UNIVERSAL HEALTH SERVICES, INC....(N=3,516) (N=2,425) (N=1,013) (N=1,774) 8.5 (N=2,891) 0.4 0.5 0.5 28.3 1.3 1.0 0.9 (N=1,796) (N=688) (N=1,222) The Brief Psychiatric Rating Scale

by the NUMBERS

OUR IMPACT IN

2019

U N I V E R S A L H E A L T H S E R V I C E S , I N C .

BEHAVIORAL HEALTH DIVISION

Our Impact In 2019 – By The Numbers*U.S. DATA ONLY

Quality patient care is the cornerstone of the UHS Mission Statement.

To provide superior quality healthcare services that:

Patients recommend to family and friends, Physicians prefer for their patients, Purchasers select for their clients, Employees are proud of, and Investors seek for long-term returns.

Quality is embedded in the core principles of the organization as well.

Continuous Improvement in Measurable Ways• Identify key needs and assess how

well we meet those needs.• Continuously improve services and

measure progress.• People at all levels of the

organization participate in decision making and process improvement.

Compassion• Never lose sight of the fact that

we provide care and comfort to people in need.

• Patients and families who rely upon us receive respectful and dignified treatment at all times.

A Message from Karen Johnson The Clinical Services Department and Mental Health Outcomes are very pleased to share 2019 By the Numbers, highlighting the Division’s clinical and quality outcome successes. The past year saw an ever-increasing commitment to high-quality care and patient safety. This document reflects your unwavering attention to our mission - to take care of our patients.

Please take this document and share it with your facility staff. We do not always take the time to celebrate and this is certainly one way to remind them that their hard work matters.

Each day presents its unique challenges and offers an opportunity to continue our efforts to improve the lives of the individuals we treat. We are deeply grateful to each of you for maintaining that singular focus. It is a privilege to work with each of you to obtain and sustain these outstanding results.

Karen E. Johnson, MSW

Senior Vice President, Clinical Services & Behavioral Health Division Compliance Officer, Universal Health Services

3

Child Population At a Glance

Length Of Stay By Level Of Care

PATIENT PROFILEAverage Age 10 years

Sex 42% Female; 58% Male

Race 62% White; 27% African American; 2% Other; 9% UTD

Hispanic Ethnicity 15%

Diagnostic ComplexityAverage Number of Psychiatric Diagnoses 2.3

Average Number of Co-morbid Medical Conditions 0.7

Percent of Patients with at least one Co-morbid Medical Condition 42%

Length of StayAverage Length of Stay 13 days

INPATIENT 9 DAYS PHP 17 DAYS IOP 27 DAYS RESIDENTIAL 111 DAYS

Top 5 Primary Psychiatric Diagnoses

Mood Disorders

Childhood Onset Disorders

Anxiety & Other Nonpsychotic Disorders

Schizophrenia & Other Psychotic Disorders 2%2%

7%8%

81%

Disorders of Personality and Behavior

Patients Served By Level Of Care

IOP

PHP

Residential

Inpatient

2.3%

1.1%

82.7%

13.9%

4

Adolescent Population At a Glance3.5%

10.7%

7.0%

78.7%









Mood Disorders

Anxiety & Other Nonpsychotic Disorders

Childhood Onset Disorders

Disorders of Personality and Behavior 1%2%3%6%

86%

Schizophrenia & Other Psychotic Disorders

IOP

PHP

Residential

Inpatient




INPATIENT 9 DAYS PHP 16 DAYS IOP 27 DAYS RESIDENTIAL 139 DAYS

5

Schizophrenia & Other Psychotic Disorders 21%Psychoactive Substance Use 22%

Adult Population At a Glance

IOP

PHP

Residential

Inpatient









Mood Disorders

Behavioral Syndromes with Physical Factors

6

Older Adult Population At a Glance









Mood Disorders

Schizophrenia & Other Psychotic Disorders

Disorders Due to Physiological Conditions

Psychoactive Substance Use 5%7%

9%23%

56%

Non-Psychiatric Diagnosis

97.3%

0.3%2.4%

Inpatient


IOP

PHP


INPATIENT 11 DAYS PHP 11 DAYS IOP 40 DAYS


7

Our Patients Improved

UHS BH Percent of Patients with Meaningful Improvement*

*Due to rounding, numbers may add up to more than 100%

In 2019, 171 UHS Behavioral Health facilities with 866 distinct programs captured clinical outcomes measures for approximately 267,263 patients. We continue to expand our support in 2020 for clinical outcomes measures. While most providers are focused only on patient satisfaction, our commitment to quantifying our clinical care using both clinician ratings and patient self-report tools allows UHS to benchmark, improve, and report on the high quality care provided.

We are pleased that UHS can demonstrate that approximately 75% of our patients exhibit statistically meaningful improvement using patient self-report rating scales. This is consistent with the literature on meaningful change in Behavioral Health. Patients have statistically meaningful improvement if their change is large enough to be attributable to treatment. Patients identified as having ‘No effect’ may have experienced positive change, however their change was not clearly evident as measured by the rating scale. Patients often report that they “feel better” after treatment and measures of statistically meaningful improvement help programs quantify those feelings of improvement. Potentially, all patients at a program can have statistically meaningful improvement.

CABA-Y (Child Inpatient)

CABA-Y (Adolescent Inpatient)

CABA-Y (Adolescent RTC)

BASIS-32TM (Adult Inpatient)

BASIS-32TM (Substance Abuse – Adult RTC)

87%

80%

76%

81%

84%

10%

16%

17%

13%

12%

3%

4%

7%

6%

4%

50% 100%0%

DeclineNo EffectImprovement

171

866

267,263

Facilities

Programs

Patients

8

Child Patient Improvement

BPRS-C-9 (Inpatient)

CABA-I (Inpatient)

CABA-I (Partial Hospitalization)

CABA-Y (Partial Hospitalization)

LESS SEVERE

LESS SEVERE

LESS SEVERE

MORE SEVERE

MORE SEVERE

MORE SEVERE

(N=3,516)

(N=2,425)

(N=1,013)

(N=1,774)

(N=2,891)8.5

0.4

0.5

0.5

28.3

1.3

1.0

0.9

(N=1,796)

(N=688)

(N=1,222)

The Brief Psychiatric Rating Scale for Children 9-item (BPRS-C-9) is a clinician’s rating of the level of severity of a patient’s functioning and symptoms obtained through a structured interview conducted with the patient. The BPRS-C-9 is scored on a scale of 0 to 54, where higher scores indicate greater severity. BPRS-C-9 change scores may range from -54 to 54, where positive scores indicate improvement, and higher positive scores indicate greater improvement.

Child and Adolescent Behavioral Assessment Informant (CABA-I): A questionnaire to assess problem behaviors based on patient informant responses. The total scores range from 0 to 3, with higher scores indicating greater severity. Change scores range from -3 to +3, with higher scores indicating greater improvement.


Child and Adolescent Behavioral Assessment Youth (CABA-Y): A questionnaire to assess problem behaviors based on patient responses. The total scores range from 0 to 3, with higher scores indicating greater severity. Change scores range from -3 to +3, with higher scores indicating greater improvement.

91%

91%

78%

68%

OF PATIENTS IMPROVED




0 25 302015105

0 1.21.00.80.60.40.2

ADMISSION

ADMISSION

ADMISSION

ADMISSION

DISCHARGE

DISCHARGE

DISCHARGE

DISCHARGE

0 0.60.2 0.4 0.8

1.4

1.0

LESS SEVERE MORE SEVERE0 1.00.60.2 0.4 0.8 1.2

9

Adolescent Patient Improvement

BPRS-C-9 (Inpatient)

CABA-I (Inpatient)

CABA-I (Partial Hospitalization)

CABA-Y (Partial Hospitalization)

LESS SEVERE

LESS SEVERE

MORE SEVERE

MORE SEVERE

(N=12,381)

(N=7,253)

(N=1,871)

(N=4,420)

(N=11,716)

(N=6,528)

(N=1,196)

(N=3,071)

The Brief Psychiatric Rating Scale for Children 9-item (BPRS-C-9) is a clinician’s rating of the level of severity of a patient’s functioning and symptoms obtained through a structured interview conducted with the patient. The BPRS-C-9 is scored on a scale of 0 to 54, where higher scores indicate greater severity. BPRS-C-9 change scores may range from -54 to 54, where positive scores indicate improvement, and higher positive scores indicate greater improvement.



Child and Adolescent Behavioral Assessment Youth (CABA-Y): A questionnaire to assess problem behaviors based on patient responses. The total scores range from 0 to 3, with higher scores indicating greater severity. Change scores range from -3 to +3, with higher scores indicating greater improvement.

LESS SEVERE MORE SEVERE

88%

88%

75%

63%





0 1.00.60.2 0.4 0.8 1.2

0 1.00.80.40.2 0.6

7.5

0 20 2515105

ADMISSION

DISCHARGE

0.4

1.1ADMISSION

DISCHARGE

0.5

1.1ADMISSION

DISCHARGE

0.5

0.8ADMISSION

DISCHARGE

24.3

30

LESS SEVERE MORE SEVERE0 1.21.00.80.60.40.2 1.4

10

72%

Adult Patient Improvement

BASIS-32TM (Inpatient)

PHQ-9 (Inpatient)

BASIS-32TM (Partial Hospitalization)

BASIS-32TM (Intensive Outpatient)

LESS SEVERE

LESS SEVERE

LESS SEVERE

LESS SEVERE

MORE SEVERE

MORE SEVERE

MORE SEVERE

MORE SEVERE

(N=44,165)

(N=24,925)

(N=8,078)

(N=3,769)

(N=49,670)0.7

4.9

0.9

0.8

1.8

14.0

1.5

1.4

(N=27,152)

(N=4,477)

(N=2,863)

Behavior and Symptom Identification Scale (BASIS-32): 32-item patient self-report instrument that provides an overall score and five individual factor scores: relation to self and others, daily living skills, depression/anxiety, impulsive/addictive behavior, and psychosis. The total scores range from 0 to 4, with higher scores indicating greater severity. Change scores range from -4 to +4, with higher scores indicating greater improvement. BASIS 32© McLean Hospital, used with permission.

Patient Health Questionnaire (PHQ-9): 9-item self-report measure of a patient’s level of depression over the past week obtained through either a structured interview conducted with the patient or the patient’s independent completion of the instrument. The PHQ-9 is scored on a scale of 0 to 27, where higher scores indicate greater severity. PHQ-9 change scores may range from -27 to 27, where positive scores indicate improvement, and higher positive scores indicate greater improvement.



81%

75%

65%





0 1.0 2.01.61.40.80.60.40.2

0 12108642

ADMISSION

ADMISSION

ADMISSION

ADMISSION

DISCHARGE

DISCHARGE

DISCHARGE

DISCHARGE

0 1.20.60.2 0.4 0.8 1.0

0 1.61.21.00.2 0.6 0.8 1.4

1.2 1.8

14 16

1.4 1.6 1.8

0.4

11

Residential & Substance Abuse Patient Improvement

Adult Residential

Adult Inpatient

Adult Partial Hospitalization

CABA-I (Adolescent Residential)

BASIS-32TM (Substance Abuse)



LESS SEVERE

LESS SEVERE

LESS SEVERE

LESS SEVERE

MORE SEVERE

MORE SEVERE

MORE SEVERE

MORE SEVERE

(N=3,103)

(N=1,489)

(N=6,224)

(N=4,006)

(N=2,785)

(N=1,033)

(N=5,975)

(N=2,522)





86%

84%

76%

74%





0 1.00.60.2 0.4 0.8 1.8

0 1.61.40.80.40.2 0.6

0.5

1.4

0 1.0 1.61.41.20.80.60.40.2

ADMISSION

DISCHARGE

0.5

1.5

0 1.61.00.80.60.40.2

ADMISSION

DISCHARGE

0.8

1.7ADMISSION

DISCHARGE

0.6

1.4ADMISSION

DISCHARGE

1.2 1.4

1.2 1.4 1.6

1.0 1.2

12

91%90%

86%

feel better at discharge than when admitted.

were satisfied with their treatment.

would recommend the facility to someone needing treatment.

Patient Satisfaction

UHS BH Patient Satisfaction Grand Mean On a scale of 1 to 5

2018

4.474.494.464.474.464.45

20172016201520142013

Patient satisfaction is critical to patient-centered care and an important indicator of provider success. Research suggests that higher patient satisfaction is associated with improved treatment outcomes. Communicating patient satisfaction results to patients and families contemplating treatment options and to payers contemplating coverage decisions is vital to providing confidence in our services.

The UHS Behavioral Health Division is committed to continually improving patient experience and satisfaction. 2019

4.47

13

Specialty Education

Our education programs provide continuation of schooling at our facilities while youth are receiving treatment. UHS provides personalized learning plans that meet each patient where they are when admitted and prepares them for a seamless transition back to their traditional school environment. Through individualized instruction, patients have access to a menu of curriculum options that includes direct instruction, remediation, credit recovery, online learning and post-secondary opportunities.

Best in Class Satisfaction

The Academic Staff Truly Cares About My Child

OF PARENTS OR GUARDIANS

AGREE

OF PARENTS OR GUARDIANS

AGREE

Satisfied With The Facility’s Education Program

87%

87%FEWER RESPONDENTS

FEWER RESPONDENTS

MORE RESPONDENTS

MORE RESPONDENTS

(N=1,266)

(N=1,280)87%

87%

0% 30%10% 20% 40% 50% 60% 70% 80% 90% 100%

0% 30%10% 20% 40% 50% 60% 70% 80% 90% 100%

High School Completions

211HS diplomas/GEDs

14

Serving Those Who Serve

Programs also treat personnel from the Reserves and National Guard; however, outcomes data volume is insufficient for reporting.

Primary Diagnostic Category

Army Navy Coast GuardMarineCorpsAir

Force

Primary diagnostic patterns vary by branch and personnel status. Mood disorders are more common among active duty personnel while substance use is more common among veterans. Active duty personnel also suffer more from anxiety disorders. Mood Disorders

Active Active Active Active Active RetiredRetiredRetiredRetiredRetired

Substance Use Anxiety Disorders

34%

23%

42% 49%37% 43% 47% 49% 50%

8%

52%38%

43%

27%

51%26%

46%

24%

67%

40% 54%

8%

36%

6%27%

5%

26% 25%8%

PCL-5 Meaningful Improvement

The PTSD Checklist for DSM-V (PCL-5) is a 20-item self-report measure of the 20 DSM-V PTSD symptoms.

73%

81%

18%

12%

8%

7%50%0% 100%

All Inpatient Military (N=2,904)

Military Inpatients with PTSD Diagnosis (N=1,280)

UHS, through its subsidiaries, operates a number of military-specific inpatient programs that treat active duty military personnel and veterans. Outcomes data provides a glimpse into this unique population’s mental health needs and how well those needs are being met.



8%

15

45-Day Follow-Up:Improvement That LastsUHS has a voluntary opportunity for patients and families to share with our facilities how they are doing 45 days after discharge. This is a unique non-research-based longitudinal look at continuity of care, patient improvement, and satisfaction. Patient responses to the aftercare survey 45 days after discharge indicate that the vast majority of patients would recommend their treatment facility, are continuing on medications, and most importantly, are sustaining the improvements made during treatment.

Average severity scores for Adult Inpatients at Admission, Discharge, and 45-Day Follow-up shows that patients tend to maintain the majority of their improvement.

Average severity scores for Adolescent Inpatients at Admission, Discharge, and 45-Day Follow-up shows that patients tend to maintain the majority of their improvement.

BASIS-32TM Severity

CABA-I Severity

Admission (N=44,165)

Admission (N=7,253)

Discharge (N=49,670)

Discharge (N=6,528)

2.0

1.6

1.6

1.2

0.8

0.4

0.0

1.2

0.8

0.4

0.0Follow-up (N=569)

Follow-up (N=283)

Sustained Recovery

Sustained Recovery

LOW

ER S

EVER

ITY

HIG

HER

SEV

ERIT

YLO

WER

SEV

ERIT

YH

IGH

ER S

EVER

ITY

4,175

2,965

1,210

Follow-up Surveys

Adult/Older Adult Patients

Child/Adolescent Patients

16

BASIS-32TM (Adult Inpatient)

CABA-I (Child/Adolescent Inpatient)

Percent of Patients with Meaningful Improvement from Admission to Follow-Up*

82%

80%

11%

13%

7%

7%

50%0% 100%



45 Days After Discharge...

88% of patients reported no suicidal thoughts or attempts89% of patients reported no re-hospitalization79% of patients recommend UHS versus other facilities73% of patients reported a positive quality of life67% of patients reported they were working or were students

Improvement That Lasts

17

Satisfaction That Lasts

86%

92%

89%

OF PATIENTSCONTACTED 45 DAYS

AFTER DISCHARGERATE PROGRAM WELL


AFTER DISCHARGEWOULD RECOMMEND


AFTER DISCHARGEREPORT PROGRAM

HELPED

Rate Overall Satisfaction Positively

Would Recommend Program

Report That The Program Helped

FEWER RESPONDENTS

FEWER RESPONDENTS

FEWER RESPONDENTS

MORE RESPONDENTS

MORE RESPONDENTS

MORE RESPONDENTS

(N=364,760)

(N=362,888)

(N=364,323)

(N=3,078)

(N=3,006)

(N=2,966)

Post Discharge Satisfaction: The patient follow-up survey includes a set of standardized questions that we ask patients across different programs, allowing for cross-program comparisons of satisfaction. Patient satisfaction scores are measured on a scale from 1 (Poor) to 5 (Excellent).

Patient responses to the aftercare survey indicate that the vast majority of patients continue to hold their treatment program in high regard.

Post Discharge Satisfaction: The patient follow-up survey includes a set of standardized questions that we ask patients across different programs, allowing for cross-program comparisons of satisfaction. Recommend scores are measured on a scale from 1 (Definitely Would Not) to 4 (Definitely Would).

89%

92%

86%

91%

86%

90%

DISCHARGE

DISCHARGE

DISCHARGE

FOLLOW-UP

FOLLOW-UP

FOLLOW-UP

0% 30%10% 20% 40% 50% 60% 70% 80% 90% 100%

0% 30%10% 20% 40% 50% 60% 70% 80% 90% 100%

0% 30%10% 20% 40% 50% 60% 70% 80% 90% 100%

Post Discharge Satisfaction: The patient follow-up survey includes a set of standardized questions that we ask patients across different programs, allowing for cross-program comparisons of satisfaction. Patient satisfaction scores are measured on a scale from 1 (Not at All) to 4 (A Great Deal).

18

Partnering With Community Professionals

Referral Source Satisfaction

UHS values our relationships with the professionals in the communities we serve and we strive to be responsive to their needs. We conduct referral source satisfaction surveys to help us continually improve as we aim to reach even higher goals.

As a result of our responsiveness, clinical expertise, nationally recognized specialty programs, and proven outcomes, 81% of professional referral sources indicate that UHS is their provider of choice.

UHS BH Referral Source Satisfaction Grand Mean

Ease Of Admission

Timeliness Of Disposition Information

Helpfulness Of Staff

Overall Care Coordination

Quality Of Patient Care

4.1

3.9

4.2

4.0

4.1

54321

Overall average score for all facilities out of a possible score of 5.

1,507 Referral source satisfaction surveys collected in 2019.

82% Survey respondents that indicated a UHS facility was their “provider of choice.”

19

Comparison groups include units in medical surgical facilities.

Comparative Performance

UHS Behavioral Health Outperforms Industry Benchmarks

The Hospital-Based Inpatient Psychiatric Services (HBIPS) “core” measures were developed by The Joint Commission (TJC), an organization that accredits hospitals, as a common point of performance comparison across Behavioral Health facilities. The HBIPS measures describe a set of “core” best practices for inpatient psychiatric care and performance rates for these measures are publicly reported. Hospitals that effectively integrate these processes into clinical and quality improvement practices should positively impact psychiatric patients.

The Inpatient Psychiatric Facility Quality Reporting (IPFQR) program was developed by the Centers for Medicare and Medicaid Services (CMS) as mandated by the Social Security and Affordable Care Acts. To meet program requirements, Inpatient Psychiatric Facilities (IPFs) collect and annually submit aggregate data as defined by CMS. CMS describes the program as giving “consumers care quality information to help them make more informed decisions about their healthcare options.”

When considering the publically reported chart-abstracted discharge measures, UHS typically outperforms the HBIPS and/or IPFQR comparison benchmarking for overall measures. UHS’s performance focus is clearly demonstrated by matching or outpacing the majority of measure set comparisons.

+ We respect the patient’s right to refuse these offerings. * IMM only applicable for Q4-Q1 discharges** METSCRN, TransRecPt and TransRecPrvdr are CMS-only measures

MEASURE GOAL UHS 2019 TJC Q2 2019 CMS 2018

HBIPS-1: Admission screening for violence risk, substance use, psychological trauma history and patient strengths completed Increase in Rate 97.08% 95.02% N/A

HBIPS-5: Patients discharged on multiple antipsychotic medications with appropriate justification Increase in Rate 73.67% 62.56% 61.00%

SUB-2: Alcohol Use Brief Intervention Provided or Offered Increase in Rate 86.30% 80.06% 83.00%

SUB-2a+: Alcohol Use Brief Intervention Provided Increase in Rate 76.53% 72.63% 75.00%

SUB-3: Alcohol and Other Drug Use Disorder Treatment Provided or Offered at Discharge Increase in Rate 73.75% 51.69% 70.00%

SUB-3a+: Alcohol and Other Drug Use Disorder Treatment at Discharge Increase in Rate 59.68% 41.01% 59.00%

TOB-2: Tobacco Use Treatment Provided or Offered Increase in Rate 88.49% 76.77% 81.00%

TOB-2a+: Tobacco Use Treatment Provided Increase in Rate 33.73% 39.39% 46.00%

TOB-3: Tobacco Use Treatment Provided or Offered at Discharge Increase in Rate 71.94% 46.64% 57.00%

TOB-3a+: Tobacco Use Treatment Provided at Discharge Increase in Rate 6.76% 17.32% 18.00%

IMM-2*: Influenza Immunization Increase in Rate 79.79% * 83.00%

METSCRN: Patients discharged on 1+ antipsychotic medications with a metabolic screening Increase in Rate 83.41% ** 74.00%

TransRecPt: Transition Record with Specified Elements Received by Discharged Patients Increase in Rate 86.78% ** 63.00%

TransRecPrvdr: Timely Transmission of Transition Record to Next Provider Upon Discharge Increase in Rate 74.22% ** 55.00%

Universal Corporate CenterP.O. Box 61558

367 South Gulph RoadKing of Prussia, PA 19406

www.uhsinc.com

200734-0257 3/20

Documents

UNIVERSAL HEALTH SERVICES, INC....(N=3,516) (N=2,425) (N=1,013) (N=1,774) 8.5 (N=2,891) 0.4 0.5 0.5 28.3 1.3 1.0 0.9 (N=1,796) (N=688) (N=1,222) The Brief Psychiatric Rating Scale