Annual Utilization Report of Home Health Agencies / Hospices
Facility Name:TORRANCE MEMORIAL HOME HEALTH AND HOSPICE
OSHPD ID:406194028Report Status:Submitted
License Category:Home Health AgencyReport Year:2006
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:TORRANCE MEMORIAL HOME HEALTH AND HOSPICE
2.OSHPD ID Number:406194028
3.Street Address:3330 LOMITA BLVD.
4.City:TORRANCE
5.Zip:90505-5073
6.Facility Phone No.:( 310) 784 - 3739 ext.
7.Administrator Name:Pamela Lemkin
8.Administrator E-mail Address:pam.lemkin@tmmc.com
9.Was this agency in operation at any time during the year?:Yes
10.Operation Open From:1/1/2006
11.Operation Open To:12/31/2006
12.Name of Parent Corporation:
13.Corporate Business Address:
14.City:
15.State:
16.Zip:-
17.Person Completing Report:Keith Tate
18.Phone No.:310-784-3791
19.Fax No.:310-784-3717
20.E-mail Address:keith.tate@tmmc.com
25.Entity Type:Home Health Agency with Hospice Program
26.Entity RelationSole Facility
30.Submitted by:406194028
31.Submitted Date and Time:3/27/2007 4:29:25 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 ACHCNone
11.Accredited by CHAPNone
12.Accredited by JCAHOAccredited
13.Accredited by otherNone
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 ServicesNo
21.Blood TransfusionsNo
22.Enterostomal TherapyYes
23.IV Therapy (Includes Chemo and TPN)Yes
24.Mental Health CounselingNo
25.PediatricYes
26.Psychiatric NursingYes
27.Respiratory / Pulmonary TherapyNo
28.OtherNo
Persons Receiving Services
Line
No.		(1)
30.Number of unduplicated persons seen by your agency during the reporting year.2,220
Home Health Care
Line
No.		Other Home Health Visits(1)
No. of Visits
31.Pre-Admission Screening / Evaluations2,585
32.Outpatient Visits0
33.Other0
34.Total2,585
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 Years1653
2.11 - 20 Years22192
3.21 - 30 Years28222
4.31 - 40 Years46306
5.41 - 50 Years1011,064
6.51 - 60 Years2021,839
7.61 - 70 Years3133,786
8.71 - 80 Years6266,830
9.81 - 90 Years7086,641
10.91 Years and Older1581,644
15.Total2,220 22,577
Admissions By Source Of Referral
Line
No.		Source Of Referral(1)
Admissions
21.Another Home Health Agency1
22.Clinic0
23.Family / Friend0
24.Hospice0
25.Hospital (Discharge Planner, etc.)767
26.Local Health Department0
27.Long Term Care Facility (SN / IC)73
28.MSSP0
29.Payer (Insurance, HMO, etc.)1,098
30.Physician244
31.Self1
32.Social Service Agency0
34.Other19
35.Total2,203
Discharges By Reasons
Line
No.		Reason for Discharge(1)
Discharges
41.Admitted to Hospital154
42.Admitted to SN / IC Facility40
43.Death50
44.Family / Friends Assumed Responsibility348
45.Lack of Funds0
46.Lack of Progress14
47.No Further Home Health Care Needed1,381
48.Patient Moved out of Area17
49.Patient Refused Service44
50.Physician Request15
51.Transferred to Another HHA6
52.Transferred to Home Care (Personal Care)59
53.Transferred to Hospice75
54.Transferred to Outpatient Rehabilitation147
59.Other75
60.Total2,425
Visits By Type Of Staff
Line
No.		Type of Staff(1)
Visits
71.Home Health Aide1,206
72.Nutritionist (Diet Counseling)0
73.Occupational Therapist621
74.Physical Therapist7,299
75.Physician0
76.Skilled Nursing12,823
77.Social Worker493
78.Speech Pathologist / Audiologist120
79.Spiritual and Pastoral Care13
84.Other2
85.Total22,577
Visits By Primary Source Of Payment
Line
No.		Source Of Payment(1)
Visits
91.Medicare9,150
92.Medi-Cal225
93.TRICARE (CHAMPUS)7
94.Other Third Party (Insurance, etc.)2,026
95.Private (Self Pay)143
96.HMO / PPO (Includes Medicare and Medi-Cal HMOs)10,935
97.No Reimbursement0
99.Other (Includes MSSP)91
100.Total22,577
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		17223
2.HIV infections04200
3.Malignant neoplasms: Lung162.0 - 162.9
197.0, 231.2		1498
4.Malignant neoplasms: Breast174.0 - 174.9
175.0 - 175.9
198.2, 198.81, 233.0		679
5.Malignant neoplasms: Intestines152.0 - 154.8
159.0,  197.4,  197.5,  197.8
198.89, 230.3, 230.4, 230.7		17212
6.Malignant neoplasms: All other sites, excluding those in #3, 4, 5140.0 - 208.91
230.0 - 234.9		42580
7.Non-malignant neoplasms: All sites210.0 - 229.9
235.0 - 238.9
239.0 - 239.9		38
8.Diabetes mellitus250.00 - 250.9352631
9.Endocrine, metabolic, and nutritional diseases; Immunity disorders240.0 - 246.9
251.0 - 279.9		30237
10.Diseases of blood and blood forming organs280.0 - 289.91265
11.Mental disorder290.0 - 31918105
12.Alzheimer's disease331.02097
13.Disease of nervous system and sense organs320.0 - 330.9
331.11 - 389.9		35518
14.Diseases of cardiovascular system391.0 - 392.0
393 - 402.91
404.00 - 429.9		1101,056
15.Diseases of cerebrovascular system430 - 438.973565
16.Diseases of all other circulatory system390,  392.9
403.00 - 403.91
440.0 - 459.9		30510
17.Diseases of respiratory system460 - 519.998583
18.Diseases of digestive system520.0 - 579.967688
19.Diseases of genitourinary system580.0 - 608.9
614.0 - 629.9		46396
20.Diseases of breast610.0 - 611.9315
21.Complications of pregnancy, childbirth, and the puerperium630 - 677844
22.Diseases of skin and subcutaneous tissue680.0 - 709.91472,616
23.Diseases of musculosketal system and connective tissue (include pathological fx, malunion fx, and nonunion fx)710.00 - 739.9112962
24.Congenital anormalies and perinatal conditions (include birth fractures)740.0 - 779.9953
25.Symptoms, signs, and ill-defined conditions (exclude HIV positive test)780.01 - 795.6
795.79
796.0 - 799.9		4102,782
26.Fractures (exclude birth fx, pathological fx, malunion fx, nonunion fx)800.00 - 829.174818
27.All other injuries830.0 - 959.9591,173
28.Poisonings and adverse effects of external causes960.0 - 995.94434
29.Complications of surgical and medical care996.00 - 999.9721,144
30.Health services related to reproduction and developmentV20.0 - V26.9
V28.0 - V29.9		47
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		47684
33.Other health services for specific procedures and aftercareV50.0 - V59.95805,588
34.Visits for Evaluation and AssessmentV60.0 - V85.416
45.Total2,22022,577
* The list of ICD-9-CM codes excluded: 795.71, V08, V27.0-V27.9.
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.HIV04200
52.Alzheimer's Disease331.038507
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 patients258
2.Survivors of persons not receiving hospice care763
Volunteer Services
Line
No.		Volunteer Services(1)
No. of Volunteers		(2)
Volunteer Hours
3.Patient / Family Services524,323
4.Bereavement16944
5.Administrative10364
6.Medicare Reportable Hours
(sum lines 3-5)		5,631
7.Fundraising2120
9.Other142
10.Total815,793
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 CareYes
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 - RN5,385
22.Nursing - LVN0
23.Social Services1,082
24.Hospice Physician Services0
25.Homemaker and Home Health Aide2,679
26.Chaplain386
29.Other Clinical Services409
30.Total9,941
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 Years0000
2.2 - 5 Years0000
3.6 - 10 Years0000
4.11 - 20 Years0000
5.21 - 30 Years0000
6.31 - 40 Years2002
7.41 - 50 Years5409
8.51 - 60 Years713020
9.61 - 70 Years1916035
10.71 - 80 Years4040080
11.81 - 90 Years41790120
12.91 + Years1929048
15.Total1331810314
Unduplicated Hospice Patients By Gender and Race
Line
No.		Race(1)
Male		(2)
Female		(3)
Other / Unknown		(4)
Total
21.White901310221
22.Black613019
23.Native American0000
24.Asian / Pacific Islander2520045
25.Other / Unknown1217029
30.Total1331810314
Unduplicated Hospice Patients By Gender And Ethnicity
Line
No.		Ethnicity(1)
Male		(2)
Female		(3)
Other / Unknown		(4)
Total
31.Hispanic1013023
32.Non-Hispanic1231680291
33.Unknown0000
35.Total1331810314
Hospice Patient Admissions By Source Of Referral
Line
No.		Source of Referral(1)
Patients
41.Home Health Agency0
42.Hospital (Discharge Planner, etc.)150
43.Long-Term Care Facility2
44.Other Hospice0
45.Payer (Insure, HMO,etc.)57
46.Physician63
47.RCFE / ARF/ CLHF0
48.Self / Family / Friend4
49.Social Service Agency0
54.Other2
55.Total278
Hospice Patient Discharges By Reason
Line
No.		Reason for Discharge(1)
Patients
61.Death240
62.Patient Moved Out of Area3
63.Patient Refused Service15
64.Transferred to Another Local Hospice4
65.Prognosis Extended7
66.Patient Desired Curative Treatment2
69.Other6
70.Total277
Hospice Patients Discharged By Length Of Stay
Line
No.		Length of Stay
(Days)		(1)
Patients
71.0-5 Days61
72.6-10 Days37
73.11-15 Days30
74.16-20 Days23
75.21-30 Days29
76.31-60 Days35
77.61-90 Days12
78.91-120 Days8
79.121-150 Days4
80.151-180 Days10
84.181 + Days28
85.Total277
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 Angeles27824037314
92.00000
93.00000
94.00000
95.00000
96.00000
97.00000
98.00000
99.00000
100.Total27824037314
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 Patients, 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		1202,1023,803
2.Heart391.0 - 392.0
393 - 402.91
404.0 - 404.9 with fifth digit 1 or 3
410.00 - 429.9		421,0985,748
3.Dementia and Cerebral Degeneration290.0 - 294.9
331.0-331.9		255991,930
4.Lung, excluding cancer460 - 519.9251,1011,940
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		8260308
6.Liver, excluding cancer570 - 573.934431
7.HIV0426212299
8.Brain Stroke and late effects430 - 436
438.0 - 438.9
997.02		631103
9.Coma, with or without brain injury780.01 - 780.09
850.4
851.0 - 854.1 with fifth digit 5		27123
10.Diabetes250.00 - 250.93000
11.ALS*335.202173264
19.OtherAll other codes that are not in lines 1-11.382,1192,287
20.Total2777,81016,736
* 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.Medicare26514,6473262014,741
2.Medi-Cal45150056
3.Medi-Cal Managed Care000000
4.Managed Care29754000754
5.Private Insurance16456140461
6.Self Pay000000
7.Charity000000
9.Other*000000
10.Total31415,9083866016,012
* 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.Home14,1750014,175
22.Hospital0384886
23.SNF247000247
24.CLHF00000
25.RCFE / ARF1,4861801,504
29.Other00000
30.Total15,9083866016,012
Section 10 - Hospice Income and Expenses Statement
Detail Of Operating Expenses
Line
No.		(1)
Total
General Service Cost Centers
30.Administrative and General$40,950
Inpatient Care Service
31.Inpatient - General Care$34,200
32.Inpatient - Respite Care$9,240
Nursing Home
33.Room and Board SNFMedi-Cal Pass through Payments( $9,949 )
34.Medi-Cal Room and Board Contractual Payments$19,230
Program Supervision
35.Hospice Program / Team Supervision (Non-visit wages)$0
Visiting Services
36.Physician Services$35,178
37.Nursing Care$618,839
38.Rehabilitation Services (PT, OT, Speech)$0
39.Medical Social Services - Direct$421,522
40.Spiritual Counseling$0
41.Dietary Counseling$0
42.Counseling - Other$0
43.Home Health Aides and Homemakers$53,085
44.Other Visiting Services$0
Hospice Service Cost Centers
45.Drugs, Biologicals and Infusion$342,919
46.Durable Medical Equipment / Oxygen$243,124
47.Patient Transportation$5,384
48.Imaging, Lab and Diagnostics$0
49.Medical Supplies$67,929
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$32,570
55.Volunteer Program Costs$7,756
56.Fundraising$0
Other Costs
57.Other Program Costs*$960,720
59.Total Operating Expenses$2,882,697
* Program costs including community education and outreach program costs.
Hospice Income Statement
Line
No.		(1)
Total
Gross Patient Revenue
101.Medicare$2,148,915
102.Medi-Cal (Excluding Room and Board)$42,362
103.Medi-Cal Managed Care (Excluding Room and Board)$0
104.Managed Care (Non Medi-Cal)$153,556
105.Private Insurance$84,561
106.Self-Pay$0
109.Other Payers$0
110.Total Gross Patient Revenue (sum of lines 101 through 109)$2,429,394
Write-Offs and Adjustments
111.Contractual Adjustments$100,637
112.Denials / Bad Debt$0
113.Charity$0
119.Other Write-offs and Adjustments$67,896
120.Total Write-Offs and Adjustments (sum of lines 111 through 119)$168,533
125.Net Patient Revenue (line 110 minus line 120)$2,260,861
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)$2,260,861
Operating Expenses
151.General Service Cost Centers$40,950
152.Inpatient Care Service$43,440
153.Nursing Home$9,281
154.Program Supervision$0
155.Visiting Services$1,128,624
156.Hospice Service Cost Centers$659,356
157.Other Hospice Costs$40,326
159.Other Costs$960,720
160.Total Operating Expenses (sum of lines 151 through 159)$2,882,697
165.Net from Operations (line 145 minus line 160)-$621,836
170.Income Tax$0
175.Net Income (line 165 minus line 170)-$621,836
General Comments:
Errors and Warnings