Presenter Disclosures Audrey Hoener C Michelle CasiasCommunities ommunities FY16 (1) The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: School Desk to Hygienist Chair: Expanding Access to Preventative Hygiene to All Denver Students No relationships to disclose Audrey Hoener, MM Michelle Casias, RDH 1 Children s Oral Health Care by Insurance Children living in poverty are more likely to have tooth decay and are less likely to see a dentist. The Awards 3 The Colorado Health Institute Findings from the 2013 Colorado Health Access Survey 4 1
State of Colorado and Denver School- Based Health Centers The need in Denver Public Schools Colorado s Hygienist Practice Act 16 SBHCs including 3 regionals Integration into Denver Health 5 6 School Oral Health Program Expansion The Awards Robust SBHC Program Medical Mental Health Health Education School RN Outreach & Enrollment School Support Services August 1, 2014 May 15, 2015 Enrolled students 12,392 Users 10,920 Visits 26,066 7 8 2
Indiv. Cost Patient Chair $3,580.00 Patient Chair Carrying case $214.00 Computer/Sensor/Intraoral stand $169.00 Proseal II $4,892.00 Extra 2L reservoir Water hook-up on Proseal II $27.00 Operator Chair $345.00 Assistant Chair $530.00 Portable Instrument/Supply Cabinet $2,850.00 Nomad X-ray Unit $6,886.00 Nomad X-ray Case $308.00 Cavitron Jet Plus $5,830.00 Sidekick instrument Sharpener $374.00 Valo Cure Light Cordless kit $920.69 RDH Freedom Hygiene Handpiece Premium kit $1,249.99 Operator x-ray vest $335.00 Pt. x-ray vest $249.00 Instrument Soaker/Ultrasonic instrument cleaner $600.00 Bib Clips $4.00 Procedure Trays $11.00 Bonding wrap eyewear (orange filter) $11.00 Pro-vision mini econo eyewear (pedo) $5.00 Uvex genesis tinted lens black glasses (adult) $22.00 Operator Protective Glasses $21.00 Patient Hand Mirror $14.00 Brush and Floss Model $92.00 Chairside instructor $67.00 Floss Dispenser $6.00 XCP Bitewing rings $12.00 XCP Bitewing Prongs $36.00 Eezee grip digital Sensor holder PA's $58.00 Schick w/remote 33 revolution size 2 sensor $8,605.00 Schick 33 size 0 Sensor $4,200.00 Schick USB intra-oral Camera $3,170.00 Camera USB Cable $51.00 DCV License (x-ray software) $295.00 Laptop with Dental Software $3,600.00 Red SST Instrument retrieval tray (red tote) $233.20 Ultra mini led Headlight w/2 batteries $800.00 2oz Measuring Cup $4.99 2 Quart liquid container $1.96 Total $50,679.83 6/8/2015 School Oral Health Program Expansion School Oral Health Program Expansion Dental Sealant Program 9 10 Portable Dental Hygiene Suite Staff Portable Dental Hygiene Suite Equipment Equipment Instruments Consumables Dental Materials Office Supplies Direct Costs Year One 11/1/14- Salary (at 1.0 Actual 10/31/15 Personnel FTE) FTE Total Dental Hygienist $67,350.00 1.0FTE $67,350.00 Clerical Support III $35,796.80 1.0FTE $35,796.80 Total Personnel $103,146.80 Benefits 29.10% of Salaries $27,849.64 Total Personnel and Benefits $130,996.44 Program Operational Costs Equipment and supplies $15,000.00 Toral Program Operation Costs $15,000.00 $145,996.44 Total Direct Costs Indirect Costs 33.5% of Modified Total Direct Costs $43,883.81 Total Indirect Costs $43,883.81 11 GRAND TOTAL COSTS $189,880.24 12 3
Getting the child in the chair Are you welcome? Do they want you? Space SBHC Consent Telephone Encounter Home Care Brushing /Flossing Diet Professional Care Regular dental visits Dental cleanings Exam 13 14 Preventing Oral Disease Oral disease is the #1 preventable disease among children. Dental sealants Caries Gingivitis/Periodontitis Hard tissue disease Soft tissue inflammatory disease 15 tooth decay by 81% 16 4
Fluoride Varnish Periodontal Debridement aka Dental Cleaning Process by which hard and soft bacterial deposits are removed from the supragingival and subgingival surfaces of the teeth, including the disruption of bacterial cell walls of non-adherent plaque resulting in the healing of soft tissues Prophylaxis Non-surgical Periodontal Therapy 17 18 Advantages of preventative dental hygiene services being extended to all SBHC users Intraoral photography Oral Cancer Screening Dental Screening Oral Hygiene Instruction Radiographs Improve academic performance Less class time missed Earlier disease detection Contributes to the goal of SBHC Enhanced overall health care 19 20 5
Advantages Advantages Eliminating Barriers Transportation Co-payments Access Safe Place Rapports (SBHC staff but School RN) Flexible Schedule Language Home care tools and instruction 21 Treatment Time Costs(Average) Experience Procedure 2 Surface Filling 1 hour $175 Local Anesthesia - 1-2 injections Scaling and Root 2-4 visits at 1 hour = $980 Local Anesthesia - 3-6 Planing total 8 hours injections Preventative Time Costs(Average) Experience Procedure Dental Sealant 30 minutes 8 $35 ea. tooth No shots, No drills permanent molars Exam, Dental Cleanings 45min-1 hour $175 x 2 year No shots, No drills Oral Hygiene Instr. 22 Before and After Dental cleaning Oral Cancer screening 17 Year old junior Lesion 1 st detected 6 months prior by SBHC PA 23 24 6
19 year old senior 5 year old kindergartener 25 26 27 28 7
Reimbursement Sustainability One year activity projection for SBHC dental program Year One Encounters Number Number AVG Total Reimb. Estimated by INS of total of Charge Charges Rates by Reimbursem ent ins code insurance dtl insurance Category (Payer encounter Encounter per Visit by INS INS C31 CHP+ KAISER FQHC CHP 1.1% 1,380 15 222.37 3,376 33.6% 1,134 D34 CHP+ DENTAL DH CHP 3.2% 1,380 45 222.37 9,899 55.7% 5,510 M01 CICP CICP 2.2% 1,380 30 222.37 6,599 5.0% 330 N01 DHMP OPTION A DHMP 1.1% 1,380 15 222.37 3,300 5.0% 165 Q21 SCHOOL BASED NONE/UNK Other 53.8% 1,380 742 222.37 164,984 0.0% - MEDICAID DENTAL Medicaid 36.6% 1,380 505 222.37 112,189 120.4% 135,122 U03 Z10 DH MEDICAID CHOICE Medicaid 2.2% 1,380 30 222.37 6,599 32.0% 2,112 Choice Total: 100.0% 1,380 306,946 144,373 80% of Total 115,498.19 Year Two Number of Encounters Number Encounter Total by INS of total s by AVG Charges Reimb. Estimated (Payer encounter Insurance Charge by INS Rates by Reimbursem ent ins code insurance dtl insurance Category Mix) (%) s (E*D) per Visit (G*F) INS C31 CHP+ KAISER FQHC CHP 1.0% 1,380 14 222.37 3,069 33.6% 1,031 D34 CHP+ DENTAL DH CHP 4.8% 1,380 66 222.37 14,730 55.7% 8,198 M01 CICP CICP 2.2% 1,380 30 222.37 6,599 5.0% 330 N01 DHMP OPTION A DHMP 1.1% 1,380 15 222.37 3,300 5.0% 165 Q21 SCHOOL BASED NONE/UNK Other 45.0% 1,380 621 222.37 138,092 0.0% - MEDICAID DENTAL Medicaid 42.0% 1,380 580 222.37 128,886 120.4% 155,231 U03 Z10 DH MEDICAID CHOICE Medicaid 4.0% 1,380 55 222.37 12,275 32.0% 3,928 Choice Total: 100.0% 1,380 306,950 168,884 80% of Total 135,106.99 29 Federally Qualified Health Centers Encounter rate versus Fee for Service Solo hygienist or a team of 2? Billing private insurance 30 Hygienist at every regional SBHC Visits at a SBHC with a dentist 31 32 8
Audrey Hoener Director of Outreach Services Denver Health Audrey.Hoener@dhha.org (303) 602-8969 Michelle Casias School Oral Health Program Hygienist Denver Health Michelle.Casias@dhha.org (303) 602-8963 33 9