Annual Utilization Report of Home Health Agencies / Hospices
Facility Name:KAISER FOUNDATION HOSPITAL LOS ANGELES HHA
OSHPD ID:406190723Report Status:Submitted
License Category:Home Health AgencyReport Year:2016
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
Section 11 - Hospice Inpatient Facility/Unit
General Comments
View Errors and Warnings
Section 1 - General Information
1.Facility Name:KAISER FOUNDATION HOSPITAL LOS ANGELES HHA
2.OSHPD ID Number:406190723
3.Street Address:3699 WILSHIRE BLVD
STE 3
4.City:LOS ANGELES
5.Zip:90010
6.Facility Phone No.:( 213) 351 - 4520 ext.
7.Administrator Name:Vilma Monroy
8.Administrator E-mail Address:vilma.x.monroy@kp.org
9.Was this agency in operation at any time during the year?:Yes
10.Operation Open From:1/1/2016
11.Operation Open To:12/31/2016
12.Name of Parent Corporation:Kaiser Foundation Hospital Los Angeles Metro HH
13.Corporate Business Address:3699 Wilshire Blvd., 3rd Floor
14.City:Los Angeles
15.State:CA
16.Zip:90010 -
17.Person Completing Report:Vilma Monroy
18.Phone No.:323-783-7520
19.Fax No.:323-783-1593
20.E-mail Address:vilma.x.monroy@kp.org
25.Entity Type:Home Health Agency with Hospice Program
26.Entity RelationParent
30.Submitted by:vxmonroy
31.Submitted Date and Time:3/14/2017 2:56:21 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 JCAHODeemed Status
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?Yes
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.Non-hospice Palliative CareYes
29.OtherNo
Persons Receiving Services
Line
No.		(1)
30.Number of unduplicated persons seen by your agency during the reporting year.3,534
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?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 Years65179
2.11 - 20 Years46307
3.21 - 30 Years47596
4.31 - 40 Years53796
5.41 - 50 Years1581,712
6.51 - 60 Years4183,982
7.61 - 70 Years9107,340
8.71 - 80 Years1,0129,119
9.81 - 90 Years9119,943
10.91 Years and Older3254,018
15.Total3,945 37,992
Admissions By Source Of Referral
Line
No.		Source Of Referral(1)
Admissions
21.Another Home Health Agency8
22.Clinic0
23.Family / Friend0
24.Hospice1
25.Hospital (Discharge Planner, etc.)2,436
26.Local Health Department0
27.Long Term Care Facility (SN / IC)130
28.MSSP0
29.Payer (Insurance, HMO, etc.)0
30.Physician937
31.Self0
32.Social Service Agency0
34.Other39
35.Total3,551
Discharges By Reasons
Line
No.		Reason for Discharge(1)
Discharges
41.Admitted to Hospital83
42.Admitted to SN / IC Facility38
43.Death138
44.Family / Friends Assumed Responsibility76
45.Lack of Funds0
46.Lack of Progress4
47.No Further Home Health Care Needed1,693
48.Patient Moved out of Area23
49.Patient Refused Service38
50.Physician Request4
51.Transferred to Another HHA37
52.Transferred to Home Care (Personal Care)2
53.Transferred to Hospice141
54.Transferred to Outpatient Rehabilitation924
59.Other8
60.Total3,209
Visits By Type Of Staff
Line
No.		Type of Staff(1)
Visits
71.Home Health Aide0
72.Nutritionist (Diet Counseling)0
73.Occupational Therapist989
74.Physical Therapist8,985
75.Physician0
76.Skilled Nursing25,656
77.Social Worker2,361
78.Speech Pathologist / Audiologist0
79.Spiritual and Pastoral Care0
84.Other1
85.Total37,992
Visits By Primary Source Of Payment
Line
No.		Source Of Payment(1)
Visits
91.Medicare1,261
92.Medi-Cal98
93.TRICARE (CHAMPUS)0
94.Other Third Party (Insurance, etc.)61
95.Private (Self Pay)210
96.HMO / PPO (Includes Medicare and Medi-Cal HMOs)36,254
97.No Reimbursement100
99.Other (Includes MSSP)8
100.Total37,992
Section 4 - Health Care Utilization
Patients And Visits By Principal Diagnosis For Which Care Was Given*
Line
No.		Principal Diagnosis
ICD-10-CM Codes
Patients
(1)		Visits
(2)
1.Infectious and Parasitic diseases (exclude HIV)A00-B99 (exclude B20)218
2.HIV infectionsB2029
3.Malignant neoplasms: LungC34, C78.0, C7A.090, D02.20-D02.2223179
4.Malignant neoplasms: BreastC50, C79.2, C79.80- C79.89, D05.90-D05.92453
5.Malignant neoplasms: IntestinesC17-C21, C26.0, C78.4, C78.5, C7A.010-C7A.029, D01.0-D01.49429
6.Malignant neoplasms: All other sites, excluding those in #3, 4, 5C00-D09*61696
7.Non-malignant neoplasms: All sitesD10-D4928
8.Diabetes mellitusE08-E1321317
9.Endocrine, metabolic, and nutritional diseases; Immunity disordersE00-E07, E15-E884203
10.Diseases of blood and blood forming organsD50-D77, D80-D8955454
11.Mental disorderF01-F99362
12.Alzheimer's diseaseG30.0-G30.943383
13.Disease of nervous system and sense organsG00-G26, G31-G96, G98-H57, H60-H9428370
14.Diseases of cardiovascular systemI10-I11, I13, I20-I526073,233
15.Diseases of cerebrovascular systemI60-I6972673
16.Diseases of all other circulatory systemI00, I02.9, I12, I15, I70-I96, I9955666
17.Diseases of respiratory systemJ00-J94, J96-J9963727
18.Diseases of digestive systemK00-K90, K9241504
19.Diseases of genitourinary systemN00-N53, N70-N9766896
20.Diseases of breastN60-N6517
21.Complications of pregnancy, childbirth, and the puerperiumO00-O9A913
22.Diseases of skin and subcutaneous tissueL00-L75, L80-L9948310,095
23.Diseases of musculosketal system and connective tissue (include pathological fx, malunion fx, and nonunion fx)M00-M95, M997564,159
24.Congenital anormalies and perinatal conditions (include birth fractures)P00-P96, Q00-Q9900
25.Symptoms, signs, and ill-defined conditions (exclude HIV positive test)R00-R9919106
26.Fractures (exclude birth fx, pathological fx, malunion fx, nonunion fx)S02, S12, S22, S32, S42, S49, S52, S59, S62, S72, S79, S82, S89, S922501,533
27.All other injuries, *excluding fracturesS00-T34* , T51-T7916505
28.Poisonings and adverse effects of external causesT36-T5000
29.Complications of surgical and medical careD78, E89, G97, H59, H95, I97, J95, K91, K94, L76, M96, N98-N99, T80-T8800
30.Health services related to reproduction and developmentZ00.1-Z00.3, Z30-Z36, Z39, Z76583
31.Infants born outside hospital (infant care)Z38.1, Z38.2, Z38.4, Z38.5, Z38.7, Z38.814
32.Health hazards related to communicable diseases (exclude HIV test result)Z21-Z28, Z77-Z9900
33.Other health services for specific procedures and aftercareZ40-Z536905,688
34.Visits for Evaluation and AssessmentZ00.0, Z01-Z18, Z55-Z685596,319
45.Total3,94537,992
** The list of ICD-10-CM codes excluded: V00-Y99, Z37, and Z52.
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-10-CM Code(1)
Patients		(2)
Visits
51.HIVB20420
52.Alzheimer's DiseaseG30.0-G30.951499
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 JCAHODeemed Status
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 patients235
2.Survivors of persons not receiving hospice care652
Volunteer Services
Line
No.		Volunteer Services(2)
Volunteer Hours
3.Patient / Family Services311
4.Bereavement388
5.Administrative12
6.Medicare Reportable Hours
(sum lines 3-5)		711
7.Fundraising0
9.Other48
10.Total759
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 Inpatient Facility / UnitNo
12.Specialized Pediatric ProgramNo
13.Bereavement services to survivors of persons not receiving hospice careYes
14.Adult Day CareNo
15.Hospice Physician Consultation VisitsNo
16.Non-hospice Palliative Care Service ProvidedYes
17.Other ServicesNo
(1) If Line 11 is checked then complete Section 11, Lines 1 through 20.
Visits By Type Of Staff
(Include After-Hours and Bereavement Visits)
Line
No.		Type of Staff(1)
Visits
21.Nursing - RN3,677
22.Nursing - LVN0
23.Social Services1,090
24.Hospice Physician Services115
25.Homemaker and Home Health Aide2,026
26.Chaplain590
29.Other Clinical Services0
30.Total7,498
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 Years1203
6.31 - 40 Years1304
7.41 - 50 Years68014
8.51 - 60 Years1636052
9.61 - 70 Years4128069
10.71 - 80 Years3433067
11.81 - 90 Years3246078
12.91 + Years1536051
15.Total1461920338
Unduplicated Hospice Patients By Gender and Race
Line
No.		Race
(1)

Male
(2)

Female		(3)
Other / Unknown
(4)

Total
21.White52640116
22.Black3149080
23.Native American0000
24.Asian / Pacific Islander817025
25.Other / Unknown4652098
26.More than one race910019
30.Total1461920338
Unduplicated Hospice Patients By Gender And Ethnicity
Line
No.		Ethnicity
(1)

Male
(2)

Female		(3)
Other / Unknown
(4)

Total
31.Hispanic2025045
32.Non-Hispanic1261670293
33.Unknown0000
35.Total1461920338
Hospice Patients Discharged By Reason
Line
No.		Reason for Discharge(1)
Patients
61.Death266
62.Patient Moved Out of Area5
63.Patient Refused Service5
64.Transferred to Another Local Hospice2
65.Prognosis Extended24
66.Patient Desired Curative Treatment2
69.Other8
70.Total312
Hospice Patients Discharged By Length Of Stay
Line
No.		Length of Stay
(Days)		(1)
Patients
71.0-7 Days81
72.8-30 Days73
73.31-90 Days75
74.91-179 Days61
75.180+ Days22
85.Total312
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 Angeles30026650346
92.0000
93.0000
94.0000
95.0000
96.0000
97.0000
98.0000
99.0000
100.Total30026650346
Number Of Hospice Admissions By Diagnosis
Line
No.		Diagnosis
ICD-10-CM Codes

No. of New
Admissions

(1)
Re-admissions
Previously Seen
by Another
Hospice
Program

(2)
Re-admissions
Previously Seen
by This
Hospice
Program
(3)
Total
Admissions
(1)+(2)+(3)
(4)
101.CancerC00-D09164016180
102.HeartA01.02, A18.84, A32.82, A36.81, A39.5, A52.00, A52.03, A52.06, A54.83, B26.82, B33.2, B37.6, B58.81, I01-I09, I10-I11, I13, I20-I52, I97.0-I97.1, I97.3-I97.7, M05.3, M32.11-M32.12, T82.0-T82.2, T82.5-T82.9, T86.2-T86.3200727
103.Dementia & Cerebral
Degeneration		A50.17, F01-F09, F10.27, F10.97, F13.27, F13.97, F18.27, F18.97, F19.27, F19.97, G30-G323101849
104.Lung, excluding cancerA01.03, A02.22, A15, A22.1, A36.0-A36.2, A37, A42.0, A43.0, A54.5, A54.84, B00.2, B01.2, B05.2, B06.81, B08.5, B25.0, B37.1, B38.0-B38.2, B59, B77.81, J00-J99, M32.13, T81.82, T86.85038
105.Kidney, excluding cancer
and diabetic
kidney disease
A02.25, A18.11, A36.84, A54.21, A51.44, I12, I15.0-I15.1, M32.14-M32.15, N00-N29, T82.4, T86.10022
106.Liver, excluding cancerA06.4, A51.45, A52.74, B00.81, B15-B19, B25.1, B26.81, B58.1, B67.0, B67.5, B67.8, K00-K77, K91.81, T86.47018
107.HIVB200000
108.Brain Stroke and late effectsA52.04, A52.05, G45, I60-I69, I97.81-I97.8260612
109.Coma, with or without brain injuryR40.0-R40.4, S060000
110.DiabetesE08-E130000
111.ALS*G12.211023
112.GI disease, excluding cancerK25-K63, K920000
113.Multiple SclerosisG350022
114.Congenital DefectsQ00.0 - Q99.91001
115.General Debility and Failure to ThriveG93.3, R41.81, R53.8, R54, R62.51, R62.71001
119.OtherAll other codes that are not in lines 101-115450954
120.TOTAL281066347
*Amytrophic lateral sclerosis (ALS), also called Lou Gehrig's Disease
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-10-CM codes are provided only as a guide to you. You may use definitions for diagnosis groups or the Local Medical Review Policy (LMRP) diagnosis codes from your fiscal intermediary, provided they match in a general way with the ICD-10-CM codes.
Discharged Hospice Patients, Visits And Patient Days By Diagnosis
Line
No.		Diagnosis
ICD-10-CM Codes
Number of Live Discharges

(1)
No. of Discharges due to Death

(2)
Total Number of Discharges

(3)
Visits for Discharged Patients

(4)
Discharged Patients Total Days of Care

(5)
1.CancerC00-D09151521673,2696,971
2.HeartA01.02, A18.84, A32.82, A36.81, A39.5, A52.00, A52.03, A52.06, A54.83, B26.82, B33.2, B37.6, B58.81, I01-I09, I10-I11, I13, I20-I52, I97.0-I97.1, I97.3- I97.7, M05.3, M32.11-M32.12, T82.0-T82.2, T82.5-T82.9, T86.2-T86.3421258831,844
3.Dementia and Cerebral DegenerationA50.17, F01-F09, F10.27, F10.97, F13.27, F13.97, F18.27, F18.97, F19.27, F19.97, G30-G321129401,2602,943
4.Lung, excluding cancerA01.03, A02.22, A15, A22.1, A36.0-A36.2, A37, A42.0, A43.0, A54.5, A54.84, B00.2, B01.2 B05.2, B06.81, B08.5, B25.0, B37.1, B38.0-B38.2 B59, B77.81, J00-J99, M32.13, T81.82, T86.8178517873
5.Kidney, excluding cancerA02.25, A18.11, A36.84, A54.21, A51.44, I12, I15.0- I15.1, M32.14-M32.15, N00- N29, T82.4, T86.11012550
6.Liver, excluding cancerA06.4, A51.45, A52.74, B00.81, B15-B19, B25.1, B26.81, B58.1, B67.0, B67.5, B67.8, K00-K77, K91.81, T86.4246156497
7.HIVB2000000
8.Brain Stroke and late effectsA52.04, A52.05, G45, I60- I69, I97.81-I97.8247115071,069
9.Coma, with or without brain injuryR40.0-R40.4, S0600000
10.DiabetesE08-E1300000
11.ALS*G12.21303229936
12.GI disease, excluding cancerK25-K63, K9200000
13.Multiple SclerosisG35112199389
14.Congenital DefectsQ00.0 - Q99.901196
15.General Debility and Failure to ThriveG93.3, R41.81, R53.8, R54, R62.51, R62.7011915
19.OtherAll other codes that are not in lines 1-11.641479642,095
20.Total482643128,02717,688
* 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 Inpatient Respite Care		(5)
Days of Continuous Care		(6)
Total Patient Care Days
1.Medicare34716,52800016,528
2.Medi-Cal000000
3.Medi-Cal Managed Care000000
4.Managed Care1482,8860002,886
5.Private Insurance000000
6.Self Pay000000
7.Charity000000
8.Veterans Administration000000
9.Other*000000
10.Total49519,41400019,414
* 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)
No. of Patients Served		(2)
Days of Routine Home Care		(3)
Days of Inpatient Care		(4)
Days of Inpatient Respite Care		(5)
Days of Continuous Care
(6)

Total Patient Care Days
21.Home49516,528016,528
22.Hospital00000
23.SNF000000
24.CLHF000000
25.RCFE / ARF / RCFCI0000
26.ICF / MR0000
27.Prison0000
28.Homeless0000
29.Other1482,8860002,886
30.Total64319,41400019,414
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
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
Gross Patient Revenue for Hospice Four Levels of Care
101.Medicare$0
102.Medi-Cal (Excluding SNF Room and Board)$0
103.Medi-Cal Managed Care (Excluding SNF 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 Revenue for Hospices Four Levels of Care$0
Room & Board Revenue
1101.SNF Room & Board pass Through Receivable from Medi-Cal$0
1102.Medi-Cal Room & Board Contractual Payments to SNF( $0)
1103.Net Room & Board Revenue$0
1104.Total Gross Patient Revenue (Sum of Lines 110 and 1103)$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 1104 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
160.Total Operating Expenses (from line 59)$0
165.Net from Operations (line 145 minus line 160)$0
170.Income Tax$0
175.Net Income (line 165 minus line 170)$0
Section 11 - Hospice Inpatient Facility/Unit
HOSPICE OPERATED SITES AND NUMBER OF BEDS
Line
No.		(1)
Name		(2)
Address		(3)
City		(4)
State		(5)
Zip		(6)
Type of Licensed Beds		(7)
No. of Beds
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.Total0
LEVELS OF CARE HOSPICE SITES PROVIDE
Line
No.		Type of Care(1)
No. of Patient days
11.General Inpatient Care0
12.Inpatient Respite care0
13.Continuous Care0
14.Routine Care0
20TOTAL0
General Comments:
Errors and Warnings