Future Models for the Dental School Clinic

Transcription

1 Future Models for the Dental School Clinic Enhancing Clinic Revenue 56 th Council of Deans Conference November 16, 2014 John W. Reinhardt

2 2012 DEANS CONFERENCE PRIORITY AREAS FOR FURTHER STUDY 1. Role of oral health and dentistry in the evolving primary care environment, and 2. Strategies for increasing clinical net revenue

3 SIX POTENTIAL STRATEGIES FOR INCREASING NET REVENUE (COUNCIL OF DEANS WORK GROUP SUMMARY REPORT ) 1. Increasing Awareness of the Role of Dental School Clinics in Providing Patient Care 2. Increasing Awareness of the Challenges and Opportunities to Enhancing Revenue* 3. Benchmarking Clinical Operations and Sharing Effective Strategies* 4. Sharing Models for Enhanced Reimbursement 5. Review Accreditation and Licensure Requirements to Understand Impact on Clinical Ef[iciency 6. Undertake a CCI- like Effort to Envision the Future of the Clinical Model

4 DESIGN OF CLINICAL EDUCATION WHAT S HAPPENING IN OUR CLINICS? Is education a byproduct of patient care (patient focused)? Is patient care a byproduct of clinical education (student focused)? Answer: both; but how a school thinks about this issue has implications for clinical operation

5 THREE BACKGROUND ARTICLES Evolution of Dental School Clinics as Patient Care Delivery Centers Allan J. Formicola, et al., Journal of Dental Education, December 2006 The Fundamental Financial Problems of Dental Education and Their Impact on Education, Operations, Scholarship, and Patient Care Howard L. Bailit, Journal of Dental Education, February 2008

6 BACKGROUND ARTICLES Financing Clinical Dental Education Howard L. Bailit, et al., Journal of Dental Education, February 2008

7 My opportunity to explore this issue Faculty Development Leave (Sept. 1, 2014 June 30, 2015) for UNMC-specific study Big Ten/Committee on Institutional Cooperation (CIC) Dental Schools Deans and CFOs ADEA/William J. Gies Educational Fellowship for national study partnering with Council of Deans Work Group (July 1, 2014 June 30, 2015)

8 OVERARCHING GOAL ALL THREE STUDIES Maximizing net revenue in patient- centered, educationally sound clinical activities by providing leaders the data to guide decisions (evidence- based) on curriculum and expense management

9 WHY SHARE DATA? Benchmarks tell us where we stand Best practices can be identi[ied and explored Better decision- making ADEA Deans Conference 2014

10 IL IN IA MD MI MN NE OH Rutgers VALUE OF SMALL GROUP STUDY (BIG TEN MODEL) 1. Similar schools (public) in similar universities (large, research- focused) with similar interests 2. Somewhat regional (within 500 miles of Chicago until recently) making direct, face- to- face meeting easier 3. An academic relationship (Committee on Institutional Cooperation) that encourages collaboration 4. Ef[iciency for re[ining ideas and gathering/sharing information 5. Relationships and trust- - sharing sensitive information

11 SURVEY PLAN: Deans and Chief Financial/Business Of[icers met in June 2014

12 CHICAGO, JUNE 2014

13 Big Ten Survey (FY 2013) KEY BUSINESS VARIABLES Hours of clinic assigned by class (D3 & D4) and residents Fees comparing 20 key procedures (also collected policies on fee setting) Revenue (collections) Average per student (annually) and per hour

14 BIG TEN SURVEY RESULTS summary information ADEA Deans Conference 2014

15 Big Ten Survey Predoctoral results; clinic hours and productivity Category Mean Maximum Minimum Total D3 + D4 Clinic Hours Available 2,175 2,743 1,540 D3 revenue per hour $ 16 $ 23 $ 9 D4 revenue per hour $ 21 $ 25 $ 14

16 PREDOCTORAL FEE COMPARISON (RED INDICATES RANGE >DOUBLE) ADA Procedure Code D0120 Periodic oral evaluajon (recall) Intraoral- - complete series (including D0210 bitewings) Resin- based composite - two surfaces, D2331 anterior D2740 Crown - porcelain/ceramic substrate Anterior endodonjc therapy (excluding final D3310 restorajon) D5110 Complete denture maxillary Mandibular parjal denture cast metal D5214 framework Fee Comparison Mean Maximum Minimum ,

17 POSTGRADUATE ANNUAL REVENUE PER RESIDENT* Type of Program Mean Maximum Minimum Oral Surgery 153, ,382 52,554 Pediatric DenJstry 67, ,242 29,396 *data from 8 schools

18 RESIDENT COLLECTIONS PER HOUR FIVE ADVANCED PROGRAMS FY 2013 PG CollecJons per hour AVE. MAX. MIN. EndodonJcs (n=8) $ 62 $ 104 $ 32 GPR (n=3) $ 83 $ 90 $ 72 OrthodonJcs (n=8) $ 70 $ 103 $ 30 Pediatric DenJstry (n=7) $ 55 $ 115 $ 19 PeriodonJcs (n=8) $ 62 $ 120 $ 26

19 Other Models to Consider ENVISIONING THE FUTURE IT S TOUGH TO MAKE PREDICTIONS, ESPECIALLY ABOUT THE FUTURE YOGI BERRA ADEA Deans Conference 2014

20 EVOLVING CLINICAL EDUCATION MODELS (thank you to Deans who shared their details with me) 1. Reducing or eliminating the in- school student clinic (Expanded Community- Based Clinics)

21 A.T. STILL UNIVERSITY MISSOURI SCHOOL OF DENTISTRY & ORAL HEALTH A unique public- private clinical collaboration: A.T. Still University (construction and ownership) & Grace Hill Federally Quali[ied Health Center (maintenance & clinic operations) Co- managed by both with a joint agreement on risk/revenue sharing

22 A.T. STILL UNIVERSITY MISSOURI SCHOOL OF DENTISTRY & ORAL HEALTH KIRKSVILLE CAMPUS

23 ATSU MISSOURI SCHOOL OF DENTISTRY & ORAL HEALTH Preclinical didactic and psychomotor education at the Kirksville campus.

24 (200 miles)

25 Corner of Truman Parkway and Park Avenue, St. Louis

26 ST. LOUIS FACILITY A unique, large- scale dental school clinic and educational building in an underserved community Senior students will also travel to externships in community health clinics half of their senior year

27 ST. LOUIS FACILITY Ground breaking April, 2014 Anticipated opening June- July, ,000 sq. ft. of [inished space occupying 2 [loors Clinics: 92 dental chairs Mid- October 2014

28 ADVANTAGES Shared [inancing ATSU construction and ownership, Grace Hill maintenance and supplies Access to FQHC 330 base funding Enhanced Medicaid reimbursement Joint management Grace Hill Dental Director will also be appointed as ATSU Associate Dean for Clinical Operations Grace Hill will hire dentists and staff, those dentists will maintain ATSU adjunct faculty appointments ATSU will employ additional dental faculty Area of high dental need Keeping with the ATSU philosophy of community service

29 EAST CAROLINA UNIVERSITY SCHOOL OF DENTAL MEDICINE Home clinic on Greenville campus With 111 student clinic chairs Eight 16- chair Community Service Learning Centers (CSLCs) in underserved areas of the state

30 ECU SCHOOL OF DENTAL MEDICINE GREENVILLE, NC

31 ECU SCHOOL OF DENTAL MEDICINE COMMUNITY SERVICE LEARNING CENTERS

32 COMMUNITY SERVICE LEARNING CENTERS D4 students spend 24 weeks (total) in 3 Community Service Learning Centers CSL dental clinics partner with federally quali[ied or community health centers, local public health departments, community colleges or local hospitals

33 COMMUNITY SERVICE LEARNING CENTERS Basic model: 7,700 square feet, 16 dental chairs 1.5 faculty 2 AEGD residents; 4 dental students (2 w/patients) 5 dental assistants 1 or more hygienist (s) 1 business manager 3 front desk personnel

34 CSLC FLOOR PLAN (16 CHAIRS)

35 ADVANTAGES State supported the cost of construction and equipment; supports ongoing maintenance, custodial, and utility costs (public school) Integration with community health centers (interprofessional activities) Students experience the business operations of a small, multi- dentist clinic Signi[icant opportunities for community- based research; all on one clinic management system (axium) Can selectively send students to a clinic where services match their speci[ic educational need Local dentists have reacted favorably since the CSLCs treat high levels of Medicaid patients and give those dentists the opportunity to market their practices and community to 20 students and 2 residents per year

36 EVOLVING CLINICAL EDUCATION MODELS 2. Modifying the operations of an in- school student clinic (management or care delivery) Potential bene[its: More business- like operation of a large and complex clinic; patient- centered care emphasis Opportunity for dental schools and their universities to more closely understand and collaborate with each other Improved [inancial bottom line

37 UNIVERSITY of MARYLAND SCHOOL OF DENTISTRY Univ. of Maryland Faculty Dental Service Plan 501(c)(3) Professional (tax- exempt) Corporation (since 1985)

38

39 ADVANTAGES Allows business [lexibility set up for all Univ. of Maryland School of Dentistry clinics (student, resident, faculty) Corporate advantages, when compared to state system: Ability to hire more promptly Easier to adjust work assignments, re- write job descriptions, modify work hours, etc. to meet emerging demands Much easier to reward outstanding employees Improved purchasing (centralized) of supplies, equipment and materials to control costs (negotiating with supply companies or manufacturers for best price); don t have to go through state approvals or bidding processes except for larger equipment Responsibility- centered budgeting processes easier to implement ([iscal accountability by cost centers) departments allowed to retain 50% of pro[its if they generate the revenue

40 VIRGINIA COMMONWEALTH UNIVERSITY SCHOOL OF DENTISTRY VCU Dental Care 501(c)(3) Professional (tax- exempt) Corporation

41 VCU CORPORATE STRUCTURE Was formed in 1995 to operate the Dental Faculty Practice Association; in 2001 all resident clinics and in 2009 all student clinics were added

42 ADVANTAGES Greater freedom to be creative/[lexible to meet business challenges (example: less constrained hiring latitude to follow market salaries, not state salaries, and thus compete for the strongest job applicants) Ability to invest reserve funds to give those funds an opportunity to grow Simpli[ied the application (which was successful) for federal Electronic Health Record incentive payments Greater opportunity to create clinical performance incentives, including a Variable Clinical Earnings Component to faculty salaries (in FY2014 over $2M contributed to faculty salaries) Provides a public/marketing image (VCU Dental Care) that is more re[ined and business- like than a typical student clinic

43 MIDWESTERN UNIVERSITY COLLEGE OF DENTAL MEDICINE - ARIZONA

44 MIDWESTERN UNIVERSITY, ARIZONA D3 and D4 students are paired together, working as partners, and assigned patients to treat as part of a generalist- led group practice. One of the students is the provider and the other is the chairside assistant for each procedure.

45 PATIENT ADVANTAGES Speed/Ef[iciency - more treatment in less time (often quadrant dentistry) Security - - two students seeing everything, in addition to the faculty students adjust who is primary provider based upon complexity Continuity - when the D4 graduates, patient is already well- acquainted with the new D4 Fees similar to the Big Ten dental schools

46 STUDENT ADVANTAGES Ef[iciency - - a dental assistant all the time (and even one who knows the EDR and can assist with data entry) Peer review all the time Collaborative (shared) learning

47 FACULTY/SCHOOL ADVANTAGES Teaching two students at once on a single case (another ef[iciency; good faculty- to- student ratio) Fewer faculty and smaller facility (since fewer patients treated & fewer chairs used at a given time) with fewer disposable materials such as chair covers, gloves, etc. Financial productivity of paired students is very good

48 Combined D3+D4 Averages, FY 13 Big Ten Per 2 Students Per Hour $39,891 $37 Midwestern AZ Per 2 Students Per Hour $61,818 $47 COMBINED D3+D4 ANNUAL COLLECTIONS Big Ten Dental Schools and Midwestern- Arizona College of Dental Medicine

49 SUMMARY OF CURRENT ADEA SURVEY PLANS Focus on revenue Focus on predoctoral and postgraduate programs (not faculty practice or dental hygiene) Data from in house clinics or remote clinics that are directly controlled by the dental school Will include expense- side question on patient visits and clinic staf[ing (support staff, not faculty) Purpose is to give leaders the ability to identify benchmark programs and determine opportunities to consider changes at their schools Survey to launch in 2015 Results back to you, promptly And Oinally, University of Nebraska Medical Center College of Dentistry

50 ADEA DEANS CONFERENCE 2014 Thank you for your attention comments, questions, or suggestions?