginning prenatal care in the first trimester

Numerator: All female patients who received perinatal care during the program year (regardless of when they began care) who initiated care in the first trimester either at the grantee's service delivery location or with another provider.
Denominator (Universe): Number of female patients who received prenatal care during the program year (regardless of when they began care), either at the grantee's service delivery location or with another provider. Initiation of care means the first visit with a clinical provider (MD, NP, CNM) where the initial physical exam was done and does not include a visit at which pregnancy was diagnosed or one where initial tests were done or vitamins were prescribed.

Percentage of children with 2nd birthday during the measurement year with appropriate immunizations

Numerator: Number of children in the "universe" who received all of the following: 4 DTP/DTaP, 3 IPV, 1 MMR, 3 Hib, 3 HepB, 1VZV (Varicella) and 4 Pneumoccocal conjugate, prior to or on their 2nd birthday whose second birthday occurred during the measurement year (prior to 31 December), among those children included in the denominator.

Denominator (Universe): Number of children with at least one medical encounter during the reporting period, who had their second birthday during the reporting period, who did not have a contraindication for a specific vaccine. For measurement year 2009, this includes children with a date of birth on or after January 1, 2007 and on or before December 31, 2007, who were seen for the first time in the clinic prior to their second birthday, regardless of whether or not they came to the clinic for vaccinations or well child care.

Percentage of women 21-64 years of age who received one or more Pap tests during the measurement year or during the two years prior to the measurement year

Numerator: Number of female patients 24-64 years of age receiving one or more Pap tests during the measurement year or during the two years prior to the measurement year (for measurement year 2009, patients born on or after January 1, 1945 and on or before December 31, 1985), among those women included in the denominator.

Denominator (Universe): Number of female patients 24-64 years of age during the measurement year (for measurement year 2009, patients born on or after January 1, 1945 and on or before December 31, 1985) who were seen for a medical encounter at least once during 2008 and were first seen by the grantee before their 65th birthday.

Health Outcomes / Disparities

Percentage diabetic patients whose HbA1c levels are less than or equal to 9 percent

Numerator: Number of adult patients age 18 to 75 years of age with a diagnosis of Type 1 or Type 2 diabetes whose most recent hemoglobin A1c level during the measurement year is  < 9%, among those patients included in the denominator.
Denominator (Universe): Number of adult patients age 18 to 75 years of age as of December 31 of the measurement year (for measurement year 2009, date of birth on or after January 1, 1934 and on or before December 31, 1991) with a diagnosis of Type 1 or Type 2 diabetes, who have been seen in the clinic at least twice during the reporting year and do not meet any of the exclusion criteria.

Percentage of adult patients with diagnosed hypertension whose most recent blood pressure was less than 140/90
Numerator: Patients 18 to 85 years of age (for measurement year 2009, date of birth on or after January 1, 1924 and on or before December 31,1991) with a diagnosis of hypertension with most recent systolic blood pressure measurement < 140 mm Hg and diastolic blood pressure < 90 mm Hg.
"Denominator (Universe): All patients 18 to 85 years of age as of December 31 of the measurement year (for measurement year 2009, date of birth on or after January 1, 1924 and on or before December 31,1991) with diagnosis of hypertension and have been seen at least twice during the reporting year, and have a diagnosis of hypertension before June 30 of the measurement year."

Percentage of births less than 2,500 grams to health center patients
Numerator: Women in the "Universe" whose child weighed less than 2,500 grams during the measurement year, regardless of who did the delivery.
Denominator (Universe): Total births for all women who were seen for prenatal care during the measurement year regardless of who did the delivery.

Additional Measures 

In addition to the above UDS clinical measures, health centers must include one Behavioral Health (e.g., Mental Health or Substance Abuse) and one Oral Health performance measure of their choice in the Health Care Plan.

Financial Viability / Costs

Total cost per patient
Numerator: Total accrued cost before donations and after allocation of overhead.
Denominator: Total number of patients
UDS Lines: T8AL17CC/T4L6A for existing grantees

Medical cost per medical encounter
Numerator: Total accrued medical staff and medical other cost after allocation of overhead (excludes lab and x-ray cost).
Denominator: Non-nursing medical encounters (excludes nursing (RN) and psychiatrist encounters).
UDS Lines: T8AL1CC + T8AL3CC/T5L15CB - TT5L11CB for existing grantees

Change in net assets to expense ratio
Numerator: Ending Net Assets - Beginning Net Assets
Denominator: Total Expense
Note: Net Assets = Total Assets – Total Liabilities

Working capital to monthly expense ratio
Numerator: Current Assets - Current Liabilities
Denominator: Total Expense / Number of Months in Audit

Long term debt to equity ratio
Numerator: Long Term Liabilities
Denominator: Net Assets


Requirements & Regulations Related Links
 

Authorizing Legislation (Section 330 of the Public Health Service Act)

Community Health Center Program Regulations

Migrant Health Program Regulations

Grant Award Requirements

Program Information Notices & Program Assistance Letters

Medicare Benefit Policy Manual, Chapter 13


Preventive and Primary
Health Care Guidelines
 

Clinical Information

Preventive Services

Clinical Practice

CDC Catch-up Immunization Scheduler