Survival Strategies for Safety Net Dental Clinics

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Survival Strategies for Safety Net Dental Clinics by Frank Beck

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Survival Strategies for Safety Net Dental Clinics

  1. 1. SURVIVAL STRATEGIES FOR SAFETY NET DENTAL CLINICS THURSDAY OCTOBER 20, 2011M. Frank Beck, DDS, FAAHD, MAGD, FICOI, DSCDADental Program Director
  2. 2. Catholic Healthcare Partners CHP
  3. 3. St. Elizabeth Health Center Ambulatory Care Center Description: •Internal Medicine Clinics •Pediatric Clinic •Women’s Health Center •Pre-Natal Clinic •Gynecological Clinic •Surgical/Trauma Clinic •Ambulatory Care Pharmacy •WIC Program •Prescription Assistance Program •Specialty Clinics
  4. 4. Ambulatory Care Center Purpose of Service1. Provide health services to the ambulant patient of low income, no insurance and under insured referrals from other physicians, surgeons, Family Health Center (but not limited to this group).2. Provide for diagnosis and treatment of disease entities.3. Provide preventive health education and promote wellness on patient and family basis.4. Provide education and training opportunities for Ambulatory Care medical residents and medical/nursing students and related health professions.
  5. 5. Mission StatementThe mission of the Ambulatory Care Center is to provide individuals with healthcare, which includes prevention, diagnosis, treatment, and education regardless of theireconomic status. We are committed to delivering high quality medical care to everyonein need, with an emphasis on the poor and underserved residents within the community.As a teaching facility for the residency programs, the Ambulatory Care Center is alsodevoted to providing residents and students an education that emphasizes propermedical treatment as well as concern and respect for our patients and community.The Ambulatory Care Center is part of the Humility of Mary Health Partners, whichcontinues the healing ministry of the Sisters of Humility of Mary.
  6. 6. Adj : Grades of excellence
  7. 7. Hospital-Based General PracticeSafety Net Dental ResidencyDental Clinic Program
  8. 8. SCOPE OF SERVICES PROVIDED Mobile Inpatient Emergency CommunitDental Operatin Dental Floor Departmen yClinic g Room Vans Consults t Consults Education Floor Emergency Follow-ups Follow-ups
  9. 9. SCOPE of SERVICES PROVIDEDDENTAL MOBILECLINIC DENTAL VANS
  10. 10. INPATIENT FLOOR CONSULTSFOLLOWUP TREATMENTEMERGENCY ROOM CONSULTSFOLLOWUP TREATMENT The dental residents/ faculty provide coverage for 24 hour emergent care. This enables dental pathology to be intercepted and treated at an earlier stage of progression. Early interception of dental pathology prevents fulminant progression and extension to involve and exacerbate existing systemic co-morbidities. Not only does this reduce risk for the patient, but also significantly reduces cost to the hospital facility by preventing multi-organ system involvements.
  11. 11. LEVEL ONE TRAUMA CENTER
  12. 12. OUTPATIENT ORAL SURGICAL/GENERAL DENTALPROCEDURES IN THE MAIN OPERATING ROOM One of only three sites in the tri-county area to provide for comprehensive dental needs for the mentally-challenged, developmentally disabled, pediatric and frail/elderly. CDC data clearly demonstrates that people with disabilities and complex health conditions are at greater risk for oral disease. Early access to dental care will obviously prevent the progression of dental disease to a more fulminant pathology. However, less obvious is the fact that early access to dental care will also prevent the fulmination of coexisting systemic disease such as, CV, DM, HBP.
  13. 13. COMMUNITY EDUCATION The faculty, residents and staff educate the community regarding oral health and provide direction so members of the community may access the dental services they need.
  14. 14. SYSTEMS OF MANAGEMENT  Ensure Consistent Delivery of Care  Ensure Continuity of care
  15. 15. DEVELOP AND IMPLEMENTPOLICIES AND PROCEDURES
  16. 16. DEVELOP/IMPLEMENTINSTRUMENTS TOMEASURE & EVALUATEPERFOMANCE
  17. 17. PERFORMANCE PARAMETERS SAFETY NET RESIDENT PATIENT CAREDENTAL CLINIC EDUCATION Individuall Collectivel Faculty Residents y y
  18. 18. DENTAL CLINIC PERFORMANCE MEASURES Gross Charges Expenses # of Visits Rev per Cost per visit # of Unduplicated New pts # of Transactions/ No-Show Rate Emerg Rate # Children TOTAL # sealantsBaseline visit Pts visit receiving sealants applied <213 mo6 mo9 mo12 mo15 mo18 mo21 mo24 mo # of completed DDS RDH CDA treatments TPC’s 1-30 31-60 61-90 91+ Medicaid Sliding Fee 0 Sliding Fee Commercial Ins Other ** pay Scale Sliding Fee 20% or more3 mo6 mo9 mo12 mo15 mo18 mo21 mo24 mo
  19. 19. DENTAL CLINIC PERFORMANCE MEASURES Gross Expense # of Rev Cost per # of New # of No-Show Rate Emerg # Children TOTAL #Baseline Charges s Visits per visit Unduplicated pts Transactions/ Rate receiving sealants visit Pts visit sealants applied <213 mo 2.646 mo 2.689 mo 2.5012 mo 3.4215 mo 3.2718 mo 3.4221 mo 3.724 mo
  20. 20. # OF TRANSACTIONS/VISIT  2.64  3.7  40% increase!
  21. 21. AVG # PROCEDURES/ENCOUNTER  Ohio Safety Nets  2.4
  22. 22. RELATIVE ANNUALIZED # PT VISITS 3665 Pt Visits / 6months (3.7 vs. 2.4) Effectively Translates 5650 Pt Visits
  23. 23. NET RESULT OF INCREASE #CPT/VISIT  Increase Revenue/Visit  Decrease Cost/Visit  Increase Sustainability
  24. 24. OPERATORY TURNAROUND Disinfect/Set-up Operatory Meet/Greet/Seat Patient Procedure (procedures)** Operatory Breakdown Dismiss patient Documentation
  25. 25. Additional Considerations  Economy of Time  Economy of Materials  Favorable Ergonomics - by minimizing repetitive tasking
  26. 26. HOW do we accomplish this?Conversion of OBSTACLES into OPPORTUNITIES
  27. 27. OBSTACLES•No Show Rate•Transportation Barriers•Re-Appointment Intervals•Follow-Up Compliance
  28. 28. INCORPORATION OF OPEN/CLOSED DENTALAPPT CONCEPTS  Quadrant dentistry for those sitting in chair when next patient no shows.  Continuation of serial appointments  Conversion of emergency appointments to definitive care.
  29. 29. DENTAL CLINIC REVENUE SOURCES IME/DME Medicaid DSH In Kind Support HMHPBaseline EAGLESOFT Med Floor $564,000 DME Anthem ODH CHP HMHP 1000 ACC/R HRSA HRSA Curr In Kind Grant Totals Cross Consults 100,000 65,00 25,00 112,000 F Equip Grant Support HMHP Coding 1500 Totals 0 0 Facility Fees Professional Fees ER GRANTS3 mo 76,1256 mo 76,125 ***9 mo 1st 76,125 *** Med Cross12 mo 2nd Coding15 mo 3rd18 mo 4th21 mo24 mo
  30. 30. DEFINITIVE CARE DENTISTRY Only a dentist is trained and licensed to provide the DEFINITIVE CARE that the oral health needs of Ohioans require Without access to the definitive care provided by the dentist, many patients have sought care in a more costly setting such as a hospital emergency room.
  31. 31. DEFINITIVE DENTAL CARE CONT’D Treatment of patients requiring dental care in a hospital emergency room generally consists of little more than two prescriptions:  An antibiotic for infection  An analgesic for pain Thus, the patient receives only symptomatic relief and re-enters the system in the future presenting more fulminant pathology, requiring the utilization of even more resources
  32. 32. DEFINITIVE DENTAL CARE CONT’D In some cases the results of poor dental care have been deadly. A child in Mississippi and another in Maryland died in 2008, as a result of infections caused by decayed teeth. A similar life-threatening situation presented to SEHC Dental Clinic late in 2008 when a high risk 3rd trimester female presented to the dental clinic with multiple decayed and abscessed teeth.  OB/GYN consultation was obtained, appropriate medications prescribed and surgery scheduled  The patient did not show for surgery  Next presentation to EOR via ambulance in coma
  33. 33. UNNECESSARYVISITS IN THEEMERGENCY ROOM
  34. 34. METHODS Level I and II visits at SEHC Main ED from 10/07 thru 08/08 were analyzed (n = 3,088). Data provided by S. Rivello. Each encounter ICD9 diagnosis was reviewed to ascertain its necessity as a ED visit (by DG). Any encounter with associated procedures was considered necessary. Variables analyzed included self pay status, demographics, charges, and temporal variability.
  35. 35. Vaginitis 6 UTI 10 Gout 10 Other sprain 12 Cervicalgia Viral/ varicella 13 16 UNNECESSARY ED VISIT BY TOP 30 DIAGNOSIS ICD9 Bipolar/ depression/mental health 16 Other 18 Anxiety 18 Chronic pain 19 Dressing change/ sutures 20 Earwax 22 Sinusitis/ rhinitus 22 Joint pain/ osteoarthritis 24 Hypertension 26Pharyngitis/ Nasopharyngitis/strep 27 Bronchitis/ asthma 27 Repeat prescription 30 Scabies 31 Limb cramp/ myalgia 31 Hives 33 Allergy 35 STD/ VD/ HIV testing 40 URI/ cough 40 Backache/ lumbago/ disc 60Conjunctivitis/blepharitis/chalazion 85 Back sprain 92 Otitis media 154 Dermatitis 180 Dental 391
  36. 36. DEVELOPMENT AND IMPLEMENTATIONOF DEFINITIVE CARE CLINIC Our experiences in providing access to oral health care has clearly demonstrated that the PRIMARY motivating factor responsible for our patient population seeking care is PAIN not PREVENTION
  37. 37. ER CONSULT BY DENTAL RESIDENT Rx Antibiotic Rx 1-2 Analgesics LA Injection Appt 700am following day
  38. 38. INSTITUTIONAL QUALITY OF CARE Render definitive care Most appropriate venue Most cost effective manner
  39. 39. PERFORMANCE PARAMETERS SAFETY NET RESIDENT PATIENT CAREDENTAL CLINIC EDUCATION Individuall Collectivel Faculty Residents y y
  40. 40. PATIENT CARE QUALITY ASSESSMENT Collectively Individually
  41. 41. COLLECTIVELY Community Impact Performance measures
  42. 42. DENTAL CLINIC PERFORMANCE MEASURES Gross Charges Expenses # of Visits Rev per Cost per visit # of Unduplicated New pts # of Transactions/ No-Show Rate Emerg Rate # Children TOTAL # sealantsBaseline visit Pts visit receiving sealants applied <213 mo6 mo9 mo12 mo15 mo18 mo21 mo24 mo # of completed DDS RDH CDA treatments TPC’s 1-30 31-60 61-90 91+ Medicaid Sliding Fee 0 Sliding Fee Commercial Ins Other ** pay Scale Sliding Fee 20% or more3 mo6 mo9 mo12 mo15 mo18 mo21 mo24 mo
  43. 43. INDIVIDUALLY HMHP Physician Practice Satisfaction Surveys Quarterly
  44. 44. PERFORMANCE PARAMETERS SAFETY NET RESIDENT PATIENT CAREDENTAL CLINIC EDUCATION Individuall Collectivel Faculty Residents y y
  45. 45. RESIDENT EDUCATION QUALITY ASSESSMENTCODA Resident Resident QT Eval of QT FacultyStandards Continuous Repetition Residents by Evals QA/QI Sign off Faculty Sheets Residents DME
  46. 46. CODA STANDARDS
  47. 47. CODA STANDARDS Table of Contents PAGE Mission Statement of the Commission on Dental Accreditation .............................................. 2 Accreditation Status Definitions .................................................................................................. 3 Introduction ................................................................................................................................. 4 Goals ............................................................................................................................................. 6 Educational Environment ............................................................................................................ 9 Definition of Terms Used in Accreditation Standards ............................................................ 14 Accreditation Standards for Dental Education Programs ...................................................... 17 1- Institutional Effectiveness ............................................................................................ 17 2- Educational Program.................................................................................................... 20 2-1 Instruction ............................................................................................................. 20 2-3 Curriculum Management ...................................................................................... 20 2-9 Critical Thinking ................................................................................................... 22 2-10 Self-Assessment .................................................................................................... 23 2-11 Biomedical Sciences ............................................................................................. 23 2-15 Behavioral Sciences .............................................................................................. 24 2-17 Practice Management and Health Care Systems .................................................. 25 2-20 Ethics and Professionalism ................................................................................... 25 2-21 Clinical Sciences ................................................................................................... 26 3- Faculty and Staff ........................................................................................................... 29 4- Educational Support Services ...................................................................................... 30 4-1 Admissions ............................................................................................................ 30 4-5 Facilities and Resources ........................................................................................ 30 4-6 Student Services .................................................................................................... 31 4-7 Student Financial Aid ........................................................................................... 31 4-9 Health Services ..................................................................................................... 31 5- Patient Care Services .................................................................................................... 33 6- Research Program ........................................................................................................ 35
  48. 48. CODA STANDARDS Mission Statement of the Commission on Dental Accreditation The Commission on Dental Accreditation serves the public by establishing, maintaining and applying standards that ensure the quality and continuous improvement of dental and dental-related education and reflect the evolving practice of dentistry. The scope of the Commission on Dental Accreditation encompasses dental, advanced dental and allied dental education programs. Commission on Dental Accreditation Revised: January 30, 2001
  49. 49. RESIDENT CONTINUOUS QA/QIPARTICIPATION
  50. 50. RESIDENT STEP REPETITION SIGN OFF SHEETS
  51. 51. QT EVAL OF RESIDENTS BY FACULTY ST. ELIZABETH HEALTH CENTER EVALUATION OF COMPETENCIES GENERAL PRACTICE DENTAL RESIDENCY PROGRAM Resident: ___________________ Evaluation Period: _________________ Faculty: ______________________________________________ Date:_________________________ Faculty Signature:_______________________________________ Please circle the number corresponding to the resident’s performance in each area. Unsatisfactory= Several behaviors performed poorly or missed (rating 1, 2 or 3) Satisfactory= Most behaviors performed acceptably (ratings 4, 5,or 6); satisfactory performance is described below) Superior= All behaviors performed very well (ratings 7,8, or 9) Unsatisfactory Satisfactory Superior Professionalism 1. Demonstrates integrity and 1 2 3 4 5 6 7 8 9 ethical behavior; Accepts Takes responsibility for actions willingly; admits mistakes; puts patient responsibility and follows needs above own interests; recognizes & addresses ethical dilemmas & through on tasks conflicts of interest; maintains patient confidentiality; is industrious & dependable; completes tasks carefully & thoroughly; responds to requests in a helpful & prompt manner. 2. Practices within the scope 1 2 3 4 5 6 7 8 9 of his/her abilities Recognizes limits of his/her abilities; asks for help when needed; refers patients when appropriate; exercises authority accorded by position and/or experiences. 3. Demonstrates care and 1 2 3 4 5 6 7 8 9 concern for patients and Responds appropriately to patient & family emotions; establishes rapport; their families regardless of provides reassurance; is respectful & considerate; does not rush; is sensitive age, gender, ethnicity or to issues related to each patient’s culture, age, gender & disabilities; provides sexual orientation; Responds equitable care regardless of patient culture or socioeconomic status. to each patient’s unique characteristics and needs Interpersonal & Communication Skills 4. Always demonstrates integrity, respect 1 2 3 4 5 6 7 8 9 compassion, and empathy for patient. Establishes trust. Primary concern is for the patient’s welfare. Maintains credibility, excellent rapport with patients and families. 5. Communicates effectively 1 2 3 4 5 6 7 8 9 with other healthcare Maintains complete & legible medical records; writes clear & concise professionals consultation reports & referral letters; makes organized & concise presentations of patient information; gives clear & well-prepared presentations. 6. Works effectively with 1 2 3 4 5 6 7 8 9 other members of the Demonstrates courtesy to and consideration of consultants, therapists, healthcare team & other team members; invites others to share their knowledge & opinions; makes requests not demands; negotiates & compromises when disagreements occur; handles conflict constructively. Dental Knowledge 7. Extensive and well applied. Knowledge 1 2 3 4 5 6 7 8 9 Of disease, pathophysiology, diagnosis and Therapy. Consistently up-to-date. Self- Motivated to acquire knowledge. 8. Identifies all the patient’s problems. 1 2 3 4 5 6 7 8 9 Interrelates abnormal findings with altered dental pathology. Establishes sensible differential diagnoses. Provides orderly succession of testing, therapeutic recommendations
  52. 52. QT EVAL OF FACULTY BY RESIDENTS S t. Elizabe th He a lth Ce n te r D e p a rtm e n t Of D e n ta l Ed u c a tio n EVALU ATION of CORE FACU LTY by RES ID EN TS Ac a d e m ic Ye a r: 2011-2012 D a te s :_ J u ly – Oc to be r 2011______ P lea se eva lu a t e t h e fa cu lt y list ed below, r a t in g in a ll of t h e ca t egor ies or in dica t in g N/A. F a c u lty N a m e _________________ TEACHIN G CATEGORIES Ex c e lle n t Go o d F a ir P oor N /A 1. Tea ch in g E n t h u sia sm 2. Over a ll Tea ch ing Abilit y a . Ba sic Scien ce b. Clinica l Scien ce c. Lect u r e Con t en t d. Oper a t in g Room e. Con fer en ce At t en da n ce f. Con fer en ce P a r t icipa t ion 3. Wer e t h er e per son a lit y con flict s? Yes No If yes, plea se expla in : 4. Recom m en da t ion s/com m en t s: RE SIDE NT _____________________SIGNATURE _________________________________ P le a s e re tu rn to La ris s a Mc E lra th , D e n ta l Ed u c a tio n AS AP E va l. by Res.-of Core F a cu lt y (qt.
  53. 53. DIRECTOR OF MEDICAL EDUCATION• Completes Statistical Analysis and Evaluation• Faculty/Resident Retention, Advancement or Termination

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