Health Center Basics - NNOHA...Patient Care: Scope of Service •PHASE II: Rehabilitative services,...
Transcript of Health Center Basics - NNOHA...Patient Care: Scope of Service •PHASE II: Rehabilitative services,...
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Health Center Fundamentals 101:
Lifelong Learning
Irene Hilton, DDS, MPH
Monday, October 25, 2010
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Learning Objectives
Describe the 5 defining characteristics of Health Centers
Understand the Health Center role in delivering health care
Learn the expected scope of oral health care services in Health Centers
Understand how public health concepts relate to oral health care in Health Centers
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NNOHA’s Practice Management Resources
Operations Manual for Health Center Oral Health Programs:
Health Center Fundamentals – Published!
Leadership (under review)
Financials (under review)
Quality (in progress)
Risk Management
Integrating Specialty Care Services
Workforce and Staffing
Understanding Reimbursements
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History of Health Centers
• Economic Opportunity Act (1964) Established Community Health Centers (CHCs)
• Health Center Consolidation Act (1996) Combined under Section 330 of the Public Health
Service Act Accepted Term: Health Centers
• Community Health Centers • Migrant Health Centers • Homeless Health • Public Housing
• Tremendous Growth (last 10 years)
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FQHC vs. Health Center
• Federally Qualified Health Center: relates to the way encounters are reimbursed
• All 330 Health Centers are FQHC’s
• Rates are determined at the state level
• Not all FQHC’s are 330 Health Centers
County Health Departments, IHS clinics
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Health & Human Services
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What is a Health Center?
• Public or private not-for-profit organization that provides primary health services to populations with limited access
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Health Center Five Program Fundamentals
1. Located in or serve a high need community 1. Governed by a community board composed of a
majority of HC patients 1. Provide comprehensive primary health care
services as well as supportive services 1. Provide services available to all with fees adjusted
based on ability to pay.
2. Meet other performance and accountability requirements
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Role of Health Centers
• Entry point for low-income populations
20% of Medicaid visits nationwide
• Elimination of traditional barriers to accessing health care
Cost
Geography
Culture/Language
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Future Roles
• Created an infrastructure for delivering health care
• Key component in health care reform
Capacity for newly insured?
2008- 12 million Health Center medical patients do not have access to dental services (15M-3M)
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Funding
• Traditional reimbursement sources
Third-party payer revenues from insurance plans including FQHC Medicaid
Patient fees
• 330 Grant
• Private grants and donations
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Future Role
• Incubator for innovation in payment methodologies
• Pay 4 Performance
Measures
IT capability
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HC Administration
• Board of Directors Approve grant application and budget
Approve scope of service and general policies for HC operations
Approve changes
• Executive Director Manages the daily functions of the HC and oversees the
performance of health care
• Management Team In addition to the Executive Director, the team typically consists
of a Chief Financial Officer (CFO), Chief Information Officer, Clinical / Medical Director, and a Dental Director, who usually report to the ED.
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Why a Dental Director Should Report to the ED
• Medical Director may not understand dental any more than the ED
• Medical Director may not understand the differences between medical practice and dental practice
• Medical director already very busy
• Dental can have tight financial margins- need immediate access to information and decision makers
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Role of Dental Director
• Willing to lead, advocate for dental
• Willing to learn skills needed
• Logical, common sense points
• You are the expert about dental…after all you are delivering the care!
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Role of Dental Director
• Increased collaboration
Medical
IT
• Data/evidence based decisions
• Appreciation of financials
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Basic Dental Public Health Concepts
• Public health is “people health”
• Focus is on the collective health status of a group of people
Health center population
Community
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Basic Dental Public Health Concepts
• Concepts HC dental provider must consider: • Disease pattern of the target population
• Demand & resources available
• Payment structure
• Providing both individual patient treatment planning & surveillance of total population
• Prioritize service & treatment based on availability of resources, size of the target population, disease pattern, demand and a reasonable definition of dental health verses ideal
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Community Health Needs Assessment
• Estimated number of users. • Existing providers and resources, assessment of
unmet need. • Demographics of service population • Oral health status, prevention, and
treatment needs. • Barriers to access/availability
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Form Dictates Function
• Needs assessment defines characteristics of dental program Capacity Location Culture/language Scope of Service
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Patient Care: Scope of Service
• PHASE I: Prevention, maintenance and/or elimination of oral pathology that results from dental caries or periodontal disease
Level I - Emergency Dental Services
Level II - Preventive Dental Care
Level III - Expected Services- basic
• If not available on site Level I & II must be available through contractual arrangement (1998 & later programs)
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Patient Care: Scope of Service
• PHASE II: Rehabilitative services, such as dentures, partials, crown and bridge, elective oral surgical procedures, periodontal surgery, and orthodontics.
Level IV - Recommended Services- If a Health Center can find low cost solutions to replace dentition, patients may be assisted in obtaining employment, education or enhancing self esteem.
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Staffing
• Staffing pattern depends on the mix of services offered
Most efficient for maximized encounters & revenues
State practice acts
• Training and experience appropriate to the culture and needs of the community
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Licensure, Credentialing and Privileging • Professional staff must maintain
necessary, professional certification, licensure and credentialing.
• Requirements dictated by each state.
Exemptions
• JCACHO
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Quality Management
• Goals of the Quality Management System:
Assure and improve the quality of oral health care delivery
Improve oral health care status of the community
Integrate quality into the long term operational planning and management of the center
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Quality Assessment
• Objective periodic chart audit/peer review
• Objective tracked service use measures
• Subjective patient satisfaction/outcomes survey
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Quality Improvement
• A process that is both prospective and retrospective
• Improve quality of the system and therefore the health status of the target population.
PDSA
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Risk Management
• Risk management is the identification, assessment, and prioritization of risks (effect of uncertainty) followed by coordinated and economical application of resources to minimize, monitor, and control the probability and/or impact of adverse events
• In tandem with Quality Improvement System
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FTCA Coverage
• The Federal Tort Claims Act (FTCA) provides coverage for all deemed Health Center employees against parties claiming to have been injured by negligent actions.
• HC employees considered employees of the United States- claims would be brought against federal government.
• Volunteers not covered.
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Quality & Churning
• Churning- systematic, institutionalized practice of maximizing revenues by maximizing visits/encounters
• Each payer method has inherent flaw
• Encounter based
• FFS
• Capitation
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Examples of Churning
• Separation of exam & imaging procedures
• Separation of exam, imaging & P&F for children
• Lack of quadrant dentistry especially if small restorations
• Separation of sealants
• Lack of definitive treatment of emergencies
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Adverse Outcomes
• Lack of comp/preventive care
• Return emergency visits
• Patient dissatisfaction
• Increased clinical risk
• Increased time burden for patients & caregivers
• Below standard of care as taught in dental schools
• Fraud
• Never finish Tx plans
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I.D. via Quality System
• Chart audit
Separation of procedures
• Tracked service use measures
Low rates of Tx plan completion
• Patient satisfaction
Low because multiple visits
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Strategies to Counter
• KNOW YOUR BASELINE DATA • Clear policies
• Scope of service and population served
• Control emergencies & N/S
• Sufficient clinical resources
• Quality management system
• More than “no money, no mission”
• What is the Mission?
• Optimal health outcomes
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Health Center Advantages
• Co-location of primary health care services
Established, accepted model (40 years)
• Efficiencies of scale in the total system
• Facilitates improved health outcomes IF there is cross department collaboration
Untapped potential
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Health Center Advantages
• Benefits of Collaboration
Important ally and bridge to patients and the community
Gain effective advocates to support oral health resources
• Oral Health Collaborative Pilot http://www.nnoha.org/oralhealthcollab.html
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For More Information…
• Order a printed copy, or download the PDF version of the Fundamentals Chapter at:
http://www.nnoha.org/practicemanagement/manual.html
• Watch the webinar, “The Balancing Act: FQHC Dental Program Productivity and Financial Impact”: http://www.nnoha.org/practicemanagement/webinars.html
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Attend other Practice Management
Sessions at the Conference! Tuesday, October 26 9:00-10:00 - Understanding Health Center Dental Program
Financials Allen Patterson, CPA, FACMPE, MHA 2:00-3:30 - Becoming an Outstanding Leader Dan Watt, DDS Wednesday October 27 9:00-10:00 - Quality Assessment, Quality Improvement &
HRSA’s Oral Health Measures Dan Watt, DDS and Marty Lieberman, DDS 1:00-2:00 - Integrating Specialty Care Services Scott Wolpin, DMD 1:00-2:00 - HRSA FTCA Program and Risk Management Jay Anderson, DMD, MHSA 3:00-4:30 - Best Practices Roundtable Janet Bozzone DMD, MPH
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Irene Hilton, DDS, MPH
Silver Avenue Family Health Center
NNOHA
www.nnoha.org
303-957-0635
www.nnoha.org/forums.html
THANK YOU!