survival strategies for safety net dental clinics
DESCRIPTION
Survival Strategies for Safety Net Dental Clinics by Frank BeckTRANSCRIPT
SURVIVAL STRATEGIES FOR SAFETY NET DENTAL CLINICSTHURSDAY OCTOBER 20, 2011
M. Frank Beck, DDS, FAAHD, MAGD, FICOI, DSCDADental Program Director
Catholic Healthcare Partners CHP
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
St. Elizabeth Health CenterAmbulatory Care Center
1. 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.
Ambulatory Care CenterPurpose of Service
Mission Statement
The mission of the Ambulatory Care Center is to provide individuals with health care, which includes prevention, diagnosis, treatment, and education regardless of their economic status. We are committed to delivering high quality medical care to everyone in 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 also devoted to providing residents and students an education that emphasizes proper medical 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, which continues the healing ministry of the Sisters of Humility of Mary.
QUALITY
Adj : Grades of excellence
Hospital-Based Safety Net Dental Clinic
General Practice Dental Residency Program
Dental Clinic
SCOPE OF SERVICES PROVIDED
Mobile Dental Vans
Inpatient Floor
Consults
Emergency
Department
Consults
Operating
Room
Community
Education
Floor Follow-
ups
Emergency Follow-
ups
SCOPE of SERVICES PROVIDED
DENTAL CLINIC
MOBILE DENTAL VANS
INPATIENT FLOOR CONSULTSFOLLOWUP TREATMENT
EMERGENCY ROOM CONSULTS FOLLOWUP 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.
LEVEL ONE TRAUMA CENTER
OUTPATIENT ORAL SURGICAL/GENERAL DENTAL PROCEDURES 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.
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.
If You don’t know where your going ….
Any road will get you there!
SYSTEMS OF MANAGEMENT
Ensure Consistent Delivery of Care
Ensure Continuity of care
DEVELOP AND IMPLEMENT POLICIES AND PROCEDURES
DEVELOP/IMPLEMENT INSTRUMENTS TO MEASURE & EVALUATE PERFOMANCE
PERFORMANCE PARAMETERS
SAFETY NET DENTAL CLINIC
PATIENT CARERESIDENT
EDUCATION
Individually
Collectively
Faculty Residents
DENTAL CLINIC PERFORMANCE MEASURES
BaselineGross Charges Expenses # of Visits Rev per
visitCost per visit # of Unduplicated
PtsNew pts
# of Transactions/visit
No-Show Rate Emerg Rate
# Children receiving sealants <21
TOTAL # sealants applied
3 mo
6 mo
9 mo
12 mo
15 mo
18 mo
21 mo
24 mo
DDS RDH CDA**
# of completed treatments TPC’s
1-30 31-60 61-90 91+ Medicaid Sliding Fee 0 paySliding Fee 20% or more
Sliding Fee Scale
Commercial Ins
Other
3 mo
6 mo
9 mo
12 mo
15 mo
18 mo
21 mo
24 mo
DENTAL CLINIC PERFORMANCE MEASURES
BaselineGross Charges
Expenses
# of Visits
Rev per visit
Cost per visit
# of Unduplicated Pts
New pts
# of Transactions/visit
No-Show Rate Emerg Rate
# Children receiving sealants <21
TOTAL # sealants applied
3 mo 2.64
6 mo 2.68
9 mo 2.50
12 mo 3.42
15 mo 3.27
18 mo 3.42
21 mo 3.7
24 mo
# OF TRANSACTIONS/VISIT
2.64 3.7 40% increase!
AVG # PROCEDURES/ENCOUNTER
Ohio Safety Nets 2.4
RELATIVE ANNUALIZED # PT VISITS
3665 Pt Visits / 6months (3.7 vs. 2.4)
Effectively Translates 5650 Pt Visits
NET RESULT OF INCREASE #CPT/VISIT
Increase Revenue/Visit Decrease Cost/Visit Increase Sustainability
OPERATORY TURNAROUND
Disinfect/Set-up Operatory
Meet/Greet/Seat Patient Procedure (procedures)** Operatory Breakdown Dismiss patient Documentation
Economy of Time Economy of Materials Favorable Ergonomics - by
minimizing repetitive tasking
Additional Considerations
HOW do we accomplish this?
Conversion of OBSTACLES into OPPORTUNITIES
• No Show Rate
• Transportation Barriers
• Re-Appointment
Intervals
• Follow-Up Compliance
OBSTACLES
INCORPORATION OF OPEN/CLOSED DENTAL APPT CONCEPTS
Quadrant dentistry for those sitting in chair when next patient no shows.
Continuation of serial appointments Conversion of emergency
appointments to definitive care.
DENTAL CLINIC REVENUE SOURCESBaseline
EAGLESOFT Med Cross Codin
g
ER
FloorConsults
IME/DME$564,000
Medicaid DME
DSHAnthem100,000
ODH65,000
CHP25,000
HMHP112,000
1000 ACC/RF1500
HRSA Equip
HRSA Curr
In Kind Grant Support HMHP Totals
Grant TotalsIn Kind Support HMHP
3 mo 76,125
6 mo 76,125 ***
9 mo 1st 76,125 ***
12 mo 2nd
15 mo 3rd
18 mo 4th
21 mo
24 mo
Facility Fees Professional Fees
GRANTS
Med Cross Coding
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.
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
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
UNNECESSARY VISITS IN THE EMERGENCY ROOM
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.
391
180154
92
8560
40
4035
33
3131
30
2727
26
2422
22
2019
18
1816
16
1312
10
106
Dental
Dermatitis
Otitis media
Back sprain
Conjunctivitis/blepharitis/chalazion
Backache/ lumbago/ disc
URI/ cough
STD/ VD/ HIV testing
Allergy
Hives
Limb cramp/ myalgia
Scabies
Repeat prescription
Bronchitis/ asthma
Pharyngitis/ Nasopharyngitis/strep
Hypertension
J oint pain/ osteoarthritis
Sinusitis/ rhinitus
Earwax
Dressing change/ sutures
Chronic pain
Anxiety
Other
Bipolar/ depression/mental health
Viral/ varicella
Cervicalgia
Other sprain
Gout
UTI
Vaginitis
UNNECESSARY ED VISIT BY TOP 30 DIAGNOSIS ICD9
DEVELOPMENT AND IMPLEMENTATION OF 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
ER CONSULT BY DENTAL RESIDENT
Rx Antibiotic Rx 1-2 Analgesics LA Injection Appt 700am following day
INSTITUTIONAL QUALITY OF CARE
Render definitive care Most appropriate venue Most cost effective manner
PERFORMANCE PARAMETERS
SAFETY NET DENTAL CLINIC
PATIENT CARERESIDENT
EDUCATION
Individually
Collectively
Faculty Residents
PATIENT CARE QUALITY ASSESSMENT
Collectively
Individually
COLLECTIVELY
Community Impact Performance measures
DENTAL CLINIC PERFORMANCE MEASURES
BaselineGross Charges Expenses # of Visits Rev per
visitCost per visit # of Unduplicated
PtsNew pts
# of Transactions/visit
No-Show Rate Emerg Rate
# Children receiving sealants <21
TOTAL # sealants applied
3 mo
6 mo
9 mo
12 mo
15 mo
18 mo
21 mo
24 mo
DDS RDH CDA**
# of completed treatments TPC’s
1-30 31-60 61-90 91+ Medicaid Sliding Fee 0 paySliding Fee 20% or more
Sliding Fee Scale
Commercial Ins
Other
3 mo
6 mo
9 mo
12 mo
15 mo
18 mo
21 mo
24 mo
INDIVIDUALLY
HMHP Physician Practice Satisfaction Surveys
Quarterly
PERFORMANCE PARAMETERS
SAFETY NET DENTAL CLINIC
PATIENT CARERESIDENT
EDUCATION
Individually
Collectively
Faculty Residents
RESIDENT EDUCATION QUALITY ASSESSMENT
CODA Standards
Resident Continuous QA/QI
Resident Repetition Sign off Sheets
QT Eval of Residents by Faculty
QT Faculty Evals
Residents
DME
CODA STANDARDS
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
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
RESIDENT CONTINUOUS QA/QI PARTICIPATION
RESIDENT STEP REPETITION SIGN OFF SHEETS
QT EVAL OF RESIDENTS BY FACULTYST. 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 and treatments. Educates patients and families. Provides high quality, appropriate, cost effective and comprehensive care.
QT EVAL OF FACULTY BY RESIDENTS
St. Elizabeth Health Center Department Of Dental Education
EVALUATION of CORE FACULTY by RESIDENTS
Academic Year: 2011-2012 Dates:_ J uly – October 2011______
Please evaluate the faculty listed below, rating in all of the categories or indicating N/A. Faculty Name _________________ TEACHING CATEGORIES Excellent Good Fair Poor N/A 1. Teaching Enthusiasm 2. Overall Teaching Ability a. Basic Science b. Clinical Science c. Lecture Content d. Operating Room e. Conference Attendance f. Conference Participation 3. Were there personality conflicts? Yes No I f yes, please explain: 4. Recommendations/comments: RESIDENT _____________________SIGNATURE_________________________________
Please return to Larissa McElrath, Dental Education ASAP Eval. by Res.-of Core Faculty (qt.
DIRECTOR OF MEDICAL EDUCATION
• Completes Statistical Analysis and Evaluation
• Faculty/Resident Retention, Advancement or Termination
