MISSOURI HOSPITAL ASSOCIATION Profile of … FQHC...2018 Missouri FQHC Profiles 3 The Missouri Hospital Association is pleased to provide you with this Profile of Missouri Federally

Profile of Missouri Federally Qualified Health CentersSEPTEMBER 2018

MISSOURI HOSPITAL ASSOCIATION

2018 Missouri FQHC Profiles 3

The Missouri Hospital Association is pleased to provide you with this Profile of Missouri Federally Qualified Health Centers. This report examines the payer mix, service mix, finances, staffing levels and quality measures of federally qualified health centers from both a statewide and national perspective. In addition, 28 main FQHCs — which collectively provide health care services at 190 locations throughout the state — are profiled individually.

All exhibits are based on publically available data submitted annually by each health center to the U.S. Health Resources and Services Administration. This first edition of MHA’s Profile of Missouri Federally Qualified Health Centers utilizes HRSA data from calendar year 2016.

The following Missouri FQHCs are profiled in this report.

ADVOCATES FOR A HEALTHY COMMUNITY

AFFINIA HEALTHCARE

BETTY JEAN KERR - PEOPLE’S HEALTH CENTERS

BIG SPRINGS MEDICAL ASSOCIATION DBA MISSOURI HIGHLAND HEALTH CARE

COMMUNITY HEALTH CTR OF CENTRAL MISSOURI

COMMUNITY TREATMENT, INC.

COMPASS HEALTH, INC.

CROSS TRAILS MEDICAL CENTER

DOUGLAS COUNTY PUBLIC HEALTH SERVICES GROUP, INC.

FAMILY CARE HEALTH CENTERS

FAMILY HEALTH CENTER OF BOONE COUNTY

FORDLAND CLINIC

GREAT MINES HEALTH CENTER

HEALTH CARE COALITION OF LAFAYETTE COUNTY

KANSAS CITY CARE CLINIC

MYRTLE HILLIARD DAVIS COMPREHENSIVE HEALTH CENTERS, INC.

NORTHEAST MISSOURI HEALTH COUNCIL, INC.

NORTHWEST HEALTH SERVICES, INC.

OZARK TRI-COUNTY HEALTH CARE CONSORTIUM DBA ACCESS FAMILY CARE

OZARKS RESOURCE GROUP

PREFERRED FAMILY HEALTHCARE INC

REGIONAL HEALTH CARE CLINIC, INC. DBA KATY TRAIL COMMUNITY HEALTH

RICHLAND MEDICAL CENTER INC

RURAL ALLIANCE FOR BETTER FAMILY HLTH

SAMUEL U RODGERS HEALTH CENTER, INC.

SOUTH CENTRAL MISSOURI COMMUNITY HEALTH CENTER

SOUTHEAST MISSOURI HEALTH NETWORK, INC.

SWOPE HEALTH SERVICES

This FQHC report represents an ongoing effort to assist in the formation of collaborative relationships between hospitals and FQHCs, and to provide meaningful and timely information about services available to the communities served by MHA’s acute and post-acute member facilities. We welcome your comments as to how the Profile of Missouri Federally Qualified Health Centers may be modified to better serve your needs. For more information concerning this report, please contact Jim Mikes, Vice President of Rural Advocacy and Regulation at [email protected].

Introduction

mailto:[email protected]

Missouri and United States Trends


MISSOURI UNITED STATESPatient Profile and Payer Mix

Number of FQHCs 29 Number of FQHCs 1367Number of Patients Served by FQHCs 527,054 Number of Patients Served by FQHCs 25,860,296Income Status (patients with known income) Income Status (patients with known income)At or below 200% of poverty 94.7% At or below 200% of poverty 92%At or below 100% of poverty 72% At or below 100% of poverty 70%Insurance status Patients served % of Total Insurance status Patients served % of TotalUninsured 136,333 25.90% Uninsured 6,059,126 23.40%Subset: Uninsured children ages 0-17years 16,915 3%

Subset: Uninsured children ages 0-17years 1,044,251 4%

Medicaid and CHIP 242,235 50% Medicaid and CHIP 12,968,647 49.20%Medicare 45,488 8.60% Medicare 2,384,323 9.20%Dual Eligible 18,860 3.60% Dual Eligible 939,492 3.60%Private Insurance 102,998 19.50% Private Insurance 4,448,200 17.20%Total served 527,054 100% Total served 25,860,296 100%

StaffingFTEs Percent FTEs Percent

Family Physicians 82.13 2.01 Family Physicians 5,721.43 2.76General Practitioners 2.10 0.05 General Practitioners 428.27 0.21Internists 28.11 0.69 Internists 1,905.08 0.92Obstetrician/Gynecologists 24.13 0.59 Obstetrician/Gynecologists 1,230.52 0.59Pediatricians 32.04 0.78 Pediatricians 2,694.68 1.3Other Specialty Physicians 3.49 0.09 Other Specialty Physicians 439.12 0.21Total Physicians 172.00 4.21 Total Physicians 12,419.10 5.98Nurse Practitioners 165.59 4.05 Nurse Practitioners 7,878.98 3.79Physician Assistants 11.23 0.27 Physician Assistants 2,924.92 1.41Certified Nurse Midwives 0.67 0.02 Certified Nurse Midwives 680.78 0.33Total NPs, PAs, CNMs 177.49 4.34 Total NPs, PAs, CNMs 11,484.68 5.53Nurses 362.49 8.86 Nurses 16,712.25 8.05Other Medical Personnel 306.94 7.51 Other Medical Personnel 28,504.19 13.73Laboratory Personnel 60.96 1.49 Laboratory Personnel 2,371.28 1.14X-Ray Personnel 38.31 0.94 X-Ray Personnel 962.37 0.46Total Medical Services 1,118.19 27.34 Total Medical Services 72,453.87 34.89Dentists 165.44 4.05 Dentists 4,474.48 2.15Dental Hygienists 84.15 2.06 Dental Hygienists 2,200.39 1.06Dental Therapists 0.00 0 Dental Therapists 25.70 0.01Dental Assistants, Aides, Techs 406.91 9.95 Dental Assistants, Aides, Techs 9,441.24 4.55Total Dental Services 656.50 16.05 Total Dental Services 16,141.81 7.77Psychiatrists 36.37 0.89 Psychiatrists 687.78 0.33Licensed Clinical Psychologists 21.77 0.53 Licensed Clinical Psychologists 821.73 0.4Licensed Clinical Social Workers 79.65 1.95 Licensed Clinical Social Workers 3,171.58 1.53Other Licensed Mental Health Providers 54.92 1.34

Other Licensed Mental Health Providers 2,298.46 1.11

Other Mental Health Staff 158.97 3.89 Other Mental Health Staff 2,212.27 1.07Total Mental Health Services 351.68 8.6 Total Mental Health Services 9,191.82 4.43Substance Abuse Services 15.90 0.39 Substance Abuse Services 1,163.10 0.56Other Professional Services 19.26 0.47 Other Professional Services 1,412.87 0.68Ophthalmologist 39.55 0 Ophthalmologist 0.32 0.02Optometrist 282.84 0.12 Optometrist 4.86 0.14Other Vision Care Staff 339.43 0.15 Other Vision Care Staff 6.15 0.16Total Vision Services 661.82 0.28 Total Vision Services 11.33 0.32Pharmacy Personnel 65.86 1.61 Pharmacy Personnel 4,529.22 2.18

6 Missouri Hospital Association

MISSOURI UNITED STATESStaffing (continued)

FTEs Percent FTEs PercentCase Managers 7,621.93 3.78 Case Managers 154.42 3.67Patient/Community Education Specialists 2,587.65 0.8

Patient/Community Education Specialists 32.54 1.25

Outreach Workers 2,645.83 1.18 Outreach Workers 48.17 1.27Transportation Staff 665.30 0.2 Transportation Staff 8.29 0.32Eligibility Assistance Workers 4,535.20 1.45 Eligibility Assistance Workers 59.32 2.18Interpretation Staff 1,061.70 0.4 Interpretation Staff 16.48 0.51Community Health Workers 879.28 0.61 Community Health Workers 24.92 0.42Other Enabling Services 500.31 0.16 Other Enabling Services 6.36 0.24Total Enabling Services 20,497.20 8.57 Total Enabling Services 350.50 9.87Other Programs/Services 74.18 1.81 Other Programs/Services 5,181.10 2.5Quality Improvement Staff 42.99 1 Quality Improvement Staff 2,119.33 1Management and Support Staff 354.76 8.67 Management and Support Staff 20,135.97 9.7Fiscal and Billing Staff 233.91 5.72 Fiscal and Billing Staff 11,900.49 5.73IT Staff 56.72 1.39 IT Staff 3,313.42 1.6Facility Staff 119.64 2.93 Facility Staff 5,036.76 2.43Patient Support Staff 618.25 15.12 Patient Support Staff 33,917.39 16.33Total Facility and Non-Clinical Support Services(Lines 30a through 32) 1,383.28 33.82

Total Facility and Non-Clinical Support Services(Lines 30a through 32) 74,304.03 35.78

Grand Total 4,089.67 100 Grand Total 207,656.17 100

Average Tenure of Key PersonnelPersons Months Persons Months

Chief Executive Officer 28 2749 Chief Executive Officer 1365 171455Chief Medical Officer 27 1729 Chief Medical Officer 1311 97150Chief Financial Officer 26 2290 Chief Financial Officer 1263 92567Chief Information Officer 12 795 Chief Information Officer 555 46163

Average Years of Tenure Average Years of Tenure CEO 8 CEO 10CMO 5 CMO 6CFO 7 CFO 6CIO 5 CIO 7

Revenues (Collections)Patient Revenue Dollars Percent Patient Revenue Dollars PercentMedicaid $199,720,341 46.3 Medicaid $10,288,791,902 43.3Medicare $21,531,226 5 Medicare $1,692,047,715 7.1Other Public Sources $3,420,140 0.8 Other Public Sources $256,154,614 1.1Private $39,386,278 9.1 Private $2,227,980,413 9.4Self Pay $23,854,466 5.5 Self Pay $1,004,791,680 4.2Total Patient Revenue $287,912,451 66.7 Total Patient Revenue $15,469,766,324 65.1Other Revenue Other RevenueBPHC Grants $97,535,742 22.6 BPHC Grants $4,422,484,040 18.6Other Federal Grants $5,879,392 1.4 Other Federal Grants $457,248,039 1.9Non-Federal Grants $33,495,475 7.8 Non-Federal Grants $2,459,504,976 10.4Other Non-Patient Revenue $6,984,203 1.6 Other Non-Patient Revenue $943,837,380 4Total Other Revenue $143,894,812 33.4 Total Other Revenue $8,283,074,435 34.9FQHC Total Revenues $431,807,263 100 FQHC Total Revenues $23,752,840,759 100


MISSOURI UNITED STATESExpenses

Dollars Percent Dollars PercentTotal Medical Services $189,308,087 45.0 Total Medical Services $13,264,326,951 57.6Other Clinical Services Other Clinical ServicesDental $107,494,489 25.6 Dental $2,753,312,141 12Mental Health $43,820,912 10.4 Mental Health $1,434,294,593 6.2Substance Abuse $1,724,048 0.4 Substance Abuse $153,609,793 0.7Vision and Other Professional Services $4,373,393 1.0 Vision and Other Professional

Services $359,554,167 1.6

Pharmacy and Pharmaceuticals $29,715,464 7.1 Pharmacy and Pharmaceuticals $2,447,388,573 10.6Total Other Clinical Services $187,128,306 44.5 Total Other Clinical Services $7,148,159,267 31.1Enabling and Other Services Enabling and Other ServicesEnabling Services $30,457,291 7.2 Enabling Services $1,685,248,811 7.3Quality Improvement $5,606,893 1.3 Quality Improvement $247,428,176 1.1Other Related Services $7,980,504 1.9 Other Related Services $666,697,408 2.9Total Enabling and Other Services $44,044,688 10.4

Total Enabling and Other Services $2,599,374,395 11.3

FQHC Total Expenses $420,481,081 100.0 FQHC Total Expenses $23,011,860,613 100

Service MixService Visits Percent Service Visits PercentMedical 973606 51.00 Medical 71297375 68.00Dental 487583 25.00 Dental 14420355 14.00Mental 264464 14.00 Mental 8508031 8.00Substance Abuse 63490 3.00 Substance Abuse 1135218 1.00Vision and Other Professional 45201 2.00 Vision and Other Professional 2651185 3.00Enabling 90886 5.00 Enabling 6104093 6.00Total Visits 1925230 100.00 Total Visits 104116257 100.00Service Patients Percent Service Patients PercentMedical 333040 50 Medical 21880295 66Dental 223954 34 Dental 5656190 17Mental 47384 7 Mental 1788577 5Substance Abuse 2806 0.4 Substance Abuse 141569 0.4Vision and Other Professional 24167 4 Vision and Other Professional 1273935 4Enabling 33434 5 Enabling 2482751 7Total Visits 664785 100 Total Visits 33223317 100

Average Cost per ServiceService Cost per Visit Service Cost per VisitMedical $194 Medical $186Dental $220 Dental $191Mental $166 Mental $169Substance Abuse $27 Substance Abuse $135Vision and Other Professional $97 Vision and Other Professional $136Enabling $335 Enabling $276Service Cost per Patient Service Cost per PatientMedical $568 Medical $606Dental $480 Dental $487Mental $925 Mental $802Substance Abuse $614 Substance Abuse $1,085Vision and Other Professional $181 Vision and Other Professional $282Enabling $911 Enabling $679FQHC Average Cost per Patient Served $798 FQHC Average Cost per Patient Served $890

ProfitabilityTotal Revenues per FQHC $14,889,906 Total Revenues per FQHC $17,375,889Total Expenses per FQHC $14,499,348 Total Expenses per FQHC $16,833,841Average FQHC Profit Margin 2.70% Average FQHC Profit Margin 3.20%

Missouri FQHC Profiles


2014 2015 2016

Age and Race/EthnicityTotal Patients 35,707 43,985 52,118Age (% of total patients)Children (< 18 years old) 52.38% 51.08% 47.04%Adult (18 - 64) 44.29% 45.67% 49.38%Older Adults (age 65 and over) 3.33% 3.25% 3.59%Patients By Race & Ethnicity (% known)Non-Hispanic White 88.55% 88.95% 89.12%Racial and/or Ethnic Minority 13.94% 13.75% 13.56%Hispanic/Latino Ethnicity 4.96% 5.25% 5.13%Black/African American1 5.80% 5.49% 5.21%Asian1 1.58% 1.53% 1.49%American Indian/Alaska Native1 0.31% 0.46% 0.56%Native Hawaiian / Other Pacific Islander1 0.21% 0.19% 0.22%More than one race1 1.62% 1.39% 1.59%Language (% known)Best Served in another language 3.04% 2.53% 2.55%

Patient CharacteristicsIncome Status (% of patients with known income)Patients at or below 200% of poverty 98.69% 97.82% 96.39%Patients at or below 100% of poverty 82.20% 76.76% 70.98%Insurance Status (% of total patients)Uninsured 21.85% 22.27% 23.75%Children Uninsured (age 0-17 years) 9.81% 8.64% 7.73%Medicaid/CHIP2 60.92% 59.66% 59.06%Medicare 5.46% 4.66% 4.12%Dually Eligible (Medicare and Medicaid) - 0.40% 2.26%Other Third Party 11.78% 13.41% 13.07%Special PopulationsHomeless 1.35% 1.44% 1.87%Agricultural Worker 0.00% 0.00% 0.00%Public Housing3 0.00% 0.00% 0.00%School Based 4.02% 4.37% 3.98%Veterans 0.86% 0.80% 0.94%

Gender of Patients by AgeWomen’s Data (% of total women)Women’s Health (ages 15-44) 41.23% 42.25% 44.76%Patients Under 15 Who are Female 39.90% 39.42% 35.66%Patients 15-64 Who are Female 56.66% 57.09% 60.42%Patients 65 and Over Who are Female 3.45% 3.49% 3.92%Men’s Data (% of total men)Men’s Health (ages 15-44) 27.33% 30.03% 33.26%Patients Under 15 Who are Male 54.51% 52.04% 47.88%Patients 15-64 Who are Male 42.31% 45.02% 48.98%Patients 65 and Over Who are Male 3.17% 2.94% 3.15%

Services (% of patients)Medical 55.95% 54.20% 51.71%Dental 53.80% 56.58% 59.18%Mental Health 3.37% 3.89% 2.96%Substance Abuse 0.00% 0.00% 0.50%Vision 2.39% 2.08% 3.39%Enabling 10.17% 11.25% 12.04%



2014 2015 2016

Clinical Data% of Patients with Medical ConditionsHypertension4 29.18% 26.27% 30.97%Diabetes5 13.67% 12.54% 14.65%Asthma 3.88% 3.55% 2.59%HIV 0.13% 0.06% 0.07%PrenatalPrenatal Patients6 1,585 1,576 1,541Prenatal Patients who Delivered 746 690 818

Adjusted Quartile

Ranking7

2014 2015 2016 2015 2016

Quality of Care MeasuresPerinatal HealthAccess to Prenatal Care (First Prenatal Visit in 1st Trimester) 67.95% 67.32% 70.21% 4 4Low Birth Weight 8.91% 6.20% 9.64% 2 3Preventive Health Screening & ServicesCervical Cancer Screening12 59.83% 64.91% 57.61% 1 1Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents 51.84% 56.33% 58.63% 2 2

Body Mass Index (BMI) Screening and Follow-Up 58.23% 62.80% 65.75% 2 2Adults Screened for Tobacco Use and Receiving Cessation Intervention13 84.99% 90.54% 94.01% 2 2

Colorectal Cancer Screening14 21.16% 28.32% 31.92% 3 3Childhood Immunization Status8 64.21% 68.26% 19.60% 3 3Screening for Clinical Depression and Follow-Up Plan15 81.99% 76.08% 82.55% 1 1Dental Sealants for Children between 6-9 Years16 - 17.02% 24.42% 4 4Chronic Disease ManagementUse of Appropriate Medications for Asthma17 74.07% 96.91% 93.29% 1 2Coronary Artery Disease (CAD): Lipid Therapy 61.62% 65.05% 70.81% 4 4Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic 77.46% 82.16% 77.27% 2 3

Controlling High Blood Pressure (Hypertensive Patients with Blood Pressure < 140/90)18 56.96% 58.27% 58.37% 3 3

Diabetes: Hemoglobin A1c Poor Control (Diabetic Patients with HbA1c > 9%) or No Test During Year19 34.12% 30.03% 37.52% 3 4

HIV Linkage to Care 25.00% 50.00% 66.67% - -

Cost DataHealth Center Service Grant Expenditures $2,923,806 $3,394,920 $4,575,767 Total Cost $24,457,106 $28,344,785 $33,640,267 Total Cost Per Patient $684.94 $644.42 $645.46




AFFINIA HEALTHCARE

2014 2015 2016






2014 2015 2016

Clinical DataMedical Conditions (% of Patients with Medical Conditions)Hypertension4 24.46% 26.03% 28.35%Diabetes5 10.08% 11.81% 13.66%Asthma 8.25% 9.43% 8.68%HIV 0.14% 0.14% 0.18%PrenatalPrenatal Patients6 1,641 1,602 1,316Prenatal Patients who Delivered 819 905 781

Adjusted Quartile

Ranking7

2014 2015 2016 2015 2016








AFFINIA HEALTHCARE




2014 2015 2016






2014 2015 2016


Adjusted Quartile

Ranking7

2014 2015 2016 2015 2016












2014 2015 2016




Services (% of patients)Medical 68.04% 67.70% 69.81%Dental 35.50% 36.32% 35.03%Mental Health 5.01% 5.37% 4.93%Substance Abuse - - 0.00%Vision 0.12% 0.03% 0.04%Enabling 13.00% 10.27% 10.58%


2014 2015 2016

Clinical DataMedical Conditions (% of Patients with Medical Conditions)Hypertension4 45.33% 23.80% 28.38%Diabetes5 19.57% 14.23% 14.04%Asthma 3.01% 2.96% 2.89%HIV 0.05% 0.01% 0.03%PrenatalPrenatal Patients6 1 4 10Prenatal Patients who Delivered 1 1 2

Adjusted Quartile

Ranking7

2014 2015 2016 2015 2016

Quality of Care MeasuresPerinatal HealthAccess to Prenatal Care (First Prenatal Visit in 1st Trimester) 100.00% 75.00% 100.00% - -Low Birth Weight 0.00% 0.00% 0.00% - -Preventive Health Screening & ServicesCervical Cancer Screening12 30.50% 21.47% 26.03% 4 4Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents 54.02% 11.43% 0.33% 4 4


Colorectal Cancer Screening14 26.16% 22.02% 25.94% 3 3Childhood Immunization Status8 46.67% 21.62% 4.67% 4 4Screening for Clinical Depression and Follow-Up Plan15 5.12% 13.00% 30.73% 4 4Dental Sealants for Children between 6-9 Years16 - 35.71% 33.10% 3 3Chronic Disease ManagementUse of Appropriate Medications for Asthma17 61.48% 90.00% 73.87% - 4Coronary Artery Disease (CAD): Lipid Therapy 74.79% 70.33% 77.65% 3 3Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic 70.81% 75.14% 66.78% 3 4



HIV Linkage to Care - 100.00% 100.00% - -






2014 2015 2016




Services (% of patients)Medical 62.73% 57.81% 57.80%Dental 47.58% 52.56% 62.39%Mental Health 6.33% 6.96% 6.86%Substance Abuse - - 1.15%Vision 2.05% 2.47% 1.44%Enabling 0.00% 1.07% 2.78%


2014 2015 2016


Adjusted Quartile

Ranking7

2014 2015 2016 2015 2016



Colorectal Cancer Screening14 43.88% 46.54% 55.73% 2 1Childhood Immunization Status8 81.55% 78.18% 13.95% 2 4Screening for Clinical Depression and Follow-Up Plan15 71.46% 91.29% 89.87% 1 1Dental Sealants for Children between 6-9 Years16 - 95.10% 38.97% 1 3Chronic Disease ManagementUse of Appropriate Medications for Asthma17 94.16% 96.63% 94.19% 1 1Coronary Artery Disease (CAD): Lipid Therapy 85.37% 77.78% 79.45% - 3Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic 84.02% 83.42% 83.55% 2 2



HIV Linkage to Care - - - - -






2014 2015 2016




Services (% of patients)Medical 44.84% 37.05% 31.58%Dental 26.65% 35.15% 53.68%Mental Health 37.51% 41.37% 32.36%Substance Abuse 0.00% - 0.00%Vision 0.00% 0.00% 0.00%Enabling 0.00% 0.00% 0.00%


2014 2015 2016


Adjusted Quartile

Ranking7

2014 2015 2016 2015 2016

Quality of Care MeasuresPerinatal HealthAccess to Prenatal Care (First Prenatal Visit in 1st Trimester) 61.90% 93.75% 92.86% - -Low Birth Weight - 0.00% 0.00% - -Preventive Health Screening & ServicesCervical Cancer Screening12 13.45% 18.37% 45.82% 4 2Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents 0.00% 18.09% 9.52% 4 4


Colorectal Cancer Screening14 38.57% 30.79% 36.71% 3 2Childhood Immunization Status8 45.83% 42.86% 9.09% - 4Screening for Clinical Depression and Follow-Up Plan15 34.29% 63.37% 55.61% 2 3Dental Sealants for Children between 6-9 Years16 - 70.94% 41.57% 1 3

Chronic Disease ManagementUse of Appropriate Medications for Asthma17 78.57% 80.00% 72.73% - -Coronary Artery Disease (CAD): Lipid Therapy 72.86% 87.65% 82.98% 1 2Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic 79.63% 67.61% 55.29% 4 4




Cost DataHealth Center Service Grant Expenditures $922,304 $1,846,749 $1,781,007 Total Cost $4,002,024 $5,525,017 $7,608,478 Total Cost Per Patient $494.08 $607.68 $675.47





2014 2015 2016


Patient CharacteristicsIncome Status (% of patients with known income)Patients at or below 200% of poverty 98.75% 98.73% 97.99%Patients at or below 100% of poverty 84.79% 85.49% 84.20%Insurance Status (% of total patients)Uninsured 19.48% 14.79% 11.41%Children Uninsured (age 0-17 years) 6.02% 4.22% 3.01%Medicaid/CHIP2 55.35% 56.05% 55.90%Medicare 11.36% 11.36% 8.80%Dually Eligible (Medicare and Medicaid) - 7.64% 5.87%Other Third Party 13.81% 17.80% 23.88%Special PopulationsHomeless 1.42% 1.40% 1.47%Agricultural Worker - 0.00% 0.00%Public Housing3 0.00% 0.00% 0.00%School Based 0.00% 0.00% 0.00%Veterans 1.77% 2.16% 1.87%




2014 2015 2016


Adjusted Quartile

Ranking7

2014 2015 2016 2015 2016

Quality of Care MeasuresPerinatal HealthAccess to Prenatal Care (First Prenatal Visit in 1st Trimester) 100.00% 78.13% 90.48% 3 -Low Birth Weight 100.00% 18.75% 14.29% - -Preventive Health Screening & ServicesCervical Cancer Screening12 42.86% 52.06% 51.83% 2 2Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents 62.86% 57.35% 69.61% 2 2


Colorectal Cancer Screening14 30.00% 26.84% 41.26% 3 2Childhood Immunization Status8 77.14% 87.30% 52.10% 1 1Screening for Clinical Depression and Follow-Up Plan15 38.57% 47.93% 71.53% 3 2Dental Sealants for Children between 6-9 Years16 - 45.42% 41.12% 2 3

Chronic Disease ManagementUse of Appropriate Medications for Asthma17 90.00% 100.00% 93.68% 1 2Coronary Artery Disease (CAD): Lipid Therapy 68.75% 76.81% 86.11% 3 2Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic 62.86% 85.48% 81.46% 2 2




Cost DataHealth Center Service Grant Expenditures $1,526,070 $2,533,010 $3,307,797 Total Cost $17,305,680 $20,783,631 $27,786,647 Total Cost Per Patient $1,033.42 $974.16 $1,075.29





2014 2015 2016

Age and Race/EthnicityTotal Patients 14,460 14,136 14,457Age (% of total patients)Children (< 18 years old) 39.29% 40.49% 35.53%Adult (18 - 64) 46.54% 45.43% 50.63%Older Adults (age 65 and over) 14.18% 14.08% 13.85%Patients By Race & Ethnicity (% known)Non-Hispanic White 89.64% 89.17% 89.59%Racial and/or Ethnic Minority 10.70% 10.92% 10.52%Hispanic/Latino Ethnicity 1.94% 2.21% 2.11%Black/African American1 7.51% 8.11% 7.71%Asian1 0.43% 0.43% 0.44%American Indian/Alaska Native1 0.23% 0.00% 0.00%Native Hawaiian / Other Pacific Islander1 0.02% 0.05% 0.02%More than one race1 0.82% 0.26% 0.31%Language (% known)Best Served in another language - 0.04% 0.03%



Services (% of patients) 2014 2015 2016

Medical 45.57% 42.93% 42.73%Dental 60.80% 62.93% 63.99%Mental Health 1.01% 1.34% 1.42%Substance Abuse - - -Vision - - -Enabling 0.95% 1.40% 1.28%


2014 2015 2016


Adjusted Quartile

Ranking7

2014 2015 2016 2015 2016

Quality of Care MeasuresPerinatal HealthAccess to Prenatal Care (First Prenatal Visit in 1st Trimester) 100.00% 100.00% 100.00% - -Low Birth Weight 0.00% - 7.14% - -Preventive Health Screening & ServicesCervical Cancer Screening12 29.73% 37.21% 41.68% 3 3Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents 50.93% 97.80% 98.77% 1 1


Colorectal Cancer Screening14 29.60% 49.65% 46.87% 1 2Childhood Immunization Status8 72.55% 74.29% 13.64% 2 -Screening for Clinical Depression and Follow-Up Plan15 12.23% 67.81% 90.66% 2 1Dental Sealants for Children between 6-9 Years16 - 98.72% 99.84% 1 1

Chronic Disease ManagementUse of Appropriate Medications for Asthma17 79.52% 100.00% 100.00% - 1Coronary Artery Disease (CAD): Lipid Therapy 84.21% 78.85% 72.45% 2 4Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic 82.19% 80.95% 83.75% 2 2









2014 2015 2016

Age and Race/EthnicityTotal Patients 7,441 8,626 9,900

Age (% of total patients)Children (< 18 years old) 36.82% 37.58% 36.05%Adult (18 - 64) 51.77% 50.50% 51.16%Older Adults (age 65 and over) 11.41% 11.92% 12.79%Patients By Race & Ethnicity (% known)Non-Hispanic White 97.29% 97.99% 97.65%Racial and/or Ethnic Minority 2.79% 2.53% 2.37%Hispanic/Latino Ethnicity 0.85% 1.43% 1.06%Black/African American1 0.49% 0.30% 0.37%Asian1 0.22% 0.21% 0.14%American Indian/Alaska Native1 0.32% 0.38% 0.19%Native Hawaiian / Other Pacific Islander1 0.09% 0.04% 0.04%More than one race1 1.35% 0.42% 0.58%Language (% known)Best Served in another language 0.19% 0.08% 0.01%




Medical 75.26% 70.29% 69.74%Dental 36.12% 39.31% 43.01%Mental Health 1.16% 2.41% 4.13%Substance Abuse 0.00% - 0.00%Vision 0.00% - 0.00%Enabling 0.00% - 0.00%


2014 2015 2016


Adjusted Quartile

Ranking7

2014 2015 2016 2015 2016







HIV Linkage to Care - 100.00% - - -






2014 2015 2016

Age and Race/EthnicityTotal Patients 20,048 20,166 20,580

Age (% of total patients)Children (< 18 years old) 40.75% 41.28% 40.05%Adult (18 - 64) 54.31% 53.62% 53.80%Older Adults (age 65 and over) 4.94% 5.10% 6.15%Patients By Race & Ethnicity (% known)Non-Hispanic White 47.96% 44.86% 41.91%Racial and/or Ethnic Minority 52.11% 55.32% 58.22%Hispanic/Latino Ethnicity 9.52% 10.14% 9.22%Black/African American1 34.74% 36.61% 39.38%Asian1 4.60% 5.25% 6.41%American Indian/Alaska Native1 1.12% 1.14% 1.22%Native Hawaiian / Other Pacific Islander1 0.11% 0.12% 0.11%More than one race1 3.76% 3.89% 3.55%Language (% known)Best Served in another language 11.66% 13.40% 14.89%




Medical 80.67% 80.24% 81.46%Dental 20.65% 22.22% 21.46%Mental Health 7.64% 11.35% 11.88%Substance Abuse 0.00% 0.00% 0.00%Vision 7.58% 7.01% 6.29%Enabling 3.17% 1.56% 1.33%


2014 2015 2016


Adjusted Quartile

Ranking7

2014 2015 2016 2015 2016













2014 2015 2016







2014 2015 2016


Adjusted Quartile

Ranking7

2014 2015 2016 2015 2016




Chronic Disease ManagementUse of Appropriate Medications for Asthma17 74.29% 88.89% 96.77% 2 1Coronary Artery Disease (CAD): Lipid Therapy 81.25% 58.57% 90.91% 4 1Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic 94.29% 87.14% 87.05% 2 1Controlling High Blood Pressure (Hypertensive Patients with Blood Pressure < 140/90)18 58.57% 74.29% 64.90% 1 2Diabetes: Hemoglobin A1c Poor Control (Diabetic Patients with HbA1c > 9%) or No Test During Year19 24.29% 27.14% 25.00% 2 1HIV Linkage to Care 100.00% - 100.00% - -




FORDLAND CLINIC

2014 2015 2016

Age and Race/EthnicityTotal Patients - 7,459 8,558Age (% of total patients)Children (< 18 years old) - 41.19% 43.21%Adult (18 - 64) - 46.56% 43.47%Older Adults (age 65 and over) - 12.25% 13.32%Patients By Race & Ethnicity (% known)Non-Hispanic White - 96.19% 95.96%Racial and/or Ethnic Minority - 4.01% 4.33%Hispanic/Latino Ethnicity - 2.04% 2.33%Black/African American1 - 0.64% 0.59%Asian1 - 0.27% 0.29%American Indian/Alaska Native1 - 0.34% 0.35%Native Hawaiian / Other Pacific Islander1 - 0.10% 0.13%More than one race1 - 0.75% 0.84%Language (% known)Best Served in another language - 0.16% 0.12%

Patient CharacteristicsIncome Status (% of patients with known income)Patients at or below 200% of poverty - 81.01% 79.19%Patients at or below 100% of poverty - 50.01% 47.81%Insurance Status (% of total patients)Uninsured - 28.97% 33.83%Children Uninsured (age 0-17 years) - 22.07% 29.26%Medicaid/CHIP2 - 33.14% 32.64%Medicare - 13.46% 12.37%Dually Eligible (Medicare and Medicaid) - 1.39% 1.27%Other Third Party - 24.43% 21.16%Special PopulationsHomeless - 0.05% 0.19%Agricultural Worker - 0.03% 0.04%Public Housing3 - - 0.00%School Based - 9.71% 12.27%Veterans - 2.36% 3.73%

Gender of Patients by AgeWomen’s Data (% of total women)Women’s Health (ages 15-44) - 35.95% 34.39%Patients Under 15 Who are Female - 30.89% 31.45%Patients 15-64 Who are Female - 56.43% 54.87%Patients 65 and Over Who are Female - 12.68% 13.68%Men’s Data (% of total men)Men’s Health (ages 15-44) - 29.24% 28.31%Patients Under 15 Who are Male - 39.49% 40.37%Patients 15-64 Who are Male - 48.77% 46.73%Patients 65 and Over Who are Male - 11.74% 12.90%

Services (% of patients)Medical - 56.25% 53.38%Dental - 49.63% 53.39%Mental Health - 1.23% 1.25%Substance Abuse - 0.00% -Vision - - -Enabling - 1.42% 0.85%


2014 2015 2016

Clinical DataMedical Conditions (% of Patients with Medical Conditions)Hypertension4 - 18.66% 29.77%Diabetes5 - 7.80% 12.94%Asthma - 4.84% 3.06%HIV - 0.05% 0.00%PrenatalPrenatal Patients6 - 48 36Prenatal Patients who Delivered - 25 25

Adjusted Quartile

Ranking7

2014 2015 2016 2015 2016

Quality of Care MeasuresPerinatal HealthAccess to Prenatal Care (First Prenatal Visit in 1st Trimester) - 29.17% 97.22% 4 1Low Birth Weight - 0.00% 0.00% - -Preventive Health Screening & ServicesCervical Cancer Screening12 - 15.52% 50.35% 4 2Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents - 96.75% 82.90% 1 1

Body Mass Index (BMI) Screening and Follow-Up - 90.40% 95.80% 1 1Adults Screened for Tobacco Use and Receiving Cessation Intervention13 - 48.88% 82.19% 4 3

Colorectal Cancer Screening14 - 23.03% 75.18% 3 1Childhood Immunization Status8 - 21.57% 4.11% 4 4Screening for Clinical Depression and Follow-Up Plan15 - 43.55% 58.01% 3 3Dental Sealants for Children between 6-9 Years16 - 8.57% 75.69% 4 1

Chronic Disease ManagementUse of Appropriate Medications for Asthma17 - 56.52% 100.00% 4 -Coronary Artery Disease (CAD): Lipid Therapy - 76.19% 65.91% - 4Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic - 72.86% 64.96% 3 4

Controlling High Blood Pressure (Hypertensive Patients with Blood Pressure < 140/90)18 - 56.29% 61.66% 4 3

Diabetes: Hemoglobin A1c Poor Control (Diabetic Patients with HbA1c > 9%) or No Test During Year19 - 24.16% 39.29% 2 4


Cost DataHealth Center Service Grant Expenditures $987,654,321 $291,688 $629,006 Total Cost $987,654,321 $2,816,772 $4,139,254 Total Cost Per Patient $987,654,321.00 $377.63 $483.67

FORDLAND CLINIC




2014 2015 2016


Patient CharacteristicsIncome Status (% of patients with known income)Patients at or below 200% of poverty 98.08% 97.95% 97.89%Patients at or below 100% of poverty 68.51% 68.69% 68.64%Insurance Status (% of total patients)Uninsured 30.45% 32.08% 33.31%Children Uninsured (age 0-17 years) 2.52% 2.67% 3.00%Medicaid/CHIP2 37.85% 39.94% 38.94%Medicare 11.71% 7.00% 7.38%Dually Eligible (Medicare and Medicaid) - 0.23% 0.21%Other Third Party 19.98% 20.98% 20.36%Special PopulationsHomeless 0.14% 0.18% 0.02%Agricultural Worker 0.00% 0.00% -Public Housing3 0.00% 0.00% 0.00%School Based 0.00% 0.00% -Veterans 1.05% 1.10% 1.09%


Services (% of patients)Medical 40.78% 38.85% 35.87%Dental 66.85% 67.29% 65.48%Mental Health 0.00% 0.00% 0.25%Substance Abuse 0.00% 0.00% -Vision 0.00% 0.00% -Enabling 0.00% 0.00% -


2014 2015 2016


Adjusted Quartile

Ranking7

2014 2015 2016 2015 2016













2014 2015 2016




Services (% of patients)Medical 70.19% 56.64% 53.58%Dental 59.12% 40.43% 52.29%Mental Health 4.84% 2.92% 3.40%Substance Abuse 0.00% 0.00% 0.00%Vision 0.00% 0.00% 0.00%Enabling - 0.00% 0.00%



2014 2015 2016


Adjusted Quartile

Ranking7

2014 2015 2016 2015 2016

Quality of Care MeasuresPerinatal HealthAccess to Prenatal Care (First Prenatal Visit in 1st Trimester) - 66.67% 87.50% - -Low Birth Weight - - - - -Preventive Health Screening & ServicesCervical Cancer Screening12 38.44% 54.65% 41.19% 2 3Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents 0.00% 0.24% 53.56% 4 3


Colorectal Cancer Screening14 4.63% 26.26% 21.16% 3 4Childhood Immunization Status8 0.00% 56.25% 3.85% - -Screening for Clinical Depression and Follow-Up Plan15 18.82% 63.27% 88.95% 2 1Dental Sealants for Children between 6-9 Years16 - 9.72% 58.57% 4 2Chronic Disease ManagementUse of Appropriate Medications for Asthma17 86.27% 86.79% 100.00% 3 -Coronary Artery Disease (CAD): Lipid Therapy 84.62% 66.67% 83.33% - -Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic 77.27% 64.86% 76.47% 4 3




Cost DataHealth Center Service Grant Expenditures $934,630 $1,170,777 $2,059,779 Total Cost $1,673,237 $3,691,124 $5,303,163 Total Cost Per Patient $609.11 $1,068.34 $1,080.73




2014 2015 2016

Age and Race/EthnicityTotal Patients - 4,582 5,958Age (% of total patients)Children (< 18 years old) - 0.76% 1.88%Adult (18 - 64) - 94.91% 93.49%Older Adults (age 65 and over) - 4.32% 4.63%Patients By Race & Ethnicity (% known)Non-Hispanic White - 43.24% 43.41%Racial and/or Ethnic Minority - 59.54% 58.41%Hispanic/Latino Ethnicity - 13.95% 13.34%Black/African American1 - 46.06% 43.35%Asian1 - 1.76% 1.83%American Indian/Alaska Native1 - 0.91% 1.10%Native Hawaiian / Other Pacific Islander1 - 0.20% 1.44%More than one race1 - 0.27% 1.00%Language (% known)Best Served in another language - 2.10% 6.98%

Patient CharacteristicsIncome Status (% of patients with known income)Patients at or below 200% of poverty - 94.37% 90.72%Patients at or below 100% of poverty - 78.75% 71.08%Insurance Status (% of total patients)Uninsured - 73.79% 66.92%Children Uninsured (age 0-17 years) - 60.00% 65.18%Medicaid/CHIP2 - 5.59% 6.50%Medicare - 3.86% 5.57%Dually Eligible (Medicare and Medicaid) - 0.96% 2.92%Other Third Party - 16.76% 21.01%Special PopulationsHomeless - 0.44% 16.20%Agricultural Worker - 0.00% 0.65%Public Housing3 - 0.00% 0.00%School Based - 0.00% 0.00%Veterans - 0.00% 0.79%

Gender of Patients by AgeWomen’s Data (% of total women)Women’s Health (ages 15-44) - 53.03% 53.71%Patients Under 15 Who are Female - 0.65% 1.30%Patients 15-64 Who are Female - 94.93% 94.13%Patients 65 and Over Who are Female - 4.42% 4.57%Men’s Data (% of total men)Men’s Health (ages 15-44) - 53.33% 54.31%Patients Under 15 Who are Male - 0.49% 1.76%Patients 15-64 Who are Male - 95.28% 93.56%Patients 65 and Over Who are Male - 4.23% 4.68%

Services (% of patients)Medical - 90.75% 84.09%Dental - 13.66% 11.25%Mental Health - 18.97% 25.31%Substance Abuse - 0.72% 0.50%Vision - 0.00% 0.05%Enabling - 13.40% 19.67%



2014 2015 2016

Clinical DataMedical Conditions (% of Patients with Medical Conditions)Hypertension4 - 20.72% 18.57%Diabetes5 - 10.92% 11.02%Asthma - 4.09% 4.07%HIV - 18.11% 21.60%PrenatalPrenatal Patients6 - 1 3Prenatal Patients who Delivered - 0 2

Adjusted Quartile

Ranking7

2014 2015 2016 2015 2016

Quality of Care MeasuresPerinatal HealthAccess to Prenatal Care (First Prenatal Visit in 1st Trimester) - 100.00% 100.00% - -Low Birth Weight - - 0.00% - -Preventive Health Screening & ServicesCervical Cancer Screening12 - 30.69% 35.03% 4 3Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents - 53.85% 28.26% - 4

Body Mass Index (BMI) Screening and Follow-Up - 28.57% 41.76% 4 3Adults Screened for Tobacco Use and Receiving Cessation Intervention13 - 75.59% 71.80% 3 4

Colorectal Cancer Screening14 - 7.39% 14.19% 4 3Childhood Immunization Status8 - 0.00% 0.00% - -Screening for Clinical Depression and Follow-Up Plan15 - 67.85% 77.83% 2 2Dental Sealants for Children between 6-9 Years16 - - - - -

Chronic Disease ManagementUse of Appropriate Medications for Asthma17 - 72.22% 98.82% 4 1Coronary Artery Disease (CAD): Lipid Therapy - 64.00% 72.73% - 4Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic - 75.32% 81.33% 2 2

Controlling High Blood Pressure (Hypertensive Patients with Blood Pressure < 140/90)18 - 42.62% 42.43% 4 4

Diabetes: Hemoglobin A1c Poor Control (Diabetic Patients with HbA1c > 9%) or No Test During Year19 - 27.01% 33.09% 1 2

HIV Linkage to Care - 100.00% 100.00% - -

Cost DataHealth Center Service Grant Expenditures $987,654,321 $231,754 $966,909 Total Cost $987,654,321 $8,575,970 $11,103,106 Total Cost Per Patient $987,654,321.00 $1,871.67 $1,863.56




2014 2015 2016






2014 2015 2016


Adjusted Quartile

Ranking7

2014 2015 2016 2015 2016













2014 2015 2016


Patient CharacteristicsIncome Status (% of patients with known income)Patients at or below 200% of poverty 96.68% 96.15% 97.00%Patients at or below 100% of poverty 54.19% 52.50% 53.83%Insurance Status (% of total patients)Uninsured 16.71% 14.68% 13.21%Children Uninsured (age 0-17 years) 11.52% 9.94% 5.37%Medicaid/CHIP2 28.31% 28.65% 30.97%Medicare 9.56% 10.01% 10.70%Dually Eligible (Medicare and Medicaid) - - 3.23%Other Third Party 45.42% 46.67% 45.12%Special PopulationsHomeless 0.37% 0.38% 0.50%Agricultural Worker 0.56% 0.53% 0.42%Public Housing3 0.00% 2.30% 2.27%School Based 0.26% - 0.00%Veterans 14.26% 12.60% 11.27%


Services (% of patients)Medical 78.04% 80.22% 77.83%Dental 29.95% 28.86% 33.14%Mental Health 3.42% 1.79% 0.63%Substance Abuse 0.00% - 0.00%Vision 0.00% - 0.00%Enabling 0.00% - 0.00%



2014 2015 2016


Adjusted Quartile

Ranking7

2014 2015 2016 2015 2016







HIV Linkage to Care 0.00% - - - -





2014 2015 2016




Services (% of patients)Medical 76.70% 75.71% 68.68%Dental 29.42% 30.74% 36.79%Mental Health 6.53% 6.36% 7.49%Substance Abuse - 0.00% -Vision - 0.00% -Enabling 3.88% 4.03% 3.80%


2014 2015 2016


Adjusted Quartile

Ranking7

2014 2015 2016 2015 2016

Quality of Care MeasuresPerinatal HealthAccess to Prenatal Care (First Prenatal Visit in 1st Trimester) - 100.00% 61.54% - -Low Birth Weight - - 14.29% - -Preventive Health Screening & ServicesCervical Cancer Screening12 21.59% 33.34% 42.08% 3 3Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents 23.62% 31.44% 53.62% 3 3






HIV Linkage to Care 12.50% 50.00% - - -






2014 2015 2016







Adjusted Quartile

Ranking7

2014 2015 2016 2015 2016













2014 2015 2016




Services (% of patients)Medical 96.85% 99.24% 63.10%Dental 26.65% 26.64% 57.02%Mental Health 11.10% 11.65% 7.68%Substance Abuse - 0.00% 0.00%Vision 0.00% 0.00% 0.00%Enabling 0.00% 0.00% 0.00%


2014 2015 2016


Adjusted Quartile

Ranking7

2014 2015 2016 2015 2016



Colorectal Cancer Screening14 33.01% 33.17% 40.10% 3 2Childhood Immunization Status8 82.61% 64.71% 28.21% - 2Screening for Clinical Depression and Follow-Up Plan15 49.43% 51.00% 83.08% 2 1Dental Sealants for Children between 6-9 Years16 - 27.66% 20.25% 4 4

Chronic Disease ManagementUse of Appropriate Medications for Asthma17 81.25% 100.00% 80.00% - -Coronary Artery Disease (CAD): Lipid Therapy 76.83% 70.97% 67.57% 3 4Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic 87.86% 87.56% 81.69% 1 2









2014 2015 2016

Age and Race/EthnicityTotal Patients 1,505 3,246 5,711Age (% of total patients)Children (< 18 years old) 28.31% 46.00% 38.78%Adult (18 - 64) 66.11% 50.28% 55.66%Older Adults (age 65 and over) 5.58% 3.73% 5.55%Patients By Race & Ethnicity (% known)Non-Hispanic White 90.65% 89.69% 87.38%Racial and/or Ethnic Minority 9.71% 10.59% 13.17%Hispanic/Latino Ethnicity 1.26% 1.45% 2.02%Black/African American1 7.41% 7.50% 8.45%Asian1 0.24% 0.28% 0.33%American Indian/Alaska Native1 0.73% 0.21% 0.29%Native Hawaiian / Other Pacific Islander1 0.16% 0.07% 0.10%More than one race1 - 1.19% 2.30%Language (% known)Best Served in another language 0.47% 0.03% 1.02%

Patient CharacteristicsIncome Status (% of patients with known income)Patients at or below 200% of poverty 96.86% 98.76% 99.40%Patients at or below 100% of poverty 87.77% 90.81% 92.22%Insurance Status (% of total patients)Uninsured 26.84% 18.45% 12.99%Children Uninsured (age 0-17 years) 22.54% 6.97% 6.14%Medicaid/CHIP2 34.09% 49.88% 63.39%Medicare 22.52% 15.00% 13.96%Dually Eligible (Medicare and Medicaid) - 9.86% 9.81%Other Third Party 16.54% 16.67% 9.67%Special PopulationsHomeless 0.73% 0.68% 3.15%Agricultural Worker 0.20% 0.15% 0.12%Public Housing3 - 0.49% 27.82%School Based 0.00% 0.00% 0.00%Veterans 0.33% 0.09% 0.56%


Services (% of patients)Medical 19.93% 32.19% 45.88%Dental 23.65% 38.08% 62.21%Mental Health 66.51% 45.35% 27.95%Substance Abuse - - -Vision - - -Enabling - - -


Clinical DataMedical Conditions (% of Patients with Medical Conditions)Hypertension4 5.61% 11.03% 10.38%Diabetes5 6.64% 7.22% 7.38%Asthma 5.67% 5.45% 2.18%HIV 0.00% 0.19% 0.11%PrenatalPrenatal Patients6 0 3 2Prenatal Patients who Delivered - 0 -

Adjusted Quartile

Ranking7

2014 2015 2016 2015 2016

Quality of Care MeasuresPerinatal HealthAccess to Prenatal Care (First Prenatal Visit in 1st Trimester) - 100.00% 100.00% - -Low Birth Weight - - - - -Preventive Health Screening & ServicesCervical Cancer Screening12 62.86% 20.00% 31.03% 4 4Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents 15.63% 40.00% 50.10% 3 3


Colorectal Cancer Screening14 20.00% 14.29% 15.49% 4 4Childhood Immunization Status8 - 33.33% 26.67% - -Screening for Clinical Depression and Follow-Up Plan15 65.71% 84.29% 76.61% 1 2Dental Sealants for Children between 6-9 Years16 - 67.14% 69.82% 1 1

Chronic Disease ManagementUse of Appropriate Medications for Asthma17 - - 100.00% - -Coronary Artery Disease (CAD): Lipid Therapy - 100.00% 88.89% - -Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic - 94.12% 96.55% - -




Cost DataHealth Center Service Grant Expenditures $810,083 $882,357 $2,616,045 Total Cost $2,145,316 $4,838,970 $6,052,837 Total Cost Per Patient $1,425.46 $1,490.75 $1,059.86





2014 2015 2016


Patient CharacteristicsIncome Status (% of patients with known income)Patients at or below 200% of poverty 99.59% 96.40% 92.82%Patients at or below 100% of poverty 66.29% 66.54% 58.57%Insurance Status (% of total patients)Uninsured 19.58% 20.94% 19.74%Children Uninsured (age 0-17 years) 4.44% 8.54% 7.11%Medicaid/CHIP2 51.10% 49.56% 50.04%Medicare 9.00% 9.97% 8.41%Dually Eligible (Medicare and Medicaid) - 3.82% 3.06%Other Third Party 20.31% 19.54% 21.81%Special PopulationsHomeless 0.08% 1.43% 0.88%Agricultural Worker 0.00% 0.00% 0.00%Public Housing3 0.76% 0.95% 0.00%School Based - 0.00% 0.00%Veterans 0.41% 0.36% 0.30%


Services (% of patients)Medical 59.92% 63.18% 59.39%Dental 49.46% 48.04% 54.12%Mental Health 4.38% 4.59% 5.31%Substance Abuse 0.00% - 0.00%Vision 0.79% 0.56% 0.25%Enabling 35.30% 15.89% 10.58%


2014 2015 2016


Adjusted Quartile

Ranking7

2014 2015 2016 2015 2016

Quality of Care MeasuresPerinatal HealthAccess to Prenatal Care (First Prenatal Visit in 1st Trimester) 88.64% 97.33% 91.67% 1 -Low Birth Weight 0.00% 0.00% 12.50% 1 -Preventive Health Screening & ServicesCervical Cancer Screening12 61.81% 60.02% 53.81% 1 2Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents 41.76% 54.75% 80.08% 2 1












2014 2015 2016







2014 2015 2016


Adjusted Quartile

Ranking7

2014 2015 2016 2015 2016












2014 2015 2016






2014 2015 2016


Adjusted Quartile

Ranking7

2014 2015 2016 2015 2016




Chronic Disease ManagementUse of Appropriate Medications for Asthma17 74.65% 100.00% 73.49% - 4Coronary Artery Disease (CAD): Lipid Therapy 67.92% 65.52% 74.55% - 3Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic 73.84% 83.87% 80.52% 2 2









2014 2015 2016




Services (% of patients)Medical 70.63% 70.23% 70.97%Dental 41.71% 40.64% 41.01%Mental Health 3.85% 4.44% 3.83%Substance Abuse 1.69% 1.71% 0.20%Vision - 0.00% 0.00%Enabling 0.58% 2.11% 1.97%



2014 2015 2016


Adjusted Quartile

Ranking7

2014 2015 2016 2015 2016







HIV Linkage to Care - - 60.00% - -





2014 2015 2016


Patient CharacteristicstIncome Status (% of patients with known income)Patients at or below 200% of poverty 99.74% 100.00% 100.00%Patients at or below 100% of poverty 77.31% 76.22% 71.46%Insurance Status (% of total patients)Uninsured 57.06% 45.35% 39.03%Children Uninsured (age 0-17 years) 17.41% 16.42% 16.67%Medicaid/CHIP2 24.58% 26.72% 31.20%Medicare 6.57% 7.14% 7.26%Dually Eligible (Medicare and Medicaid) - 3.31% 3.34%Other Third Party 11.79% 20.78% 22.51%Special PopulationsHomeless - 0.73% 0.62%Agricultural Worker - 0.00% 0.06%Public Housing3 - 0.00% 0.00%School Based - 0.00% 0.00%Veterans - 1.08% 0.94%


Services (% of patients)Medical 82.77% 78.87% 77.03%Dental 14.83% 16.82% 21.57%Mental Health 14.62% 18.03% 14.45%Substance Abuse - 0.00% -Vision - 0.00% -Enabling 1.20% - -



2014 2015 2016

Clinical DataMedical Conditions (% of Patients with Medical Conditions)Hypertension4 9.07% 24.07% 36.84%Diabetes5 12.31% 14.09% 14.05%Asthma 5.97% 6.44% 5.05%HIV 0.00% 0.05% 0.08%PrenatalPrenatal Patients6 0 0 4Prenatal Patients who Delivered - 0 0

Adjusted Quartile

Ranking7

2014 2015 2016 2015 2016

Quality of Care MeasuresPerinatal HealthAccess to Prenatal Care (First Prenatal Visit in 1st Trimester) - - 75.00% - -Low Birth Weight - - - - -Preventive Health Screening & ServicesCervical Cancer Screening12 15.26% 19.11% 22.21% 4 4Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents 0.00% 0.71% 40.83% 4 3


Colorectal Cancer Screening14 16.67% 24.12% 6.92% 3 4Childhood Immunization Status8 - 0.00% 27.78% - -Screening for Clinical Depression and Follow-Up Plan15 62.41% 50.84% 80.79% 2 1Dental Sealants for Children between 6-9 Years16 - 0.00% 68.33% 4 1

Chronic Disease ManagementUse of Appropriate Medications for Asthma17 35.00% 64.86% 92.31% 4 -Coronary Artery Disease (CAD): Lipid Therapy 28.57% 64.86% 81.82% 4 -Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic 95.83% 78.46% 71.88% 3 4




Cost DataHealth Center Service Grant Expenditures $865,556 $926,081 $1,383,865 Total Cost $1,278,431 $1,686,245 $2,503,107 Total Cost Per Patient $902.85 $725.58 $810.85




2014 2015 2016

Age and Race/EthnicityTotal Patients 16,512 15,491 15,668Age (% of total patients)Children (< 18 years old) 37.07% 42.31% 40.06%Adult (18 - 64) 53.85% 49.14% 50.90%Older Adults (age 65 and over) 9.08% 8.55% 9.04%Patients By Race & Ethnicity (% known)Non-Hispanic White 70.57% 68.32% 68.67%Racial and/or Ethnic Minority 29.67% 31.90% 31.68%Hispanic/Latino Ethnicity 6.77% 6.96% 6.42%Black/African American1 20.85% 22.67% 23.10%Asian1 0.41% 0.41% 0.38%American Indian/Alaska Native1 0.08% 0.09% 0.11%Native Hawaiian / Other Pacific Islander 1 0.56% 0.55% 0.51%More than one race 1 1.69% 1.90% 1.82%Language (% known)Best Served in another language 3.88% 3.77% 3.75%





2014 2015 2016


Adjusted Quartile

Ranking7

2014 2015 2016 2015 2016

Quality of Care MeasuresPerinatal HealthAccess to Prenatal Care (First Prenatal Visit in 1st Trimester) 100.00% 100.00% 100.00% - -Low Birth Weight - 0.00% 40.00% - -Preventive Health Screening & ServicesCervical Cancer Screening12 35.15% 38.68% 50.84% 3 2Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents 19.23% 24.67% 56.98% 4 3






HIV Linkage to Care 66.67% - 0.00% - -






2014 2015 2016






2014 2015 2016


Adjusted Quartile

Ranking7

2014 2015 2016 2015 2016



Colorectal Cancer Screening14 2.99% 10.07% 16.03% 4 4Childhood Immunization Status8 55.14% 57.78% 11.55% 4 4Screening for Clinical Depression and Follow-Up Plan15 55.71% 73.16% 77.05% 1 2Dental Sealants for Children between 6-9 Years16 - 100.00% 20.14% - 4





Cost DataHealth Center Service Grant Expenditures $8,448,006 $9,090,746 $10,204,052 Total Cost $41,333,454 $43,119,156 $44,576,000 Total Cost Per Patient $1,042.38 $1,098.21 $1,114.29




‘-’ - Data Cannot be Calculated

1 Includes Hispanic/Latino and Non-Hispanic/Latino. 2 Includes Medicaid, Medicaid CHIP and Other Public Insurance CHIP. 3 Measure revised in 2014 UDS to include patients served in health centers with and without Public Housing Primary Care funding. 4 Hypertensive adults as a percent of estimated adult medical patients of ages 18-85. 5 Diabetic adults as a percent of estimated adult medical patients of ages 18-75. 6 All health centers who provide prenatal care directly or by referral are included in the prenatal care calculations, effective 2014. 7 Adjusted Quartile Rankings: Provides a health center’s adjusted quartile ranking compared to health centers nationally for each

of the clinical performance measures. Clinical performance for each measure is ranked from quartile 1 (highest 25% of reporting health center) to quartile 4 (lowest 25% of reporting health centers). Adjusted quartile ranking is not calculated when there are fewer than 30 patients in the universe count. To learn more about the Health Center Adjusted Quartile Ranking please refer to https://bphc.hrsa.gov/datareporting/reporting/ranking.html and for FAQ’s please refer to https://bphc.hrsa.gov/datareporting/

8 Childhood Immunization Status: Change to the denominator: Children 2 years of age (previously 3 years of age). Change to the exclusions criteria: No longer permits exclusion of patients not seen ever prior to turning 2. Change to the numerator: Adds 1 Hepatitis A (Hep A), 2 or 3 rotavirus (RV), and 2 influenza (flu) vaccines. See https://ecqi.healthit.gov/ecqm/measures/cms117v4

9 Measure changed in 2015 to address uncontrolled diabetes for patients with Hba1c > 9. 10 Program conditions are based on non-compliance with Health Center Program requirements and are updated daily. To learn more

about the Health Center Program requirements, visit https://www.bphc.hrsa.gov/about/requirements/index.html

11 Effective with calendar year 2016 reporting, clinical quality measures were changed to align with the Centers for Medicare & Medicaid Services’ electronic specified clinical quality measures and therefore caution should be used for trends between 2015 and 2016 UDS CQMs. Health centers are encouraged to review the year over year differences before using for comparisons.

12 Cervical Cancer Screening: Change to the denominator: Women age 23 through 64 years (previously age 24 through 64 years). Change to the numerator: No longer includes concurrent human papillomavirus (HPV) and Pap test for those ages 30 and older. See https://ecqi.healthit.gov/ecqm/measures/cms124v4

13 Tobacco Use: Screening and Cessation Intervention: Change to the denominator: Includes patients seen twice for medical care or at least once for a preventive visit. Change to the exclusions criteria: Documentation of medical reason(s) for not screening for tobacco use (e.g., limited life expectancy, other medical reason). See https://ecqi.healthit.gov/ecqm/measures/cms138v4

14 Colorectal Cancer Screening: Change to the denominator: Change to the denominator: Patients age 50 through 75 (previously 51 through 74). Please https://ecqi.healthit.gov/ecqm/measures/cms130v4

15 Screening for Clinical Depression and Follow-Up Plan: Change to the denominator: Do not include patients who refuse to participate, urgent or emergent situations, or if the patient’s functional capacity or motivation to improve impacts the accuracy of results. See https://ecqi.healthit.gov/ecqm/measures/cms002v5

16 The Dental Sealants Screening measure was introduced in 2015 and is not comparable to prior years.

17 Use of Appropriate Medications for Asthma: Change to the denominator: Patients age 5 through 64 years (previously age 5 through 40 years), eligibility not limited to individuals with 2 medical visits ever. Change to the exclusions criteria: Patients with emphysema, chronic obstructive pulmonary disease, cystic fibrosis, or acute respiratory failure during or prior to the measurement period, patients with allergic reactions to asthma medications are no longer excluded from the measure denominator. See https://ecqi.healthit.gov/ecqm/measures/cms126v4

18 Controlling High Blood Pressure: Change to the denominator: Age 18 through 85 years (previously age 18 through 84 years), eligibility no longer limited to patients with at least 2 medical visits during the measurement, must be essential diagnosis. Change to the exclusions criteria: Exclude patients with dialysis or renal transplant before or during the measurement period and chronic kidney disease, Stage 5 (in addition to evidence of end state renal disease), and patients with a diagnosis of pregnancy during the measurement period year. See https://ecqi.healthit.gov/ecqm/measures/cms165v4

19 Diabetes: Hemoglobin A1c Poor Control: Change to the denominator: Age 18 through 75 years (previously age 18 through 74), eligibility no longer limited to patients with at least 2 medical visits during the measurement year. See https://ecqi.healthit.gov/ecqm/measures/cms122v4

* Note: Health center profile data are aggregated to the health center parent organizational level, which may be comprised of multiple service delivery sites.

Footnotes

https://bphc.hrsa.gov/datareporting/reporting/ranking.html

https://bphc.hrsa.gov/datareporting/

https://ecqi.healthit.gov/ecqm/measures/cms117v4

https://www.bphc.hrsa.gov/about/requirements/index.html











Missouri CountiesAdair CountyAndrew CountyAtchison CountyAudrain CountyBarry CountyBarton CountyBates CountyBenton CountyBollinger CountyBoone CountyBuchanan CountyButler CountyCaldwell CountyCallaway CountyCamden CountyCape Girardeau CountyCarroll CountyCarter CountyCass CountyCedar CountyChariton CountyChristian County Clark CountyClay CountyClinton CountyCole CountyCooper CountyCrawford CountyDade CountyDallas County

Daviess CountyDeKalb CountyDent CountyDouglas CountyDunklin CountyFranklin CountyGasconade CountyGentry CountryGreene CountyGrundy CountyHarrison CountyHenry CountyHickory CountyHolt CountyHoward CountyHowell CountyIron CountyJackson CountyJasper CountyJefferson CountyJohnson CountyKnox CountyLaclede CountyLafayette CountyLawrence CountyLewis CountyLincoln CountyLinn CountyLivingston CountyMacon County

Madison CountyMaries CountyMarion CountyMcDonald CountyMercer CountyMiller CountyMississippi CountyMoniteau CountyMonroe CountyMontgomery CountyMorgan CountyNew Madrid CountyNewton CountyNodaway CountyOregon CountyOsage CountyOzark CountyPemiscot CountyPerry CountyPettis CountyPhelps CountyPike CountyPlatte CountyPolk CountyPulaski CountyPutnam CountyRalls CountyRandolph CountyRay CountyReynolds County

Ripley CountySaline CountySchuyler CountyScotland CountyScott CountyShannon CountyShelby CountySt. Charles CountySt. Clair CountySt. FrancoisSt. Louis CountySt. Louis CitySte. Genevieve CountyStoddard CountyStone CountySullivan CountyTaney CountyTexas CountyVernon CountyWarren CountyWashington CountyWayne CountyWebster CountyWorth CountyWright County


ELECTRONIC HEALTH RECORD INCENTIVE PAYMENTSPayments from the Medicare and Medicaid Electronic Health Record Incentive Programs are funded through the American Recovery and Reinvestment Act of 2009. They provide incentives to Eligible Providers (as defined under ARRA) for the adoption, implementation, upgrade and Meaningful Use of certified electronic health records. These payments may be made directly to the clinic’s providers or to their designee — generally the health center. It is presumed that if the payment is made to the employees, these funds will be turned over to the health center. In the event the provider is permitted to retain some or all of these payments as part of their compensation, the amount should still be recorded as an EHR incentive payment, and the amount retained by the provider should be recorded as staff compensation.

EXPENSESAs used in this report, expenses refer to total costs (the terms are synonymous), which is the sum of direct costs plus the allocation of facility and nonclinical support services. To be consistent with all Uniform Data System calculations, which are based on cost, these amounts exclude the value of any donated facilities, services or supplies.

y Medical Services: This category includes costs for medical care personnel, services provided under agreement, laboratory and X-ray (including sonography and mammography), and other direct costs wholly attributable to medical care (e.g., staff recruitment, equipment depreciation, medical supplies, professional dues and subscriptions, continuing medical education, and travel associated with CME). It does not include costs associated with pharmacy, dental care, substance abuse specialists, mental health (psychiatrists, clinical psychologists, clinical social workers, etc.), vision care (ophthalmologists, optometrists, optometric assistants, etc.) or enabling (case management, education specialists, etc.) services. Note that for the purposes of the UDS, psychiatry and ophthalmology are not counted in the medical cost centers.

y Other Clinical Services: This category includes staff and related costs for dental, mental health, substance abuse, pharmacy, vision and services rendered by other professional personnel (e.g., chiropractors, naturopaths, occupational and physical therapists, speech and hearing therapists, and podiatrists).

y Enabling Services: This category includes enabling staff and related costs for case management, outreach, transportation, translation and interpretation, education, and eligibility assistance, including pharmacy assistance program eligibility, environmental risk reduction, and other services that support and assist in the delivery of primary care and facilitate patient access to care. It also includes the cost of staff and related costs for other program-related services, such as WIC, day care, adult day health care, job training, delinquency prevention and other activities not included in other BPHC categories.

HEALTH CENTER “LOOK-ALIKES”Health centers designated as look-alikes do not receive funding under the Health Center Program, but they do meet the requirements and receive many benefits of grantees.

PATIENTPatients are individuals who have at least one reportable visit (as defined below) during the reporting year. The term “patient” is not limited to recipients of medical or dental services; the term is used universally to describe all persons who have countable visits. Each patient may be counted once, even if the individual received more than one type of service (e.g., medical, dental, enabling). Persons who only receive services from community-based efforts, such as immunization programs, medical or dental screening programs, dental varnishing programs, and health fairs, are not counted as patients. Persons whose only service from the health center is part of the WIC program or other programs are not counted as patients. (Note: the WIC program refers to the Special Supplemental Nutrition Program for Women, Infants and Children, a federal grant program that provides, at no charge, nutritious foods, nutrition education, and referrals to health and other social services to low-income pregnant, postpartum and breastfeeding women, and infants and children up to age 5 who are at nutrition risk.) During the course of addressing the health care needs of the community, health 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 health center, whether or not documentation is done on an individual basis. These other service users include, but are not limited to, persons whose only contact is in the following occasions.

Glossary of Terms


y 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

y when the only health service provided is part of a large-scale effort, such as an immunization program, medical or dental screening program, dental varnishing program, or communitywide service program (e.g., health fair)

y when a provider is primarily conducting outreach and/or group education sessions, not providing direct services

y when the only services provided are lab tests, X-rays, sonography, mammography, retinography, immunizations or other injections, TB tests or readings, and/or filling or refilling a prescription

y when narcotic agonists or antagonists, or mixes of these, are dispensed to a patient on a daily or weekly basis

y when services are performed under the auspices of a WIC program or a WIC contract

QUALITY OF CARE INDICATORS

y Process Measures: Quality of care indicators that document services, which have been shown to be correlated with, and serve as a proxy for, good long-term health outcomes. The process measures included in this report represent a subset of those measures that must be reported by all health centers. Individual health centers also may choose to use additional measures, including modified versions of these measures in their grant applications or for other internal purposes at their discretion.

y Intermediate Outcome Measures: These indicators document measurable outcomes of clinical intervention as a surrogate for good long-term health outcomes. Increasing the proportion of patients who have a good intermediate health outcome generally leads to improved health status of the patient population in the future. Please note that low birthweight is the only negative quality measure. For this, the higher the number of infants born with below normal birthweight, the worse the performance on the measure.

REVENUESTotal revenues consist of patient revenue and other revenue.

Patient Revenue consists of five payer categories: Medicaid, Medicare, Other Public, Private and Self-pay. Except for Self-Pay, the amount listed for each category includes nonmanaged care revenue, capitated managed care revenue and fee-for-service managed care revenue.

y Medicaid: All services billed to and paid for by Medicaid (Title XIX), regardless of whether they are paid directly, through a fiscal intermediary or by a Health Maintenance Organization. If the Children’s Health Insurance Program is paid through Medicaid, it should be included in the Medicaid category; otherwise it should be reported in the Other Public category.

y Medicare: All services billed to and paid for by Medicare (Title XVIII), regardless of whether they are paid directly, through a fiscal intermediary or by an HMO. Specifically, for patients enrolled in a capitated Medicare program, including Medicare Advantage, where the health center has a contract with a private plan like Blue Cross, the payer is Medicare, even though the actual payment may have come from Blue Cross. If a patient is covered by both Medicare and Medicaid, or by Medicare and a private payer, some portion of the charge will be reclassified to these other payment sources, and patient co-payments will be reclassified to Self-Pay after the initial Medicare payment is received.

y Other Public Sources: All services billed to and paid for by state or local governments through programs other than indigent care programs. The most common of these would be CHIP when it is paid for through commercial carriers. (Note: If CHIP is paid through Medicaid, it should be included in the Medicaid category.) Other Public also includes family planning programs, including but not limited to, Title X programs, BCCCP (Breast and Cervical Cancer Control Programs with various state names), and other dedicated state or local programs. Other Public does not include state or local indigent care programs. Patients whose only payment source is one of these state or local indigent care programs are reported as uninsured, and their charges and any associated self-pay collections, etc., are reported in the Self-Pay category.

y Private: All services billed to and paid for by commercial insurance companies or by other third-party payers. Specifically, do not include any services that fall into one of the other categories. Private insurance includes insurance purchased for public employees or retirees, such as Tricare and the Federal Employees Insurance Program, as well as Workers Compensation. Insurance purchased through the ACA-supported state exchanges also are included here. Private also may


include contract payments from other organizations who engage the clinic on a fee-for-service or other reimbursement basis, such as a Head Start program that pays for annual physical exams at a contracted rate, or a school, jail or large company that pays for provision of medical care at a per-session or negotiated rate.

y Self-Pay: All services, charges and collections where the responsible party is the patient, including charges for indigent care programs. This category also includes the reclassified co-payments, deductibles and charges for uncovered services for otherwise insured individuals, which become the patient’s personal responsibility.

y Other Revenue consists of four categories: Bureau of Primary Health Care grants, other federal grants, non-federal grants or contracts, and other nonpatient revenue. The “last party rule” is used to report other revenues. The “last party rule” means that grant and contract funds should always be reported based on the entity from which the health center received them, regardless of their original origin. For example, funds awarded by the state for maternal and child health services usually include a mixture of federal funds, such as Title V, and state funds. These should be reported as state grants because they are awarded by the state. An exception to the rule is for the Medicare and Medicaid EHR Incentive Grants received for eligible providers. These payments may be made directly to the clinic’s providers. It is presumed that, as employees, these funds will be turned over to the clinic. These dollars are reported on the line for Medicaid EHR Incentive Grants even though the payment may come from the provider and not directly from the Centers for Medicare & Medicaid Services.

y Bureau of Primary Health Care Grants − Capital Improvement Program Grants − Capital Development Grants

y Other Federal Grants − Ryan White Part C HIV Early Intervention − Medicare and Medicaid EHR Incentive Grants − ARRA CIP and FIP Grant Funds − Other Federal Grants

y Non-Federal Grants or Contracts

y State Government Grants and Contractors

y State Indigent Care Programs (including the Massachusetts Free Care Pool, New Jersey

y Uncompensated Care Program, New York Public Goods Pool Funding, New Mexico Tobacco Tax

y Program and Colorado Indigent Care Program)

y Other Nonpatient Revenue: Refers to other receipts included in the federally-approved scope of project that are not related to charge-based services or to grants and contracts described elsewhere. This may include fundraising, interest income, rent from tenants, medical records fees, individual monetary donations, vending machines, public pharmacy, etc. The receipt or recognition of “community benefit” from a third party is not to be reported as other nonpatient revenue (or anywhere else) unless it is received as a cash donation, nor may health centers recognize community benefit as an amount anywhere on the UDS form.

SERVICE MIXThe “Services Provided” as used in this report reflect the percent of patients served for each of the major service categories listed below. Per UDS instructions, within each category, an individual only can be counted once as a patient. However, a person who receives multiple types of services from different categories should be counted once for each category of service. For example, a person receiving only medical services is reported once in the Medical category, regardless of the number of medical visits he or she may have had. A person receiving medical, dental and enabling services is reported once in the Medical category, once in the Dental category and once in the Enabling Services category, regardless of the number of visits the person may have had for services within each category. Thus, an individual patient may be counted only once within each category, but may be counted once for one category, two categories, three categories, etc., up to and including being counted once for all of the following categories of services.

y Medical: Services rendered by the following personnel. − Physicians — M.D.s and D.O.s (except psychiatrists, ophthalmologists, pathologists and radiologists) − Nurse Practitioners (except psychiatric 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, and phlebotomists − X-ray Personnel — radiologists, X-ray technologists, and X-ray technicians − Other Medical Personnel — medical assistants, nurse’s aides, and all other personnel providing services in conjunction

with services provided by a physician, nurse practitioner, physician assistant, certified nurse midwife or nurse

y Dental: Services rendered by the following personnel − Dentists — general practitioners, oral surgeons, periodontist and periodontists − Dental Hygienists − Other Dental Personnel — dental assistants, aides and technicians

y Mental Health: Services rendered by the following personnel. − Psychiatrists − Licensed Clinical Psychologists − Licensed Clinical Social Workers − Other Licensed Mental Health Providers — including psychiatric social workers, psychiatric nurse practitioners, family

therapists and other licensed Master’s Degree prepared clinicians − Other Mental Health Staff — including unlicensed individuals (e.g., certified individuals who provide counseling,

treatment or support services related to mental health professionals)

y Substance Abuse: Services rendered by substance abuse workers, psychiatric nurses, psychiatric social workers, mental health nurses, clinical psychologists, clinical social workers and family therapists, as well as other individuals providing counseling and/or treatment services related to substance abuse

y Vision: Services rendered by persons working in the area of eye care, specifically the following. − Ophthalmologists — medical doctors specializing in medical and surgical eye problems − Optometrists — O.D.s (non-physicians who largely perform vision correction exams and prescribe glasses for patients) − Other Vision Care Staff — ophthalmologist/optometric assistants, aides and technicians

y Other Professional Services: Other professional and ancillary health care services, including, but not limited to podiatry, chiropractic, acupuncture, naturopathy, speech and hearing pathology, and occupational and physical therapy.

y Enabling Services: Examples of enabling services include the following. − Case Managers — staff who assist patients in the management of their health and social needs, including assessment of

patient medical and/or social service needs, and maintenance of referral, tracking and follow-up systems − Patient and Community Education Specialists — health educators, with or without specific degrees in this area − Outreach Workers — individuals conducting case finding, education or other services to identify potential clients, and/or

to facilitate access or referral of potential health center patients to available health center services − Transportation Workers — individuals who provide transportation for patients or arrange for transportation, including

persons who provide for long distance transportation to major cities in some extremely remote clinic locations − Eligibility Assistance Workers — all staff providing assistance in securing access to available health, social service,

pharmacy and other assistance programs − Interpretation Staff — staff whose full time or dedicated time is devoted to translation and/or interpretation services − Personnel Performing Other Enabling Service Activities — all other staff performing enabling services not described

above

SPECIAL DESIGNATIONS

y Homeless Centers: Established under the Homeless Assistance Act of 1987 and authorized under the Public Health Service Act, the Health Care for the Homeless programs intend to improve health access for homeless people to primary health care. HCH programs deliver services in shelters and soup kitchens, on the streets, and in other places where homeless individuals are found.

y Migrant Centers: The Migrant Health Act was passed in 1962 to provide a broad array of medical and support services to migrant and seasonal farm workers and their families. Migrant centers are linked with existing social services organizations, and normally provide bicultural/bilingual health services based on culturally appropriate protocols.


STAFFINGAll staff is to be reported in terms of annualized Full-Time Equivalents. One FTE describes staff who individually or as a group worked the equivalent of full-time for one year. Each agency defines the number of hours for full-time work and may define it differently for different positions. For example, a physician can be hired as a full-time employee but only required to work nine 4-hour sessions (36 hours) per week. Similarly, clinicians may routinely stay late in the clinic or see hospitalized patients before or after normal work days. In either case, the clinician would still be considered to be 1.0 FTE. The full-time equivalent is based on employment contracts for clinicians and other exempt employees, and is adjusted for part-year employment. A person who works 20 hours per week (i.e., 50 percent time in a 40-hour work week) is reported as 0.5 FTE. Positions with less than a 40-hour base, especially clinicians, should be calculated on whatever they have as a base for that position. Agencies that have a 35-hour work week would consider 17.5 hours worked to be 0.5 FTE. Similarly, an employee who works 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 health center 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 included in this report include paid staff, volunteers, contracted personnel (paid based on worked hours or FTE), interns, residents and preceptors. Individuals who are paid by the health center on a fee-for-service basis only are not counted as FTEs since there is no basis for determining their hours, though their visits are still reported, and the patients who received services are reported.

VISITSTo be counted as having met the “visit” criteria, the interaction must be documented, face-to-face contact between a patient and a licensed or otherwise credentialed provider, who exercises independent, professional judgment in the provision of services to the patient.

y Visits by Selected Diagnoses: The total number of visits during the reporting period where the indicated diagnosis is listed in the EHR or visit/billing record. If a visit has a diagnosis among the many diagnoses not listed, it is not reported. All visits are entered into an EHR or a clinic practice management/billing systems, with one diagnosis listed as primary, and successive diagnoses listed as secondary, tertiary, etc. Each diagnosis made at a visit may be counted regardless of the number of diagnoses listed for the visit. Thus, a patient visit with a primary diagnosis of hypertension and a secondary diagnosis of diabetes will be counted once for hypertension and once for diabetes.

y Visits by Selected Tests/Screenings/Preventive and Dental Services: The total number of visits at which one or more of the listed diagnostic tests, screenings and/or preventive services were provided. During one visit, more than one test, screening or preventive service may be provided. If these procedures or tests are on different lines, each would be counted. If they are on the same line, only one would be counted. For example:

− One visit may involve more than one of the identified services, in which case, each should be reported. For example, if during a visit both a Pap test and an HIV test were provided, then a visit would be reported for both.

− If a patient receives multiple immunizations at one visit, only one visit should be reported. − Services are reported in addition to diagnoses. A hypertensive patient who also receives an HIV test would be counted

once on the hypertension line and once on HIV test line. − Services also are reported where no diagnosis is reported. A patient who comes in for intense headaches who also gets a

flu shot would be counted on the flu shot line, but not on any diagnostic line. − If a patient had more than one tooth filled during a visit, only one visit for restorative services should be reported, not

one per tooth.

© 2018 Missouri Hospital Association P.O. Box 60 | Jefferson City, MO 65102-0060 | www.mhanet.com 09/18

Documents

MISSOURI HOSPITAL ASSOCIATION Profile of … FQHC...2018 Missouri FQHC Profiles 3 The Missouri Hospital Association is pleased to provide you with this Profile of Missouri Federally