Annual Utilization Report of Home Health Agencies / Hospices
Facility Name:KHF METRO LOS ANGELES HOME HEALTH AND HOSPICE
OSHPD ID:406190723Report 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:KHF METRO LOS ANGELES HOME HEALTH AND HOSPICE
2.OSHPD ID Number:406190723
3.Street Address:3699 WILSHIRE BLVD. 3RD FLOOR
4.City:LOS ANGELES
5.Zip:90010
6.Facility Phone No.:( 323) 783 - 4375 ext. 1772
7.Administrator Name:Brenda Green
8.Administrator E-mail Address:Brenda.m.green@kp.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:Kaiser Foundation Hospital, Inc
13.Corporate Business Address:Ordway Building
One Kaiser Plaza
14.City:Oakland
15.State:CA
16.Zip:94612 -
17.Person Completing Report:Brenda Green
18.Phone No.:323-783-1772
19.Fax No.:323-783-7460
20.E-mail Address:brenda.m.green@kp.org
25.Entity Type:Home Health Agency with Hospice Program
26.Entity RelationSole Facility
30.Submitted by:406190723
31.Submitted Date and Time:3/11/2005 3:15:59 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 CounselingNo
25.PediatricYes
26.Psychiatric NursingNo
27.Respiratory / Pulmonary TherapyNo
28.OtherNo
Patient Information
Line
No.		(1)
30.Number of unduplicated patients seen by your agency during the reporting year.4,116
Home Health Care
Line
No.		Other Home Health Visits(1)
No. of Visits
31.Pre-Admission Screening / Evaluations137
32.Outpatient Visits0
33.Other173
34.Total310
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?No
41.How many total hours of other Home Care did your agency provide?0
Other Home Care Services, Staff, and Functions
Line
No.		(1)
50.Certified Nurse Assistant (CNA)No
51.Home Health AideNo
52.Homemaker ServicesNo
53.Non-intermittent Nursing (RN / LVN)No
54.OtherNo
Section 3 - Home Health Agency Patients And Visits
Patients And Visits By Age
Line
No.		Age(1)
Patients		(2)
Visits
1.0 - 10 Years2868
2.11 - 20 Years51286
3.21 - 30 Years54535
4.31 - 40 Years1241,731
5.41 - 50 Years2832,550
6.51 - 60 Years5956,226
7.61 - 70 Years97010,830
8.71 - 80 Years1,38313,452
9.81 - 90 Years1,20410,836
10.91 Years and Older2912,567
15.Total4,983 49,081
Admissions By Source Of Referral
Line
No.		Source Of Referral(1)
Admissions
21.Another Home Health Agency44
22.Clinic7
23.Family / Friend0
24.Hospice7
25.Hospital (Discharge Planner, etc.)3,123
26.Local Health Department1
27.Long Term Care Facility (SN / IC)440
28.MSSP0
29.Payer (Insurance, HMO, etc.)0
30.Physician984
31.Self1
32.Social Service Agency0
34.Other1
35.Total4,608
Discharges By Reasons
Line
No.		Reason for Discharge(1)
Discharges
41.Admitted to Hospital463
42.Admitted to SN / IC Facility37
43.Death78
44.Family / Friends Assumed Responsibility232
45.Lack of Funds0
46.Lack of Progress10
47.No Further Home Health Care Needed3,443
48.Patient Moved out of Area34
49.Patient Refused Service56
50.Physician Request7
51.Transferred to Another HHA14
52.Transferred to Home Care (Personal Care)9
53.Transferred to Hospice74
54.Transferred to Outpatient Rehabilitation154
59.Other19
60.Total4,630
Visits By Type Of Staff
Line
No.		Type of Staff(1)
Visits
71.Home Health Aide3,731
72.Nutritionist (Diet Counseling)9
73.Occupational Therapist1,521
74.Physical Therapist12,634
75.Physician0
76.Skilled Nursing29,646
77.Social Worker1,472
78.Speech Pathologist / Audiologist68
79.Spiritual and Pastoral Care0
84.Other0
85.Total49,081
Visits By Primary Source Of Payment
Line
No.		Source Of Payment(1)
Visits
91.Medicare214
92.Medi-Cal0
93.TRICARE (CHAMPUS)0
94.Other Third Party (Insurance, etc.)0
95.Private (Self Pay)0
96.HMO / PPO (Includes Medicare and Medi-Cal HMOs)48,867
97.No Reimbursement0
99.Other (Includes MSSP)0
100.Total49,081
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		64939
2.HIV infections (include AIDS, ARC, HIV)042416
3.Malignant neoplasms: Lung162.0 - 162.9
197.0, 231.2		29225
4.Malignant neoplasms: Breast174.0 - 174.9
175.0 - 175.9
198.2, 198.81, 233.0		25327
5.Malignant neoplasms: Intestines152.0 - 154.8
159.0,  197.4,  197.5,  197.8
198.89, 230.3, 230.4, 230.7		45382
6.Malignant neoplasms: All other sites, excluding those in #3, 4, 5140.0 - 208.91
230.0 - 234.9		1971,841
7.Non-malignant neoplasms: All sites210.0 - 229.9
235.0 - 238.9
239.0 - 239.9		22160
8.Diabetes mellitus250.00 - 250.931451,873
9.Endocrine, metabolic, and nutritional diseases; Immunity disorders240.0 - 246.9
251.0 - 279.9		74589
10.Diseases of blood and blood forming organs280.0 - 289.952309
11.Mental disorder290.0 - 31913101
12.Alzheimer's disease331.090568
13.Disease of nervous system and sense organs320.0 - 330.9
331.11 - 389.9		1771,393
14.Diseases of cardiovascular system391.0 - 392.0
393 - 402.91
404.00 - 429.9		5024,350
15.Diseases of cerebrovascular system430 - 438.94003,154
16.Diseases of all other circulatory system390,  392.9
403.00 - 403.91
440.0 - 459.9		1151,803
17.Diseases of respiratory system460 - 519.93032,383
18.Diseases of digestive system520.0 - 579.92582,773
19.Diseases of genitourinary system580.0 - 608.9
614.0 - 629.9		2152,446
20.Diseases of breast610.0 - 611.900
21.Complications of pregnancy, childbirth, and the puerperium630 - 67711103
22.Diseases of skin and subcutaneous tissue680.0 - 709.94648,467
23.Diseases of musculosketal system and connective tissue (include pathological fx, malunion fx, and nonunion fx)710.00 - 739.91,0327,676
24.Congenital anormalies and perinatal conditions (include birth fractures)740.0 - 779.91028
25.Symptoms, signs, and ill-defined conditions (exclude HIV positive test)780.01 - 795.6
795.79
796.0 - 799.9		1071,441
26.Fractures (exclude birth fx, pathological fx, malunion fx, nonunion fx)800.00 - 829.13042,379
27.All other injuries830.0 - 959.969664
28.Poisonings and adverse effects of external causes960.0 - 995.94560
29.Complications of surgical and medical care996.00 - 999.9501,318
30.Health services related to reproduction and developmentV20.0 - V26.9
V28.0 - V29.9		22
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		00
32.Health hazards related to communicable diseasesV01.0 - V07.9
V09.0 - V19.8
V40.0 - V49.9		118
33.Other health services for specific procedures and aftercareV50.0 - V58.91881,162
34.Visits for Evaluation and AssessmentV60.0 - V83.8910131
45.Total4,98349,081
* 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.HIV04211153
52.Alzheimer's Disease331.0124851
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.Primarily Urban
Section 6 - Hospice Services
Bereavement Services
Line
No.		Bereavement Services(1)
People Served
1.Survivors of hospice patients645
2.Survivors of persons not receiving hospice care111
Volunteer Services
Line
No.		Volunteer Services(1)
No. of Volunteers		(2)
Volunteer Hours
3.Patient / Family Services351,133
4.Bereavement8198
5.Administrative7212
6.Medicare Reportable Hours
(sum lines 3-5)		1,543
7.Fundraising00
9.Other31,116
10.Total532,659
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 ProgramYes
16.OtherNo
Visits By Type Of Staff
(Include After-Hours and Bereavement Visits)
Line
No.		Type of Staff(1)
Visits
21.Nursing - RN7,527
22.Nursing - LVN0
23.Social Services2,535
24.Hospice Physician Services688
25.Homemaker and Home Health Aide6,743
26.Chaplain176
29.Other Clinical Services113
30.Total17,782
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 Years0101
2.2 - 5 Years1102
3.6 - 10 Years0101
4.11 - 20 Years1203
5.21 - 30 Years0101
6.31 - 40 Years85013
7.41 - 50 Years2115036
8.51 - 60 Years3150081
9.61 - 70 Years73660139
10.71 - 80 Years1111130224
11.81 - 90 Years1051050210
12.91 + Years3150081
15.Total3824100792
Unduplicated Hospice Patients By Gender and Race
Line
No.		Race(1)
Male		(2)
Female		(3)
Other / Unknown		(4)
Total
21.White2092410450
22.Black1231190242
23.Native American0000
24.Asian / Pacific Islander2833061
25.Other / Unknown2217039
30.Total3824100792
Unduplicated Hospice Patients By Gender And Ethnicity
Line
No.		Ethnicity(1)
Male		(2)
Female		(3)
Other / Unknown		(4)
Total
31.Hispanic60610121
32.Non-Hispanic3223490671
33.Unknown0000
35.Total3824100792
Hospice Patient Admissions By Source Of Referral
Line
No.		Source of Referral(1)
Patients
41.Home Health Agency0
42.Hospital (Discharge Planner, etc.)327
43.Long-Term Care Facility0
44.Other Hospice0
45.Payer (Insure, HMO,etc.)0
46.Physician367
47.RCFE / ARFCLHF0
48.Self / Family / Friend0
49.Social Service Agency18
54.Other1
55.Total713
Hospice Patient Discharges By Reason
Line
No.		Reason for Discharge(1)
Patients
61.Death629
62.Patient Moved Out of Area19
63.Patient Refused Service6
64.Transferred to Another Local Hospice2
65.Prognosis Extended8
66.Patient Desired Curative Treatment14
69.Other32
70.Total710
Hospice Patients Discharged By Length Of Stay
Line
No.		Length of Stay
(Days)		(1)
Patients
71.0-5 Days157
72.6-10 Days85
73.11-15 Days66
74.16-20 Days51
75.21-30 Days63
76.31-60 Days102
77.61-90 Days60
78.91-120 Days46
79.121-150 Days26
80.151-180 Days14
84.181 + Days40
85.Total710
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.Los Angeles71362987808
92.00000
93.00000
94.00000
95.00000
96.00000
97.00000
98.00000
99.00000
100.Total71362987808
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		46512,02824,146
2.Heart391.0 - 392.0
393 - 402.91
404.0 - 404.9 with fifth digit 1 or 3
410.00 - 429.9		761,3022,441
3.Dementia and Cerebral Degeneration290.0 - 294.9
331.0-331.9		629281,894
4.Lung, excluding cancer460 - 519.9241,0131,974
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		9150207
6.Liver, excluding cancer570 - 573.911160406
7.HIV042480174
8.Brain Stroke and late effects430 - 436
438.0 - 438.9
997.02		217531,919
9.Coma, with or without brain injury780.01 - 780.09
850.4
851.0 - 854.1 with fifth digit 5		000
10.Diabetes250.00 - 250.931910
11.ALS*335.2014377
19.OtherAll other codes that are not in lines 1-11.366981,246
20.Total71017,16434,494
* 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.Medicare57424,53410937024,680
2.Medi-Cal000000
3.Medi-Cal Managed Care000000
4.Managed Care000000
5.Private Insurance000000
6.Self Pay000000
7.Charity000000
9.Other*23010,6875423010,764
10.Total80435,22116360035,444
* 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.Home33,7210033,721
22.Hospital013013
23.SNF1,5001506001,710
24.CLHF00000
25.RCFE / ARF0000
29.Other00000
30.Total35,22116360035,444
Section 10 - Hospice Income and Expenses Statement
Detail Of Operating Expenses
Line
No.		(1)
Total
General Service Cost Centers
30.Administrative and General$0
Inpatient Care Service
31.Inpatient - General Care$0
32.Inpatient - Respite Care$0
Nursing Home
33.Room and Board SNFMedi-Cal Pass through Payments( $0 )
34.Medi-Cal Room and Board Contractual Payments$0
Program Supervision
35.Hospice Program / Team Supervision (Non-visit wages)$0
Visiting Services
36.Physician Services$0
37.Nursing Care$0
38.Rehabilitation Services (PT, OT, Speech)$0
39.Medical Social Services - Direct$0
40.Spiritual Counseling$0
41.Dietary Counseling$0
42.Counseling - Other$0
43.Home Health Aides and Homemakers$0
44.Other Visiting Services$0
Hospice Service Cost Centers
45.Drugs, Biologicals and Infusion$0
46.Durable Medical Equipment / Oxygen$0
47.Patient Transportation$0
48.Imaging, Lab and Diagnostics$0
49.Medical Supplies$0
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$0
56.Fundraising$0
Other Costs
57.Other Program Costs*$0
59.Total Operating Expenses$0
* Program costs including community education and outreach program costs.
Hospice Income Statement
Line
No.		(1)
Total
Gross Patient Revenue
101.Medicare$0
102.Medi-Cal (Excluding Room and Board)$0
103.Medi-Cal Managed Care (Excluding Room and Board)$0
104.Managed Care (Non Medi-Cal)$0
105.Private Insurance$0
106.Self-Pay$0
109.Other Payers$0
110.Total Gross Patient Revenue (sum of lines 101 through 109)$0
Write-Offs and Adjustments
111.Contractual Adjustments$0
112.Denials / Bad Debt$0
113.Charity$0
119.Other Write-offs and Adjustments$0
120.Total Write-Offs and Adjustments (sum of lines 111 through 119)$0
125.Net Patient Revenue (line 110 minus line 120)$0
Other Operating Revenue
131.Grants$0
132.Donations / Contributions$0
133.Unrelated Business Income$0
139.Other$0
140.Total Other Operating Revenue (sum of lines 131 through 139)$0
145.Total Operating Revenue (line 125 plus line 140)$0
Operating Expenses
151.General Service Cost Centers$0
152.Inpatient Care Service$0
153.Nursing Home$0
154.Program Supervision$0
155.Visiting Services$0
156.Hospice Service Cost Centers$0
157.Other Hospice Costs$0
159.Other Costs$0
160.Total Operating Expenses (sum of lines 151 through 159)$0
165.Net from Operations (line 145 minus line 160)$0
170.Income Tax$0
175.Net Income (line 165 minus line 170)$0
General Comments:
Section 10 is completed by Kaiser Permanente Hospitals. Thanks.
Errors and Warnings