Annual Utilization Report of Home Health Agencies / Hospices
Facility Name:REDLANDS COMMUNITY HOSP. HOME HEALTH CARE SERVICES
OSHPD ID:406364134Report Status:Submitted
License Category:Home Health AgencyReport Year:2008
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:REDLANDS COMMUNITY HOSP. HOME HEALTH CARE SERVICES
2.OSHPD ID Number:406364134
3.Street Address:350 TERRACINA BOULEVARD
4.City:REDLANDS
5.Zip:92373
6.Facility Phone No.:( 909) 335 - 5647 ext. 6407
7.Administrator Name:James Holmes
8.Administrator E-mail Address:ges@redlandshospital.org
9.Was this agency in operation at any time during the year?:Yes
10.Operation Open From:1/1/2008
11.Operation Open To:12/31/2008
12.Name of Parent Corporation:Redlands Community Hospital
13.Corporate Business Address:350 Terracina Blvd
14.City:Redlands
15.State:CA
16.Zip:92373 - 0742
17.Person Completing Report:Geraldine Smith
18.Phone No.:909-335-5647
19.Fax No.:909-335-5648
20.E-mail Address:ges@redlandshospital.org
25.Entity Type:Home Health Agency with Hospice Program
26.Entity RelationSole Facility
30.Submitted by:geraldinesmith06
31.Submitted Date and Time:3/10/2009 5:56:32 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 (incl. Church-related)
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 TherapyNo
23.IV Therapy (Includes Chemo and TPN)Yes
24.Mental Health CounselingNo
25.PediatricNo
26.Psychiatric NursingNo
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.1,585
Home Health Care
Line
No.		Other Home Health Visits(1)
No. of Visits
31.Pre-Admission Screening / Evaluations0
32.Outpatient Visits22,385
33.Other0
34.Total22,385
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 Years00
2.11 - 20 Years246
3.21 - 30 Years665
4.31 - 40 Years14197
5.41 - 50 Years32243
6.51 - 60 Years72948
7.61 - 70 Years1642,176
8.71 - 80 Years4917,019
9.81 - 90 Years6108,009
10.91 Years and Older1943,682
15.Total1,585 22,385
Admissions By Source Of Referral
Line
No.		Source Of Referral(1)
Admissions
21.Another Home Health Agency3
22.Clinic14
23.Family / Friend0
24.Hospice0
25.Hospital (Discharge Planner, etc.)786
26.Local Health Department0
27.Long Term Care Facility (SN / IC)181
28.MSSP0
29.Payer (Insurance, HMO, etc.)3
30.Physician394
31.Self4
32.Social Service Agency0
34.Other0
35.Total1,385
Discharges By Reasons
Line
No.		Reason for Discharge(1)
Discharges
41.Admitted to Hospital25
42.Admitted to SN / IC Facility19
43.Death6
44.Family / Friends Assumed Responsibility8
45.Lack of Funds0
46.Lack of Progress8
47.No Further Home Health Care Needed717
48.Patient Moved out of Area9
49.Patient Refused Service48
50.Physician Request60
51.Transferred to Another HHA3
52.Transferred to Home Care (Personal Care)0
53.Transferred to Hospice39
54.Transferred to Outpatient Rehabilitation11
59.Other7
60.Total960
Visits By Type Of Staff
Line
No.		Type of Staff(1)
Visits
71.Home Health Aide1,426
72.Nutritionist (Diet Counseling)0
73.Occupational Therapist1,897
74.Physical Therapist6,102
75.Physician0
76.Skilled Nursing12,046
77.Social Worker832
78.Speech Pathologist / Audiologist82
79.Spiritual and Pastoral Care0
84.Other0
85.Total22,385
Visits By Primary Source Of Payment
Line
No.		Source Of Payment(1)
Visits
91.Medicare6,170
92.Medi-Cal7
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)16,208
97.No Reimbursement0
99.Other (Includes MSSP)0
100.Total22,385
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		17265
2.HIV infections04200
3.Malignant neoplasms: Lung162.2 - 162.9,
197.0, 209.22, 231.2		00
4.Malignant neoplasms: Breast174.0 - 174.9,
175.0 - 175.9,
198.2, 198.81, 233.0		113
5.Malignant neoplasms: Intestines152.0 - 154.0,
159.0,  197.4,  197.5,  197.8,
209.00 - 209.17  230.3,  
230.4, 230.7		18346
6.Malignant neoplasms: All other sites, excluding those in #3, 4, 5140.0 - 209.30,
230.0 - 234.9		00
7.Non-malignant neoplasms: All sites209.40 - 209.69
210.0 - 229.9,
235.0 - 238.9,
239.0 - 239.9		110
8.Diabetes mellitus249.00 - 250.931692,031
9.Endocrine, metabolic, and nutritional diseases; Immunity disorders240.0 - 246.9,
251.0 - 279.9		15233
10.Diseases of blood and blood forming organs280.0 - 289.911137
11.Mental disorder290.0 - 31930555
12.Alzheimer's disease331.0799
13.Disease of nervous system and sense organs320.0 - 330.9,
331.11 - 389.9		39617
14.Diseases of cardiovascular system391.0 - 392.0,
393 - 402.91,
404.00 - 429.9		3504,031
15.Diseases of cerebrovascular system430 - 438.917270
16.Diseases of all other circulatory system390,  392.9,
403.00 - 403.91,
440.0 - 459.9		130486
17.Diseases of respiratory system460 - 519.91221,629
18.Diseases of digestive system520.0 - 579.929414
19.Diseases of genitourinary system580.0 - 608.9,
614.0 - 629.9		33893
20.Diseases of breast610.0 - 611.900
21.Complications of pregnancy, childbirth, and the puerperium630 - 679.1400
22.Diseases of skin and subcutaneous tissue680.0 - 709.9411,255
23.Diseases of musculosketal system and connective tissue (include pathological fx, malunion fx, and nonunion fx)710.0 - 739.92252,461
24.Congenital anormalies and perinatal conditions (include birth fractures)740.0 - 779.900
25.Symptoms, signs, and ill-defined conditions (exclude HIV positive test)780.01 - 795.6,
795.79,
796.0 - 799.9		1192,332
26.Fractures (exclude birth fx, pathological fx, malunion fx, nonunion fx)800.00 - 829.100
27.All other injuries830.0 - 959.972807
28.Poisonings and adverse effects of external causes960.0 - 995.9400
29.Complications of surgical and medical care996.00 - 999.900
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		00
32.Health hazards related to communicable diseasesV01.0 - V07.9,
V09.0 - V19.8,
V40.0 - V49.9		34550
33.Other health services for specific procedures and aftercareV50.0 - V58.91052,951
34.Visits for Evaluation and AssessmentV60.0 - V89.0900
45.Total1,58522,385
* The list of ICD-9-CM codes excluded: 795.71, V08, V27.0-V27.9, V30-V39 with 5th digits 0 or 1, 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.HIV04200
52.Alzheimer's Disease331.0799
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 (incl. Church-related)
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 patients339
2.Survivors of persons not receiving hospice care4
Volunteer Services
Line
No.		Volunteer Services(1)
No. of Volunteers		(2)
Volunteer Hours
3.Patient / Family Services4984
4.Bereavement3300
5.Administrative3800
6.Medicare Reportable Hours
(sum lines 3-5)		2,084
7.Fundraising00
9.Other00
10.Total102,084
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 - RN3,975
22.Nursing - LVN1,274
23.Social Services644
24.Hospice Physician Services49
25.Homemaker and Home Health Aide2,837
26.Chaplain318
29.Other Clinical Services68
30.Total9,165
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 Years0101
6.31 - 40 Years1304
7.41 - 50 Years2002
8.51 - 60 Years6208
9.61 - 70 Years1611027
10.71 - 80 Years2540065
11.81 - 90 Years2764091
12.91 + Years932041
15.Total861530239
Unduplicated Hospice Patients By Gender and Race
Line
No.		Race
(1)

Male
(2)

Female		(3)
Other / Unknown
(4)

Total
21.White701320202
22.Black0202
23.Native American0101
24.Asian / Pacific Islander1304
25.Other / Unknown1515030
30.Total861530239
Unduplicated Hospice Patients By Gender And Ethnicity
Line
No.		Ethnicity
(1)

Male
(2)

Female		(3)
Other / Unknown
(4)

Total
31.Hispanic1111022
32.Non-Hispanic711380209
33.Unknown4408
35.Total861530239
Hospice Patient Admissions By Source Of Referral
Line
No.		Source of Referral(1)
Patients
41.Home Health Agency18
42.Hospital (Discharge Planner, etc.)69
43.Long-Term Care Facility7
44.Other Hospice1
45.Payer (Insure, HMO,etc.)0
46.Physician88
47.RCFE / ARF/ CLHF1
48.Self / Family / Friend14
49.Social Service Agency0
54.Other2
55.Total200
Hospice Patient Discharges By Reason
Line
No.		Reason for Discharge(1)
Patients
61.Death177
62.Patient Moved Out of Area3
63.Patient Refused Service0
64.Transferred to Another Local Hospice3
65.Prognosis Extended9
66.Patient Desired Curative Treatment8
69.Other0
70.Total200
Hospice Patients Discharged By Length Of Stay
Line
No.		Length of Stay
(Days)		(1)
Patients
71.0-5 Days36
72.6-10 Days42
73.11-15 Days20
74.16-20 Days14
75.21-30 Days9
76.31-60 Days21
77.61-90 Days17
78.91-120 Days8
79.121-150 Days5
80.151-180 Days3
84.181 + Days25
85.Total200
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.Riverside3835544
92.San Bernardino16214218195
93.0000
94.0000
95.0000
96.0000
97.0000
98.0000
99.0000
100.Total20017723239
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 - 209.30,
230.0 - 234.9		1033,7425,399
2.Heart391.0 - 392.0,
393 - 402.91,
404.0 - 404.9 with fifth digit 1 or 3,
410.00 - 429.9		231,8922,955
3.Dementia and Cerebral Degeneration290.0 - 294.9,
331.0-331.9		231,5692,233
4.Lung, excluding cancer460 - 519.9, 573.9251,0732,070
5.Kidney, excluding cancer403.00 - 403.91,
404.0 - 404.9 with fifth digit 0, 2 or 3,
405.0 - 405.9 with fifth digit 1,
580.0 - 589.9		483103
6.Liver, excluding cancer570 - 573.947171
7.HIV042000
8.Brain Stroke and late effects430 - 436,
438.0 - 438.9,
997.02		42626
9.Coma, with or without brain injury780.01 - 780.09,
850.4,
851.0 - 854.1 with fifth digit 5		000
10.Diabetes249.00 - 250.93144
11.ALS*335.20299
19.OtherAll other codes that are not in lines 1-11.116961,107
20.Total2009,16513,977
* 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.Medicare21312,67107012,678
2.Medi-Cal160006
3.Medi-Cal Managed Care000000
4.Managed Care24557000557
5.Private Insurance000000
6.Self Pay000000
7.Charity000000
9.Other*13700037
10.Total23913,27107013,278
* 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.Home9,943009,943
22.Hospital0000
23.SNF857070864
24.CLHF177000177
25.RCFE / ARF2,294002,294
29.Other00000
30.Total13,27107013,278
Section 10 - Hospice Income and Expenses Statement
Detail Of Operating Expenses
Line
No.		(1)
Total
General Service Cost Centers
30.Administrative and General$317,172
Inpatient Care Service
31.Inpatient - General Care$0
32.Inpatient - Respite Care$0
Nursing Home
33.Room and Board SNFMedi-Cal Pass through Payments( $49,937 )
34.Medi-Cal Room and Board Contractual Payments$49,937
Program Supervision
35.Hospice Program / Team Supervision (Non-visit wages)$142,876
Visiting Services
36.Physician Services$15,821
37.Nursing Care$640,898
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$395,298
Hospice Service Cost Centers
45.Drugs, Biologicals and Infusion$57,329
46.Durable Medical Equipment / Oxygen$123,547
47.Patient Transportation$0
48.Imaging, Lab and Diagnostics$0
49.Medical Supplies$19,967
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*$93,998
59.Total Operating Expenses$1,806,906
* Program costs including community education and outreach program costs.
Hospice Income Statement
Line
No.		(1)
Total
Gross Patient Revenue
101.Medicare$3,332,211
102.Medi-Cal (Excluding Room and Board)$8,825
103.Medi-Cal Managed Care (Excluding Room and Board)$0
104.Managed Care (Non Medi-Cal)$169,206
105.Private Insurance$0
106.Self-Pay$0
109.Other Payers$9,958
110.Total Gross Patient Revenue (sum of lines 101 through 109)$3,520,200
Write-Offs and Adjustments
111.Contractual Adjustments$1,387,021
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)$1,387,021
125.Net Patient Revenue (line 110 minus line 120)$2,133,179
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)$2,133,179
Operating Expenses
151.General Service Cost Centers$317,172
152.Inpatient Care Service$0
153.Nursing Home$0
154.Program Supervision$142,876
155.Visiting Services$1,052,017
156.Hospice Service Cost Centers$200,843
157.Other Hospice Costs$0
159.Other Costs$93,998
160.Total Operating Expenses (sum of lines 151 through 159)$1,806,906
165.Net from Operations (line 145 minus line 160)$326,273
170.Income Tax$0
175.Net Income (line 165 minus line 170)$326,273
General Comments:
Errors and Warnings