Annual Utilization Report of Home Health Agencies / Hospices
Facility Name:	KAISER FOUNDATION HOSPITAL VALLEYS CONTINUING CARE
OSHPD ID:	406190722	Report Status:	Submitted
License Category:	Home Health Agency	Report Year:	2005

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:	KAISER FOUNDATION HOSPITAL VALLEYS CONTINUING CARE
2.	OSHPD ID Number:	406190722
3.	Street Address:	10605 BALBOA BLVD SUITE NO.300
4.	City:	GRANADA HILLS
5.	Zip:	91344
6.	Facility Phone No.:	( 818) 832 - 7200 ext.
7.	Administrator Name:	Terry Daggi
8.	Administrator E-mail Address:	Terry.L.Daggi@kp.org
9.	Was this agency in operation at any time during the year?:	Yes
10.	Operation Open From:	1/1/2005
11.	Operation Open To:	12/31/2005
12.	Name of Parent Corporation:	Kaiser Foundation Hospital
13.	Corporate Business Address:	13652 Cantara St.
14.	City:	Panorama City
15.	State:	CA
16.	Zip:	91402 -
17.	Person Completing Report:	Treva Smith-White
18.	Phone No.:	818-832-7256
19.	Fax No.:	818-832-7461
20.	E-mail Address:	Treva.X.Smith-White@kp.org
25.	Entity Type:	Home Health Agency with Hospice Program
26.	Entity Relation	Parent
30.	Submitted by:	406190722
31.	Submitted Date and Time:	3/29/2006 4:08:17 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 ACHC None 11. Accredited by CHAP None 12. Accredited by JCAHO Accredited 13. Accredited by other None

Home Infusion Therapy / Pharmacy Only

Line No. (1) 15. Is your agency a licensed Pharmacy? No 16. Do you have a Registered Nurse on staff who makes home visits? 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 Services Yes 21. Blood Transfusions No 22. Enterostomal Therapy Yes 23. IV Therapy (Includes Chemo and TPN) Yes 24. Mental Health Counseling No 25. Pediatric Yes 26. Psychiatric Nursing No 27. Respiratory / Pulmonary Therapy No 28. Other No

Patient Information

Line No. (1) 30. Number of unduplicated patients seen by your agency during the reporting year. 5,134

Home Health Care

Line No. Other Home Health Visits (1) No. of Visits 31. Pre-Admission Screening / Evaluations 0 32. Outpatient Visits 0 33. Other 0 34. Total 0

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 Aide No 52. Homemaker Services No 53. Non-intermittent Nursing (RN / LVN) No 54. Other No

Section 3 - Home Health Agency Patients And Visits

Patients And Visits By Age

Line No. Age (1) Patients (2) Visits 1. 0 - 10 Years 66 319 2. 11 - 20 Years 70 165 3. 21 - 30 Years 83 499 4. 31 - 40 Years 119 697 5. 41 - 50 Years 215 1,293 6. 51 - 60 Years 540 4,338 7. 61 - 70 Years 971 6,375 8. 71 - 80 Years 1,326 14,085 9. 81 - 90 Years 1,400 13,852 10. 91 Years and Older 344 2,617 15. Total 5,134 44,240

Admissions By Source Of Referral

Line No. Source Of Referral (1) Admissions 21. Another Home Health Agency 4 22. Clinic 3 23. Family / Friend 0 24. Hospice 0 25. Hospital (Discharge Planner, etc.) 3,200 26. Local Health Department 0 27. Long Term Care Facility (SN / IC) 81 28. MSSP 0 29. Payer (Insurance, HMO, etc.) 0 30. Physician 1,652 31. Self 0 32. Social Service Agency 2 34. Other 13 35. Total 4,955

Discharges By Reasons

Line No. Reason for Discharge (1) Discharges 41. Admitted to Hospital 225 42. Admitted to SN / IC Facility 66 43. Death 101 44. Family / Friends Assumed Responsibility 312 45. Lack of Funds 0 46. Lack of Progress 19 47. No Further Home Health Care Needed 3,460 48. Patient Moved out of Area 32 49. Patient Refused Service 118 50. Physician Request 4 51. Transferred to Another HHA 66 52. Transferred to Home Care (Personal Care) 3 53. Transferred to Hospice 142 54. Transferred to Outpatient Rehabilitation 373 59. Other 9 60. Total 4,930

Visits By Type Of Staff

Line No. Type of Staff (1) Visits 71. Home Health Aide 4,429 72. Nutritionist (Diet Counseling) 0 73. Occupational Therapist 3,090 74. Physical Therapist 13,376 75. Physician 0 76. Skilled Nursing 19,997 77. Social Worker 3,062 78. Speech Pathologist / Audiologist 286 79. Spiritual and Pastoral Care 0 84. Other 0 85. Total 44,240

Visits By Primary Source Of Payment

Line No. Source Of Payment (1) Visits 91. Medicare 784 92. Medi-Cal 0 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) 43,456 97. No Reimbursement 0 99. Other (Includes MSSP) 0 100. Total 44,240

Section 4 - Health Care Utilization

Patients And Visits By Principal Diagnosis For Which Care Was Given*

Line No. Principal Diagnosis ICD-9-CM Code (1) Patients (2) Visits 1. Infectious and Parasitic diseases (exclude HIV) 001.0 - 041.9 045.00 - 139.8 101 809 2. HIV infections 042 2 12 3. Malignant neoplasms: Lung 162.0 - 162.9 197.0, 231.2 22 187 4. Malignant neoplasms: Breast 174.0 - 174.9 175.0 - 175.9 198.2, 198.81, 233.0 17 102 5. Malignant neoplasms: Intestines 152.0 - 154.8 159.0,  197.4,  197.5,  197.8 198.89, 230.3, 230.4, 230.7 8 51 6. Malignant neoplasms: All other sites, excluding those in #3, 4, 5 140.0 - 208.91 230.0 - 234.9 166 1,266 7. Non-malignant neoplasms: All sites 210.0 - 229.9 235.0 - 238.9 239.0 - 239.9 13 50 8. Diabetes mellitus 250.00 - 250.93 120 685 9. Endocrine, metabolic, and nutritional diseases; Immunity disorders 240.0 - 246.9 251.0 - 279.9 79 673 10. Diseases of blood and blood forming organs 280.0 - 289.9 29 246 11. Mental disorder 290.0 - 319 51 445 12. Alzheimer's disease 331.0 160 1,404 13. Disease of nervous system and sense organs 320.0 - 330.9 331.11 - 389.9 199 2,034 14. Diseases of cardiovascular system 391.0 - 392.0 393 - 402.91 404.00 - 429.9 512 4,992 15. Diseases of cerebrovascular system 430 - 438.9 269 2,031 16. Diseases of all other circulatory system 390,  392.9 403.00 - 403.91 440.0 - 459.9 113 902 17. Diseases of respiratory system 460 - 519.9 447 4,520 18. Diseases of digestive system 520.0 - 579.9 195 1,265 19. Diseases of genitourinary system 580.0 - 608.9 614.0 - 629.9 220 1,525 20. Diseases of breast 610.0 - 611.9 2 79 21. Complications of pregnancy, childbirth, and the puerperium 630 - 677 37 154 22. Diseases of skin and subcutaneous tissue 680.0 - 709.9 275 2,870 23. Diseases of musculosketal system and connective tissue (include pathological fx, malunion fx, and nonunion fx) 710.00 - 739.9 1,112 7,071 24. Congenital anormalies and perinatal conditions (include birth fractures) 740.0 - 779.9 21 131 25. Symptoms, signs, and ill-defined conditions (exclude HIV positive test) 780.01 - 795.6 795.79 796.0 - 799.9 367 2,025 26. Fractures (exclude birth fx, pathological fx, malunion fx, nonunion fx) 800.00 - 829.1 469 3,962 27. All other injuries 830.0 - 959.9 195 1,296 28. Poisonings and adverse effects of external causes 960.0 - 995.94 4 8 29. Complications of surgical and medical care 996.00 - 999.9 91 954 30. Health services related to reproduction and development V20.0 - V26.9 V28.0 - V29.9 49 87 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 2 2 32. Health hazards related to communicable diseases V01.0 - V07.9 V09.0 - V19.8 V40.0 - V49.9 4 5 33. Other health services for specific procedures and aftercare V50.0 - V58.9 338 2,391 34. Visits for Evaluation and Assessment V60.0 - V84.8 2 6 45. Total 5,691 44,240

* 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 principal or secondary diagnosis of HIV or Alzheimer's Disease and how many health care visits were made to them? The principal diagnosis for which an HIV or Alzheimer's patient was visited may have been a fracture, a skin infection, cancer, or any number of principal diagnoses. 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 principal diagnosis of the patient.

Line No. ICD-9-CM Code (1) Patients (2) Visits 51. HIV 042 6 36 52. Alzheimer's Disease 331.0 218 1,715

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 ACHC None 11. Accredited by CHAP None 12. Accredited by JCAHO Accredited 13. Accredited by other None

Agency Type As Reported On Medicare Cost Report

Line No. (1) 20. Home Health 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 patients 702 2. Survivors of persons not receiving hospice care 37

Volunteer Services

Line No. Volunteer Services (1) No. of Volunteers (2) Volunteer Hours 3. Patient / Family Services 30 908 4. Bereavement 21 3,366 5. Administrative 7 1,365 6. Medicare Reportable Hours (sum lines 3-5) 5,639 7. Fundraising 0 0 9. Other 0 0 10. Total 58 5,639

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 / Unit No 12. Specialized Pediatric Program No 13. Bereavement services to survivors of persons not receiving hospice care Yes 14. Adult Day Care No 15. Specialized Palliative Care Program Yes 16. Other No

Visits By Type Of Staff (Include After-Hours and Bereavement Visits)

Line No. Type of Staff (1) Visits 21. Nursing - RN 10,063 22. Nursing - LVN 1 23. Social Services 2,177 24. Hospice Physician Services 1,394 25. Homemaker and Home Health Aide 5,840 26. Chaplain 447 29. Other Clinical Services 296 30. Total 20,218

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 Years 0 0 0 0 2. 2 - 5 Years 1 0 0 1 3. 6 - 10 Years 1 0 0 1 4. 11 - 20 Years 1 0 0 1 5. 21 - 30 Years 0 1 0 1 6. 31 - 40 Years 6 6 0 12 7. 41 - 50 Years 14 21 0 35 8. 51 - 60 Years 39 52 0 91 9. 61 - 70 Years 78 62 0 140 10. 71 - 80 Years 129 111 0 240 11. 81 - 90 Years 126 160 0 286 12. 91 + Years 30 66 0 96 15. Total 425 479 0 904

Unduplicated Hospice Patients By Gender and Race

Line No. Race (1) Male (2) Female (3) Other / Unknown (4) Total 21. White 365 401 0 766 22. Black 19 20 0 39 23. Native American 0 0 0 0 24. Asian / Pacific Islander 15 14 0 29 25. Other / Unknown 26 44 0 70 30. Total 425 479 0 904

Unduplicated Hospice Patients By Gender And Ethnicity

Line No. Ethnicity (1) Male (2) Female (3) Other / Unknown (4) Total 31. Hispanic 49 33 0 82 32. Non-Hispanic 376 446 0 822 33. Unknown 0 0 0 0 35. Total 425 479 0 904

Hospice Patient Admissions By Source Of Referral

Line No. Source of Referral (1) Patients 41. Home Health Agency 79 42. Hospital (Discharge Planner, etc.) 316 43. Long-Term Care Facility 87 44. Other Hospice 0 45. Payer (Insure, HMO,etc.) 0 46. Physician 344 47. RCFE / ARFCLHF 0 48. Self / Family / Friend 1 49. Social Service Agency 0 54. Other 0 55. Total 827

Hospice Patient Discharges By Reason

Line No. Reason for Discharge (1) Patients 61. Death 709 62. Patient Moved Out of Area 7 63. Patient Refused Service 7 64. Transferred to Another Local Hospice 2 65. Prognosis Extended 72 66. Patient Desired Curative Treatment 0 69. Other 0 70. Total 797

Hospice Patients Discharged By Length Of Stay

Line No. Length of Stay (Days) (1) Patients 71. 0-5 Days 184 72. 6-10 Days 111 73. 11-15 Days 68 74. 16-20 Days 51 75. 21-30 Days 83 76. 31-60 Days 109 77. 61-90 Days 79 78. 91-120 Days 36 79. 121-150 Days 16 80. 151-180 Days 11 84. 181 + Days 49 85. Total 797

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 Angeles 723 617 81 823 92. Ventura 100 88 7 100 93. Kern 4 4 0 4 94. 0 0 0 0 0 95. 0 0 0 0 0 96. 0 0 0 0 0 97. 0 0 0 0 0 98. 0 0 0 0 0 99. 0 0 0 0 0 100. Total 827 709 88 927

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. Diagnosis ICD-9-CM Code (1) No. of Patient Discharges (2) Visits for Discharged Patients (3) Discharged Patients Total Days of Care 1. Cancer 140.0 - 208.91 230.0 - 234.9 438 11,395 22,300 2. Heart 391.0 - 392.0 393 - 402.91 404.0 - 404.9 with fifth digit 1 or 3 410.00 - 429.9 86 1,791 3,149 3. Dementia and Cerebral Degeneration 290.0 - 294.9 331.0-331.9 109 2,572 6,486 4. Lung, excluding cancer 460 - 519.9 43 680 1,222 5. Kidney, excluding cancer 403.00 - 403.91 404.0 - 404.9 with fifth digit 2 or 3 405.0 - 405.9 with fifth digit 1 580.0 - 589.9 4 108 109 6. Liver, excluding cancer 570 - 573.9 14 451 786 7. HIV 042 0 0 0 8. Brain Stroke and late effects 430 - 436 438.0 - 438.9 997.02 28 372 635 9. Coma, with or without brain injury 780.01 - 780.09 850.4 851.0 - 854.1 with fifth digit 5 18 291 747 10. Diabetes 250.00 - 250.93 5 188 273 11. ALS* 335.20 0 0 0 19. Other All other codes that are not in lines 1-11. 52 1,095 2,047 20. Total 797 18,943 37,754

* 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. Medicare 704 33,532 28 29 0 33,589 2. Medi-Cal 0 0 0 0 0 0 3. Medi-Cal Managed Care 0 0 0 0 0 0 4. Managed Care 0 0 0 0 0 0 5. Private Insurance 0 0 0 0 0 0 6. Self Pay 0 0 0 0 0 0 7. Charity 0 0 0 0 0 0 9. Other* 221 7,468 11 4 0 7,483 10. Total 925 41,000 39 33 0 41,072

* 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. Home 29,395 0 0 29,395 22. Hospital 8 18 0 26 23. SNF 6,397 21 33 0 6,451 24. CLHF 0 0 0 0 0 25. RCFE / ARF 5,200 0 0 5,200 29. Other 0 0 0 0 0 30. Total 41,000 39 33 0 41,072

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 $101 102. 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 $101 110. Total Gross Patient Revenue (sum of lines 101 through 109) $202 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) $202 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) $202 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) $202 170. Income Tax $0 175. Net Income (line 165 minus line 170) $202

General Comments:

Kaiser Permanente was given an exemption to completing the income and expense section. Error reports kept us from submitting unless I put a dollar value in the revenue section. That value is not correct.

Errors and Warnings