Survey Info.

Annual Utilization Report of Primary Care Clinic
Facility Name:	UNITED HEALTH CTRS OF SAN JOAQUIN VALLEY - PARLIER
OSHPD ID:	306101191	Report Status:	Submitted
License Category:	Community Clinic	Report Year:	2017

Table of Contents

Click on any of the links listed below to view the corresponding section.

Section 1 - General Information

Section 2 - Clinic Services

Section 3 - Patient Demographics

Section 4 - Encounters by Principal Diagnosis

Section 5 - Encounters by Principal Service

Section 6 - Revenue and Utilization by Payer

Section 7 - Income Statement

Section 8 - Capital Projects and Funds

General Comments

View Errors and Warnings

Section 1 - General Information

Facility Name:

UNITED HEALTH CTRS OF SAN JOAQUIN VALLEY - PARLIER

OSHPD ID Number:

306101191

Street Address:

650 S ZEDIKER AVE

City:

PARLIER

Zip:

93648

Facility Phone No.:

(559) 646 - 6618 ext. 0030

Administrator Name:

Sandra Chavez

Administrator E-mail Address:

chavezs@unitedhealthcenters.org

Was this clinic in operation at any time during the year?:

Yes

10.

Operation Open From:

1/1/2017

11.

Operation Open To:

12/31/2017

12.

Name of Parent Corporation:

United Health Centers of the San Joaquin Valley

13.

Corporate Business Address:

650 Zediker Avenue
P. O. Box 790

14.

City:

Parlier

15.

State:

16.

Zip:

93648 - 0790

17.

Person Completing Report:

Maria Huerta

18.

Phone No.:

559-646-6660

19.

Fax No.:

559-646-3652

20.

E-mail Address:

huertam@unitedhealthcenters.org

30.

Submitted by:

mariahuerta

31.

Submitted Date and Time:

3/7/2018 11:30:12 AM

Section 2 - Clinic Services

LICENSE CATEGORY (TYPE) (Completed by OSHPD.)

Line No.		(1)
1.	License Category:	Community Clinic

Federally Qualified Health Clinic (FQHC)

Line No.	Federally Qualified Health Clinics	(1)
2.	Indicate clinic type, if applicable:	FQHC

Rural Health Clinic

Line No.	Rural Health Clinic	(1)
3.	Is this a 95-210 Rural Health Clinic?	No

Table 2.1 - Community Services

Check one or more boxes for each service provided.

Line No.	Community Services	(1) Offered
10.	Adult Day Care	No
11.	Child Care	No
12.	Community Education	Yes
13.	Community Nutrition	Yes
14.	Disaster Relief	No
15.	Environmental Health	No
16.	Homeless	No
17.	Legal	No
18.	Outreach	No
19.	Social Services	No
20.	Substance Abuse	No
21.	Transportation	Yes
22.	Vocational Training Placement	No
23.	Other	No

HEALTH SERVICES

Check one or more boxes for each service provided.

Line No.		(1) Offered
100.	Medical	Yes
101.	Dental	Yes
102.	Vision
103.	Mental Health (Psychology / Psychiatry / Behavioral health)	Yes
104.	Substance Abuse (Alcohol / Drug Services)	Yes
105.	Domestic Violence
106.	Basic Lab	Yes
107.	Radiological Services	Yes
108.	Urgent Care
109.	Pharmacy	Yes
110.	Women's Health (Ob-Gyn/Family Planning/Midwives)	Yes

Table 2.2 - Languages Spoken By Staff and Patients

Check the staff box if one or more of your staff members speak a listed language. Check the patients box if 100 patients (or more than 1% of your patient population) are best served in a listed language. Estimates are acceptable if exact counts are not available.

Line No.	Language Spoken By	(1) Staff	(2) Patients
30.	Arabic	No	Yes
31.	Armenian	No	No
32.	Cambodian	No	No
33.	Chinese	No	Yes
34.	Hindustani	Yes	No
35.	Hmong	No	No
36.	Japanese	No	No
37.	Korean	No	No
38.	Laotian	No	No
39.	Portuguese	No	Yes
40.	Punjabi	Yes	Yes
41.	Russian	No	No
42.	Sign Language	No	Yes
43.	Spanish	Yes	Yes
44.	Tagalog	No	No
45.	Vietnamese	No	No

Language Summary

Line No.	Language Summary	(1)
55.	Percentage (%) of patient population best served in a non-English language (round to nearest WHOLE percent):	76%
56.	Primary non-English language spoken by patients (from list above):	Spanish

FTE's and Encounters by Primary Care Provider

Line No.	Primary Care Provider	(1) Salaried FTE's	(2) Contract FTE's	(3) Volunteer FTE's	(4) Total FTE's	(5) No. of Encounters
60.	Physicians	3.64	1.00		4.64	22,402
61.	Physician Assistants	1.80			1.80	11,239
62.	Family Nurse Practitioners				0.00	0
63.	Certified Nurse Midwives				0.00	0
64.	Visiting Nurses				0.00	0
65.	Dentists	4.04			4.04	19,868
66.	Registered Dental Hygienists (Alternative Practice)				0.00	0
67.	Psychiatrists	0.20	0.21		0.41	692
68.	Clinical Psychologists	0.90			0.90	1,370
69.	Licensed Clinical Social Workers (LCSW)	0.44			0.44	567
70.	Other Providers billable to Medi-Cal**		0.60		0.60	3,232
74.	Other Certified CPSP providers not listed above***	0.96			0.96	1,236
75.	Subtotal	11.98	1.81	0.00	13.79	60,606

** Other Providers billable to Medi-Cal - Included here are Chiropractors, Physical Therapists, Optometrists and any other professionals who are able to be reimbursed through the Medi-Cal program.

*** Comprehensive Perinatal Services Program - List all other professional not listed above that are certified by the CPSP program to render services and can be reimbursed.

FTE's and Contacts by Clinical Support Staff

Line No.	Clinical Support Staff	(1) Salaried FTE's	(2) Contract FTE's	(3) Volunteer FTE's	(4) Total FTE's	(5) No. of Contacts
80.	Registered Dental Hygienists (not Alternative Practice)	1.75			1.75	3,997
81.	Registered Dental Assistants	8.00			8.00	0
82.	Dental Assistants - Not licensed				0.00	0
83.	Marriage and Family Therapists (MFT)				0.00	0
84.	Registered Nurses				0.00	0
85.	Licensed Vocational Nurses	1.00			1.00	0
86.	Medical Assistants - Not licensed (1)	14.00			14.00	0
87.	Non-Licensed Patient Education Staff	4.00			4.00	6,150
88.	Substance Abuse Counselors (2)	1.40			1.40	877
89.	Billing Staff (3)	2.52			2.52
90.	Other Administrative Staff (4)	32.91			32.91
94.	Other Providers not listed above	6.70			6.70
95.	Subtotal	72.28	0.00	0.00	72.28	11,024

(1) Also includes Certified Medical Assistants

(2) Does not include substance abuse counseling performed by providers listed elsewhere

(3) Staff must spend 80% of time on billing

(4) Includes Executive Directors, CFO's, Medical & Dental Records staff, Medical & Dental Receptionists & other management staff

Section 3 - Patient Demographics

Race

Line No.	Race	(1) # of Patients
1.	White (include Hispanic)	13,977
2.	Black	34
3.	Native American / Alaskan Native	16
4.	Asian / Pacific Islander	116
5.	More than one race	10
9.	Other / Unknown	87
10.	Total Patients *	14,240

Ethnicity

Line No.	Ethnicity	(1) # of Patients
11.	Hispanic	12,786
12.	Non-Hispanic	1,160
13.	Unknown	294
15.	Total Patients *	14,240

Federal Poverty Level

Line No.	Federal Poverty Level	(1) # of Patients
20.	Under 100%	10,072
21.	100 - 138%	2,068
22.	139 - 200%	1,275
23.	201 - 400%	364
24.	Above 400%	313
25.	Unknown	148
26.	Total Patients by Federal Poverty Level *	14,240

Seasonal Agricultural And Migratory Workers

Line No.	Seasonal Agricultural and Migratory Workers	(1) Number
30.	Total Patients	10,579
31.	Total Encounters	45,024

Age Category

Line No.	Age Category	(1) Males	(2) Females
40.	Under 1 year	99	88
41.	1 - 4 years	363	322
42.	5 - 12 years	1,010	960
43.	13 - 14 years	238	216
44.	15 - 19 years	470	581
45.	20 - 34 years	1,159	1,927
46.	35 - 44 years	879	1,356
47.	45 - 64 years	1,453	1,926
48.	65 and over	548	645
55.	Total Patients *	6,219	8,021

Patient Coverage

Line No.	Patient Coverage	(1) # of Patients
60.	Medicare	519
61.	Medicare - Managed Care	135
62.	Medi-Cal	2,477
63.	Medi-Cal - Managed Care	4,657
64.	County Indigent / CMSP / MISP	0
65.	Private Insurance	1,165
66.	Covered California	218
67.	Alameda Alliance for Health	0
68.	My Health LA (MHLA)	0
69.	PACE Program	0
70.	Self-Pay / Sliding Fee	5,028
71.	Free	0
74.	All Other Payers	41
75.	Total Patients *	14,240

Episodic Programs

Line No.	Episodic Programs	(1) # of Patients
80.	BCCTP	248
81.	CHDP	0
82.
83.	Family PACT	133
84.	Other County Programs	0
85.	Childrens Treatment Program	0
89.	Other Payer - covered by a grant	0
90.	Total Episodic Patients (duplicated)	381

Child Health And Disability Prevention (CHDP)

Line No.	Child Health And Disability Prevention (CHDP)	(1) # of Assessments
95.	CHDP Assessments	1,647

* Totals for these tables must agree.

Section 4 - Encounters By Principal Diagnosis

Encounters by Principal Diagnosis

Report the diagnosis (or symptom, condition, problem or complaint) as the main reason for the encounter. Do not report the secondary diagnosis(es). There should be only one principal diagnosis for each encounter.

Line
No.

Classification of Diseases and/or Injuries
for each Principal Diagnosis

ICD - 10-CM Codes

(1)
# of Encounters

Infectious and Parasitic Diseases

A00-B99

1,186

Neoplasms

C00-D49

149

Endocrine, Nutritional, and Metabolic Diseases; and Immunity Disorders

E00-E89

3,474

Blood and Blood Forming Disorders

D50-D89

170

Mental, Behavioral, and Neurodevelopment Disorders

F01-F99

2,892

Nervous System and Sense Organs Diseases

G00-H95

1,530

Circulatory System Diseases

I00-I99

2,318

Respiratory System Diseases

J00-J99

2,749

Digestive System Diseases, excluding dental diagnosis

K20-K95

845

10.

Genitourinary System Diseases

N00-N99

1,052

11.

Pregnancy, Childbirth & the Puerperium

O00-O9A

172

12.

Skin and Subcutaneous Tissue Diseases

L00-L99

1,284

13.

Musculoskeletal System and Connective Tissue Diseases

M00-M99

4,825

14.

Congenital Anomalies

Q00-Q99

15.

Certain Conditions Originating in the Perinatal Period

P00-P96

16.

Symptoms, Signs, and Ill-defined Conditions

R00-R99

3,210

17.

Injury and Poisoning

S00-T88

633

18.

Factors Influencing Health Status and Contact with Health Services

Z00 – Z29, Z40 – Z99

10,894

19.

Dental Diagnosis

K00-K14

19,868

20.

Family Planning "Z" Codes

Z30 – Z39

507

21.

Other

All other codes not in lines 1-20

2,783

25.

Total

60,606

Section 5 - Encounters By Principal Service

Encounters by Principal Service

Classify each encounter by the principal CPT code that was reported on the billing document for this encounter. Do not report secondary procedures. There should be one and only one procedure code reported for each encounter.

Line No.	Principal Services	CPT Codes - 2012	(1) # of Encounters
1.	Evaluation and Management (new patient)	99201 - 99205	1,948
2.	Evaluation and Management (established patient)	99211 - 99215	28,448
3.	Hospital Related Services	99217 – 99226, 99231 - 99239, 99477	1
4.	Consultations	99241 - 99245, 99441 - 99444	33
5.	Other Evaluation and Management Services	99291 - 99292, 99354 - 99360, 99450, 99455 - 99456, 99499	55
6.	Nursing Facility Related Services	99304 - 99318	0
7.	Case Management Services	99363 - 99364, 99366 - 99368	0
8.	Preventive Medicine (infant, child, adolescent)	99381 - 99384, 99391 - 99394, 99461	1,728
9.	Preventive Medicine (adult)	99385 - 99387, 99395 - 99397	198
10.	Counseling	99401 - 99404, 99406 – 99409, 99411 – 99412, 99420 – 99429, 99605 – 99607	0
	All Other Services
11.	Anesthesia	00100 – 01999, 99100, 99116, 99135, 99140, 99151-99153	0
12.	Integumentary System	10021 - 19499	108
13.	Musculoskeletal System	20005 - 29999	37
14.	Respiratory System	30000 - 32999	0
15.	Cardiovascular System	33010 - 37799	3
16.	Hemic and Lymphatic System	38100 - 38999	0
17.	Mediastinum and Diaphragm System	39000 - 39599	0
18.	Digestive System	40490 - 49999	3
19.	Urinary System	50010 - 53899	5
20.	Male Genital System	54000 - 55920	4
21.	Intersex Surgery	55970, 55980	0
22.	Female Genital System	56405 - 58999	13
23.	Maternal Care and Delivery	59000 - 59899	0
24.	Endocrine System	60000 - 60699	3
25.	Nervous System	61000 - 64999	0
26.	Eye and Ocular Adnexa System	65091 - 68899	2
27.	Auditory System	69000 - 69979	0
28.	Radiology	70010 - 79999	15
29.	Pathology / Laboratory	80047 – 89356, 89398	9
30.	Medicine - Special Services	90281 – 99091, 99170 – 99199	4,926
31.	Family Planning "Z" Codes	"Z" codes	2,011
32.	Dental Encounters (CDT codes)	D0100-D0999	19,868
33.	CPT Category III Codes	0042T - 0463T	0
44.	Other	All other codes not in lines 1-33	1,188
45.	Total		60,606

Selected Procedure Code

Report the number of procedures for each code (or range of codes) regardless of whether it is the principal or secondary procedure code.

Line No.	Evaluation and Management Services	CPT Codes - 2012	(1) # of Procedures
50.	Mammogram	77053-77067	0
51.	HIV Testing	86689, 86701 - 86703, 87390 - 87391	1,455
52.	Pap Smear	88141 - 88155, 88164 - 88167, 88174 - 88175	888
53.	Contraceptive Management	11976, 55250, 55300, 55400, 55450, 57170, 58300 - 58301, 58600 58605, 58611, 58615, 58670 - 58671	1,148
	Vaccinations
60.	DTap, DTP, Diphtheria and Tetanus	90389, 90696-90698, 90700 -90702, 90714 - 90715, 90723	1,903
61.	Hemophilus Influenza B (Hib)	90647, 90645 - 90648	348
62.	Hepatitis A	90632 – 90634, 90636	200
63.	Hepatitis B	90740, 90743 - 90744, 90746 - 90747	37
64.	HepB and Hib	90748	0
65.	Influenza Virus Vaccine	90630, 90654-90658, 90660-90662, 90664, 90666-90668, 90685-90688	1,079
66.	Measles, Mumps and Rubella (MMR) and Varicella (MMRV)	90705-90708, 90710, 90716	197
67.	Pneumococcal	90669 - 90670, 90732	805
68.	Poliovirus	90713	32
69.	Varicella	90396, 90716	114

Section 6 - Revenue and Utilization by Payer

Revenue and Utilization by Payment Source

(Do not put any "$" signs, commas or decimals, round up to whole dollar)

Line No.		(1) Medicare	(2) Medicare Managed	(3) Medi-Cal	(4) Medi-Cal Managed	(5) County/ CMSP/MISP	(6) Private Insurance
1.	Encounters	3,347	820	18,719	22,565	0	5,282

2.	Gross Revenue (Charges at 100% Rate)	$1,111,913	$111,555	$3,466,601	$5,890,529		$903,969
3.	Sliding Fee Scale Write-offs
4.	Free/Complimentary Write-offs
5.	Contractual Adjustments	$582,209	$101,602	$1,354,348	$2,366,473		$477,282
6.	Bad Debts
7.	Grants (see Section 7)
8.	Other Adjustments
9.	Reconciliation
10.	Total Write-offs & Adjustments (sum lines 3 through 9)	$582,209	$101,602	$1,354,348	$2,366,473	$0	$477,282
15.	Net Patient Revenue (collected) (line 2 – line 10)	$529,704	$9,953	$2,112,253	$3,524,056	$0	$426,687

*Include LIHP encounters under County Indigent/CMSP/MISP

Line No.		(7) Covered California	(8) Self-Pay/ Sliding Fee	(9) Free	(10) Breast Cancer*	(11) CHDP
1.	Encounters	1,026	7,622	0	258	0

2.	Gross Revenue (Charges at 100% Rate)	$143,946	$4,721,210		$28,425
3.	Sliding Fee Scale Write-offs		$1,200,336
4.	Free/Complimentary Write-offs
5.	Contractual Adjustments	$58,895			$20,205
6.	Bad Debts
7.	Grants (see Section 7)
8.	Other Adjustments
9.	Reconciliation
10.	Total Write-offs & Adjustments (sum lines 3 through 9)	$58,895	$1,200,336	$0	$20,205	$0
15.	Net Patient Revenue (collected) (line 2 – line 10)	$85,051	$3,520,874	$0	$8,220	$0

* These include the following:
Breast Cancer Early Detection Program
Breast Cancer & Cervical Cancer Control Program

Line No.		(13) Family PACT	(14) PACE Program**	(15) My Health LA (MHLA)	(16) Alameda Alliance	(17) Other County	(18) All Other Payers
1.	Encounters	400	0	0	0	0	567

2.	Gross Revenue (Charges at 100% Rate)	$94,816					$99,200
3.	Sliding Fee Scale Write-offs
4.	Free/Complimentary Write-offs
5.	Contractual Adjustments	$41,647					$98,523
6.	Bad Debts
7.	Grants (see Section 7)
8.	Other Adjustments
9.	Reconciliation
10.	Total Write-offs & Adjustments (sum lines 3 through 9)	$41,647	$0	$0	$0	$0	$98,523
15.	Net Patient Revenue (collected) (line 2 – line 10)	$53,169	$0	$0	$0	$0	$677

** Report number of patients on Line 1 for the PACE Program

Line No.		(19) Grand Totals
1.	Encounters	60,606

2.	Gross Revenue (Charges at 100% Rate)	$16,572,164
3.	Sliding Fee Scale Write-offs	$1,200,336
4.	Free/Complimentary Write-offs	$0
5.	Contractual Adjustments	$5,101,184
6.	Bad Debts	$0
7.	Grants (see Section 7)
8.	Other Adjustments	$0
9.	Reconciliation	$0
10.	Total Write-offs & Adjustments (sum lines 3 through 9)	$6,301,520
15.	Net Patient Revenue (collected) (line 2 – line 10)	$10,270,644

Section 7 - Income Statement

Income Statement

(Do not input any "$" signs, commas or decimals, round up to whole dollar.)

Line No.	Revenue	(1)
1.	Gross Patient Revenue (from Sec 6, line 2, column 19)	$16,572,164
2.	Total Write-offs and Adjustments (from Sec 6, line 10, column 19)	$6,301,520
3.	Net Patient Revenue (from Sec 6, line 15, column 19)	$10,270,644
Other Operating Revenue
4.	Federal Funds - Grants - all others (e.g. 330 funds)	$2,546,886
400.	Federal Stimulus Grants - American Recovery and Reinvestment Act (ARRA)
401.	Federal Funds - New Access Point (NAP)
402.	Federal Funds - Increased Demand for Services (IDS)
403.	Federal Funds - Capital Improvement Project (CIP)
	State Funds
6.	Other	$104,472
	County Funds
10.	Other County Grant Programs	$113,587
11.	Local (City or District) Funds
12.	Private	$47,088
13.	Donations/Contributions
19.	Other	$291,924
20.	Total Other Operating Revenue (Sum lines 4 through 19)	$3,103,957
25.	Total Operating Revenue (line 3 + line 20)	$13,374,601
Operating Expenses
30.	Salaries, Wages, and Emplyee Benefits	$7,565,986
31.	Contract Services - Professional	$1,387
32.	Supplies - Medical and Dental	$1,141,585
33.	Supplies - Office	$60,611
34.	Outside Patient Care Services	$1,240,476
35.	Rent / Depreciation / Mortgage Interest	$384,067
36.	Utilities	$170,988
37.	Professional Liability Insurance	$24,880
38.	Other Insurance	$13,362
39.	Continuing Education	$20,758
40.	Information Technology (including EHR)
44.	All Other Expenses	$965,180
45.	Total Operating Expenses (Sum lines 30 through 44)	$11,589,280
50.	Net from Operations (line 25 - line 45)	$1,785,321

Section 8 - Major Capital Expenditures

Section 127285(3) of the Health and Safety Code requires each clinic to report "acquisitions of diagnostic or therapeutic equipment during the reporting period with a value in excess of five hundred thousand dollars ($500,000)."

Diagnostic and Therapeutic Equipment Acquired During The Report Period

Line No.		(1)
1.	Did your clinic acquire any diagnostic or therapeutic equipment that had a value in excess of $500,000? (If 'Yes', fill out lines 2 through 11, as necessary, below.)	No

Diagnostic and Therapeutic Equipment Detail

Line No.	(1) Description of Equipment	(2) Value	(3) Date of Aquisition MM/DD/YYYY	(4) Means of Acquisition
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.

Building Projects Commenced During Report Period Costing Over $1,000,000

Section 127285(4) of the Health and Safety Code requires each clinic to report the "commencement of projects during the reporting period that require a capital expenditure for the facility or clinic in excess of one million dollars ($1,000,000)."

Line No.		(1)
25.	Did your clinic commence any building projects during the report period which will require an aggregate capital expenditure exceeding $1,000,000? (If 'Yes', fill out lines 26 through 30, as necessary, below.)	No

Detail of Capital Expenditures

Line No.	(1) Description of Project	(2) Projected Total Capital Expenditure	(3) OSHPD Project No. (if applicable)
26.
27.
28.
29.
30.

Capital Fund

Line No.	Capital Fund	(1)
40.	Beginning Fund Balance
41.	Current Year Contribution
42.	Current Year Interest Earnings
43.	Current Year Expenditures
44.	Ending Fund Balance (line 40 + line 41 + line 42 - line 43)	$0

General Comments:

Errors and Warnings