Assessing UDS and Form 5B for Needs Assessment

Could you please clarify the question asked under Chapter 3 Needs Assessment, Element A?

Chapter 3 Needs Assessment, Element A wants to ensure that the health center is reviewing and documenting patient origin data from the most recent UDS report and ensuring those zip codes are accurately reflected on Form 5B. Having accurate zip codes served by a health center is important in understanding the needs of patients served. One way to ensure that most recently available data is reflected in your needs assessment is to perform a review of the zip codes your health center serves. The following would be considered a best practice:

  1. Once a health center has completed the final validation of submission of UDS data, review all the zip codes that were included in the UDS submission.
  2. Compare those updated zip codes to the zip codes that are recorded on Form 5B.
  3. If there are zip codes identified on Form 5B that are not included on the most recent UDS, or vice versa, complete an analysis to see whether zip codes on Form 5B should be added or removed.
  4. A health center doesn’t have to wait once a year to review zip codes. Patient demographics can be reviewed based on the needs of the health center.

Form 5B (Locations, Hours of Operations, and other health center site identifiers) should be a “living document” to ensure it reflects a health center’s current practice, just as the Form 5A (Scope of Services) should be.

Updating and reviewing your health center’s zip codes are considered “one piece of the puzzle” when it comes to your health center’s scope of services. Consider the following examples:

  1. A health center has noticed that after reviewing the zip codes reflected in their UDS data, there are 300 patients coming from a zip code that is not reflected on their Form 5B. Even though health centers do not turn patients away based on where a person resides, it’s important to ensure that those 300 patients from that one zip code are reflected on Form 5B. An analysis should be completed to determine at which site those 300 patients are receiving care in order to add that particular zip code to the site recorded on Form 5B. At times, the same zip code will be reflected on more than one site. 
  2. A health center has noticed they have had a decrease in patients from one particular zip code. Upon investigation, there are no residential homes in that particular zip code. All the homes have been replaced by a brand new shopping development. As there are no patients coming from that zip code, that zip code should be evaluated to see if it needs to be removed from Form 5B. 

Whether removing or adding zip codes, it is important that discussion related to zip code analysis be documented and discussed with the Board of Directors and with a health center’s HRSA Point of Contact. Any changes to Form 5B must be board approved.

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