Annual Utilization Report of Home Health Agencies / Hospices
Facility Name:ENLOE MEDICAL CENTER HOME HEALTH AGENCY
OSHPD ID:406042325Report Status:Submitted
License Category:Home Health AgencyReport Year:2004
Table of Contents
Click on any of the links listed below to view the corresponding section.
Section 1 - General Information
Section 2 - Home Health Agency
Section 3 - Home Health Agency Patients and Visits
Section 4 - Health Care Utilization
Section 5 - Hospice Description
Section 6 - Hospice Services
Section 7 - Hospice Patient Information
Section 8 - Hospice Utilization
Section 9 - Hospice Care And Source Of Payment
Section 10 - Hospice Income and Expenses Statement
General Comments
View Errors and Warnings
Section 1 - General Information
1.Facility Name:ENLOE MEDICAL CENTER HOME HEALTH AGENCY
2.OSHPD ID Number:406042325
3.Street Address:1390 E. LASSEN AVENUE
4.City:CHICO
5.Zip:95973
6.Facility Phone No.:( 530) 332 - 6050 ext. 3161
7.Administrator Name:Leslie Gungl
8.Administrator E-mail Address:leslie.gungl@enloe.org
9.Was this agency in operation at any time during the year?:Yes
10.Operation Open From:1/1/2004
11.Operation Open To:12/31/2004
12.Name of Parent Corporation:Enloe Medical Center
13.Corporate Business Address:1531 Esplanade
14.City:Chico
15.State:CA
16.Zip:95973 -
17.Person Completing Report:Sue Steffy
18.Phone No.:530-332-3178
19.Fax No.:530-899-5717
20.E-mail Address:sue.steffy@enloe.org
25.Entity Type:Home Health Agency with Hospice Program
26.Entity RelationSole Facility
30.Submitted by:406042325
31.Submitted Date and Time:3/15/2005 3:54:28 PM
Section 2 - Home Health Agency
LICENSEE TYPE OF CONTROL
Line
No.		(1)
1.Select the one category that best describes the licensee type of control of your home health agency:Non-profit Corporation
Medicare/Medi-Cal Certification
Line
No.		(1)
Certification
5.Medicare and Medi-Cal
Agency Accreditation Status
Line
No.		(1)
Accreditation Status
10.Accredited by ACHCUnknown Accreditation Status
11.Accredited by CHAPUnknown Accreditation Status
12.Accredited by JCAHOAccredited
13.Accredited by otherUnknown Accreditation Status
Home Infusion Therapy / Pharmacy Only
Line
No.		(1)
15.Do you have a Registered Nurse on staff who makes home visits?Yes
16.Is your agency a licensed Pharmacy?No
Note: If the facility is a licensed Pharmacy that only provides home infusion equipment, check “No” on line 40, then submit the report to OSHPD. The rest of the report is not applicable.
Special Services
Line
No.		(1)
20.AIDS ServicesNo
21.Blood TransfusionsNo
22.Enterostomal TherapyYes
23.IV Therapy (Includes Chemo and TPN)Yes
24.Mental Health CounselingYes
25.PediatricYes
26.Psychiatric NursingNo
27.Respiratory / Pulmonary TherapyYes
28.OtherNo
Patient Information
Line
No.		(1)
30.Number of unduplicated patients seen by your agency during the reporting year.2,432
Home Health Care
Line
No.		Other Home Health Visits(1)
No. of Visits
31.Pre-Admission Screening / Evaluations0
32.Outpatient Visits0
33.Other0
34.Total0
Other Home Health Services (Home Care Service, e.g. Continous Care)
Note: Do not complete lines 50-54 if these services were provided by an organization other than your licensed agency
Line
No.		(1)
40.Did your agency perform other Home Care Services?Yes
41.How many total hours of other Home Care did your agency provide?37,381
Other Home Care Services, Staff, and Functions
Line
No.		(1)
50.Certified Nurse Assistant (CNA)Yes
51.Home Health AideYes
52.Homemaker ServicesYes
53.Non-intermittent Nursing (RN / LVN)Yes
54.OtherYes
Section 3 - Home Health Agency Patients And Visits
Patients And Visits By Age
Line
No.		Age(1)
Patients		(2)
Visits
1.0 - 10 Years7051,785
2.11 - 20 Years37293
3.21 - 30 Years52446
4.31 - 40 Years61726
5.41 - 50 Years1311,562
6.51 - 60 Years3003,389
7.61 - 70 Years2943,027
8.71 - 80 Years4244,951
9.81 - 90 Years3553,930
10.91 Years and Older731,102
15.Total2,432 21,211
Admissions By Source Of Referral
Line
No.		Source Of Referral(1)
Admissions
21.Another Home Health Agency4
22.Clinic88
23.Family / Friend12
24.Hospice0
25.Hospital (Discharge Planner, etc.)1,792
26.Local Health Department0
27.Long Term Care Facility (SN / IC)71
28.MSSP0
29.Payer (Insurance, HMO, etc.)0
30.Physician295
31.Self4
32.Social Service Agency0
34.Other17
35.Total2,283
Discharges By Reasons
Line
No.		Reason for Discharge(1)
Discharges
41.Admitted to Hospital64
42.Admitted to SN / IC Facility19
43.Death72
44.Family / Friends Assumed Responsibility139
45.Lack of Funds8
46.Lack of Progress8
47.No Further Home Health Care Needed1,529
48.Patient Moved out of Area16
49.Patient Refused Service54
50.Physician Request27
51.Transferred to Another HHA1
52.Transferred to Home Care (Personal Care)2
53.Transferred to Hospice0
54.Transferred to Outpatient Rehabilitation89
59.Other16
60.Total2,044
Visits By Type Of Staff
Line
No.		Type of Staff(1)
Visits
71.Home Health Aide1,637
72.Nutritionist (Diet Counseling)0
73.Occupational Therapist929
74.Physical Therapist5,169
75.Physician0
76.Skilled Nursing12,310
77.Social Worker645
78.Speech Pathologist / Audiologist324
79.Spiritual and Pastoral Care0
84.Other197
85.Total21,211
Visits By Primary Source Of Payment
Line
No.		Source Of Payment(1)
Visits
91.Medicare12,968
92.Medi-Cal3,305
93.TRICARE (CHAMPUS)0
94.Other Third Party (Insurance, etc.)3,752
95.Private (Self Pay)859
96.HMO / PPO (Includes Medicare and Medi-Cal HMOs)45
97.No Reimbursement67
99.Other (Includes MSSP)215
100.Total21,211
Section 4 - Health Care Utilization
Patients And Visits By Principal Diagnosis For Which Care Was Given*
Line
No.		Principal DiagnosisICD-9-CM Code(1)
Patients		(2)
Visits
1.Infectious and Parasitic diseases (exclude HIV)001.0 - 041.9
045.00 - 139.8		320
2.HIV infections (include AIDS, ARC, HIV)04200
3.Malignant neoplasms: Lung162.0 - 162.9
197.0, 231.2		1053
4.Malignant neoplasms: Breast174.0 - 174.9
175.0 - 175.9
198.2, 198.81, 233.0		211
5.Malignant neoplasms: Intestines152.0 - 154.8
159.0,  197.4,  197.5,  197.8
198.89, 230.3, 230.4, 230.7		215
6.Malignant neoplasms: All other sites, excluding those in #3, 4, 5140.0 - 208.91
230.0 - 234.9		44592
7.Non-malignant neoplasms: All sites210.0 - 229.9
235.0 - 238.9
239.0 - 239.9		16
8.Diabetes mellitus250.00 - 250.931502,290
9.Endocrine, metabolic, and nutritional diseases; Immunity disorders240.0 - 246.9
251.0 - 279.9		1040
10.Diseases of blood and blood forming organs280.0 - 289.9310
11.Mental disorder290.0 - 319861
12.Alzheimer's disease331.000
13.Disease of nervous system and sense organs320.0 - 330.9
331.11 - 389.9		46425
14.Diseases of cardiovascular system391.0 - 392.0
393 - 402.91
404.00 - 429.9		52370
15.Diseases of cerebrovascular system430 - 438.953782
16.Diseases of all other circulatory system390,  392.9
403.00 - 403.91
440.0 - 459.9		15293
17.Diseases of respiratory system460 - 519.944384
18.Diseases of digestive system520.0 - 579.921154
19.Diseases of genitourinary system580.0 - 608.9
614.0 - 629.9		14129
20.Diseases of breast610.0 - 611.900
21.Complications of pregnancy, childbirth, and the puerperium630 - 677532
22.Diseases of skin and subcutaneous tissue680.0 - 709.951792
23.Diseases of musculosketal system and connective tissue (include pathological fx, malunion fx, and nonunion fx)710.00 - 739.927272
24.Congenital anormalies and perinatal conditions (include birth fractures)740.0 - 779.97311,823
25.Symptoms, signs, and ill-defined conditions (exclude HIV positive test)780.01 - 795.6
795.79
796.0 - 799.9		26198
26.Fractures (exclude birth fx, pathological fx, malunion fx, nonunion fx)800.00 - 829.114105
27.All other injuries830.0 - 959.924295
28.Poisonings and adverse effects of external causes960.0 - 995.9400
29.Complications of surgical and medical care996.00 - 999.935720
30.Health services related to reproduction and developmentV20.0 - V26.9
V28.0 - V29.9		00
31.Infants born outside hospital (infant care)V30.1,  V30.2,  V31.1,  V31.2,  V32.1
V32.2,  V33.1,  V33.2,  V34.1,  V34.2
V35.1,  V35.2,  V36.1,  V36.2,  V37.1
V37.2, V39.1, V39.2		516
32.Health hazards related to communicable diseasesV01.0 - V07.9
V09.0 - V19.8
V40.0 - V49.9		52195
33.Other health services for specific procedures and aftercareV50.0 - V58.998411,128
34.Visits for Evaluation and AssessmentV60.0 - V83.8900
45.Total2,43221,211
* The list of ICD-9-CM codes excluded: 795.71, V08, V27.0-V27.9, V59.01-V59.9
How many of the patients you reported in Section 3 "Patients and Visits by Age"Table had a primary or secondary diagnosis of HIV or Alzheimer's Disease and how many health care visits were made to them? The primary condition for which an HIV or Alzheimer's patient was visited may have been a fracture, a skin infection, cancer, or any number of primary conditions. What we are asking relates to the number of HIV or Alzheimer's patients among your total patient load, regardless of the nature of the treatment received or the primary condition of the patient.
Line
No.		ICD-9-CM Code(1)
Patients		(2)
Visits
51.HIV04200
52.Alzheimer's Disease331.037273
Section 5 - Hospice Description
LICENSEE TYPE OF CONTROL
Line
No.		(1)
1.Select the one category that best describes the licensee type of control of your hospice from drop down list:Non-profit Corporation
Medicare/Medi-Cal Certification
Line
No.		(1)
Certification
5.Medicare and Medi-Cal
Hospice Accreditation Status
Line
No.		(1)
Accreditation Status
10.Accredited by ACHCNone
11.Accredited by CHAPNone
12.Accredited by JCAHOAccredited
13.Accredited by otherNone
Agency Type As Reported On Medicare Cost Report
Line
No.		(1)
20.Hospital based
Location of Service Delivery
Line
No.		(1)
25.Mixed Urban and Rural
Section 6 - Hospice Services
Bereavement Services
Line
No.		Bereavement Services(1)
People Served
1.Survivors of hospice patients304
2.Survivors of persons not receiving hospice care48
Volunteer Services
Line
No.		Volunteer Services(1)
No. of Volunteers		(2)
Volunteer Hours
3.Patient / Family Services461,078
4.Bereavement31470
5.Administrative26521
6.Medicare Reportable Hours
(sum lines 3-5)		2,069
7.Fundraising00
9.Other7001,542
10.Total8033,611
Additional And Specialized Services
Check all services directly provided by OR contracted for by the hospice.
Line
No.		Additional and Specialized Hospice Services(1)
Services
11.Hospice Designated Inpatient Facility / UnitNo
12.Specialized Pediatric ProgramNo
13.Bereavement services to survivors of persons not receiving hospice careYes
14.Adult Day CareNo
15.Specialized Palliative Care ProgramNo
16.OtherNo
Visits By Type Of Staff
(Include After-Hours and Bereavement Visits)
Line
No.		Type of Staff(1)
Visits
21.Nursing - RN5,382
22.Nursing - LVN0
23.Social Services670
24.Hospice Physician Services0
25.Homemaker and Home Health Aide912
26.Chaplain0
29.Other Clinical Services268
30.Total7,232
Section 7 - Hospice Patient Information
Unduplicated Hospice Patients By Gender And Age Category
Line
No.		Age(1)
Male		(2)
Female		(3)
Other / Unknown		(4)
Total
1.0 - 1 Years1102
2.2 - 5 Years0000
3.6 - 10 Years0000
4.11 - 20 Years0000
5.21 - 30 Years0000
6.31 - 40 Years1102
7.41 - 50 Years97016
8.51 - 60 Years1714031
9.61 - 70 Years3028058
10.71 - 80 Years3530065
11.81 - 90 Years3550085
12.91 + Years1322035
15.Total1411530294
Unduplicated Hospice Patients By Gender and Race
Line
No.		Race(1)
Male		(2)
Female		(3)
Other / Unknown		(4)
Total
21.White1281400268
22.Black6107
23.Native American0000
24.Asian / Pacific Islander2305
25.Other / Unknown59014
30.Total1411530294
Unduplicated Hospice Patients By Gender And Ethnicity
Line
No.		Ethnicity(1)
Male		(2)
Female		(3)
Other / Unknown		(4)
Total
31.Hispanic59014
32.Non-Hispanic1361440280
33.Unknown0000
35.Total1411530294
Hospice Patient Admissions By Source Of Referral
Line
No.		Source of Referral(1)
Patients
41.Home Health Agency33
42.Hospital (Discharge Planner, etc.)99
43.Long-Term Care Facility13
44.Other Hospice0
45.Payer (Insure, HMO,etc.)0
46.Physician143
47.RCFE / ARFCLHF0
48.Self / Family / Friend13
49.Social Service Agency0
54.Other1
55.Total302
Hospice Patient Discharges By Reason
Line
No.		Reason for Discharge(1)
Patients
61.Death245
62.Patient Moved Out of Area2
63.Patient Refused Service1
64.Transferred to Another Local Hospice1
65.Prognosis Extended0
66.Patient Desired Curative Treatment0
69.Other23
70.Total272
Hospice Patients Discharged By Length Of Stay
Line
No.		Length of Stay
(Days)		(1)
Patients
71.0-5 Days64
72.6-10 Days37
73.11-15 Days19
74.16-20 Days17
75.21-30 Days31
76.31-60 Days52
77.61-90 Days29
78.91-120 Days6
79.121-150 Days6
80.151-180 Days6
84.181 + Days5
85.Total272
Hospice Patient Admissions By County And Discharges By Disposition
Line
No.		(1)
County of Patients's
Residence at Time of Admission		(2)
No. of
Admissions		(3)
No. of
Deaths		(4)
No. of
Non-Death Discharges		(5)
No. of
Patients Served
91.Butte24320221241
92.Glenn4131437
93.Tehama1612215
94.Colusa2001
95.00000
96.00000
97.00000
98.00000
99.00000
100.Total30224527294
Section 8 - Hospice Utilization
Please provide the number of patients discharged during calendar year reported regardless of payment source. Count the patient only under the principal diagnosis for which the patient was admitted for hospice care. Report each patient only once. The ICD-9-CM codes are provided only as a guide for you. You may use your hospice's existing definitions for diagnosis groups or the LMRP diagnosis codes from your fiscal intermediary, provided they match in a general way with the ICD-9-CM codes suggested.
Discharged Hospice Patient's Visits And Patient Days By Diagnosis
Line
No.		DiagnosisICD-9-CM Code(1)
No. of Patient Discharges		(2)
Visits for Discharged Patients		(3)
Discharged Patients Total Days of Care
1.Cancer140.0 - 208.91
230.0 - 234.9		1714,3768,448
2.Heart391.0 - 392.0
393 - 402.91
404.0 - 404.9 with fifth digit 1 or 3
410.00 - 429.9		000
3.Dementia and Cerebral Degeneration290.0 - 294.9
331.0-331.9		55988
4.Lung, excluding cancer460 - 519.905250
5.Kidney, excluding cancer403.00 - 403.91
404.0 - 404.9 with fifth digit 2 or 3
405.0 - 405.9 with fifth digit 1
580.0 - 589.9		10563342
6.Liver, excluding cancer570 - 573.96243132
7.HIV04207720
8.Brain Stroke and late effects430 - 436
438.0 - 438.9
997.02		7151129
9.Coma, with or without brain injury780.01 - 780.09
850.4
851.0 - 854.1 with fifth digit 5		141800
10.Diabetes250.00 - 250.93000
11.ALS*335.2020366
19.OtherAll other codes that are not in lines 1-11.579512,449
20.Total2727,82011,954
* Amyotrophic lateral sclerosis (ALS), also called Lou Gehrig's Disease
Section 9 - Hospice Care and Source of Payment
Please provide patient days for all patients served, including those in nursing facilities during the calendar year reported. Patients who change primary pay source during the calendar year reported should be reported for each pay source with the number of days of care recorded for each source (count each day only once even if there is more than one pay source on any one day).
Level of Care and Source of Payment
Line
No.		Source of Payment(1)
No. of Patients Served		(2)
Days of Routine Home Care		(3)
Days of Inpatient Care		(4)
Days of Respite Care		(5)
Days of Continuous Care		(6)
Total Patient Care Days
1.Medicare1908,64601008,656
2.Medi-Cal37798000798
3.Medi-Cal Managed Care000000
4.Managed Care4182000182
5.Private Insurance431,0710001,071
6.Self Pay000000
7.Charity20683000683
9.Other*000000
10.Total29411,380010011,390
* Other payment sources may include but not limited to Workers Comp., Home Health benefit, etc.
Location of Care Provided
Line
No.		Location of Care(1)
Days of Routine Home Care		(2)
Days of Inpatient Care		(3)
Days of Respite Care		(4)
Days of Continuous Care		(5)
Total Patient Care Days
21.Home9,521009,521
22.Hospital0000
23.SNF7390100749
24.CLHF00000
25.RCFE / ARF1,120001,120
29.Other00000
30.Total11,380010011,390
Section 10 - Hospice Income and Expenses Statement
Detail Of Operating Expenses
Line
No.		(1)
Total
General Service Cost Centers
30.Administrative and General$421,426
Inpatient Care Service
31.Inpatient - General Care$0
32.Inpatient - Respite Care$0
Nursing Home
33.Room and Board SNFMedi-Cal Pass through Payments( -$75,655 )
34.Medi-Cal Room and Board Contractual Payments$79,637
Program Supervision
35.Hospice Program / Team Supervision (Non-visit wages)$0
Visiting Services
36.Physician Services$24,000
37.Nursing Care$488,423
38.Rehabilitation Services (PT, OT, Speech)$21,600
39.Medical Social Services - Direct$91,287
40.Spiritual Counseling$0
41.Dietary Counseling$0
42.Counseling - Other$0
43.Home Health Aides and Homemakers$19,833
44.Other Visiting Services$0
Hospice Service Cost Centers
45.Drugs, Biologicals and Infusion$88,978
46.Durable Medical Equipment / Oxygen$24,415
47.Patient Transportation$595
48.Imaging, Lab and Diagnostics$5,366
49.Medical Supplies$12,133
50.Outpatient Services (including ER Dept.)$0
51.Radiation Therapy$0
52.Chemotherapy$0
53.Other Hospice Service Costs$0
Other Hospice Costs
54.Bereavement Program Costs$0
55.Volunteer Program Costs$2,071
56.Fundraising$0
Other Costs
57.Other Program Costs*$134,124
59.Total Operating Expenses$1,489,543
* Program costs including community education and outreach program costs.
Hospice Income Statement
Line
No.		(1)
Total
Gross Patient Revenue
101.Medicare$1,392,504
102.Medi-Cal (Excluding Room and Board)$90,721
103.Medi-Cal Managed Care (Excluding Room and Board)$0
104.Managed Care (Non Medi-Cal)$5,295
105.Private Insurance$133,610
106.Self-Pay$0
109.Other Payers$0
110.Total Gross Patient Revenue (sum of lines 101 through 109)$1,622,130
Write-Offs and Adjustments
111.Contractual Adjustments$37,523
112.Denials / Bad Debt$0
113.Charity$31,417
119.Other Write-offs and Adjustments$0
120.Total Write-Offs and Adjustments (sum of lines 111 through 119)$68,940
125.Net Patient Revenue (line 110 minus line 120)$1,553,190
Other Operating Revenue
131.Grants$0
132.Donations / Contributions$0
133.Unrelated Business Income$0
139.Other$250,000
140.Total Other Operating Revenue (sum of lines 131 through 139)$250,000
145.Total Operating Revenue (line 125 plus line 140)$1,803,190
Operating Expenses
151.General Service Cost Centers$421,426
152.Inpatient Care Service$0
153.Nursing Home$155,292
154.Program Supervision$0
155.Visiting Services$645,143
156.Hospice Service Cost Centers$131,487
157.Other Hospice Costs$2,071
159.Other Costs$134,124
160.Total Operating Expenses (sum of lines 151 through 159)$1,489,543
165.Net from Operations (line 145 minus line 160)$313,647
170.Income Tax$0
175.Net Income (line 165 minus line 170)$313,647
General Comments:
Errors and Warnings