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HomeMy WebLinkAboutAgenda - 11-16-2010 - 4dORANGE COUNTY BOARD OF COMMISSIONERS ACTION AGENDA ITEM ABSTRACT Meeting Date: November 16, 2010 Action Agenda I Item No. ~-- ' Q SUBJECT• Adjustment of Minimum Charge for Health Department Dental Services to $30 DEPARTMENT: Health PUBLIC HEARING: (YIN) No ATTACHMENT(S): INFORMATION CONTACT: Rosemary Summers, 245-2411 PURPOSE: To approve an adjustment to the minimum charge for Health Department dental services from $25 to 30 to minimize the revenue impact from adjusting the sliding fee scale downward. BACKGROUND: All Health Department clinical services have relied on software that was custom developed by Anne Presnell, an Orange County programmer using mainframe technology that allowed data collection and batch transfer to the state data system -Health Statistics Information System (RBIs). That program has served the Health Department well for over 20 years. The Information Technologies Department informed Health Department staff last fiscal year that the mainframe was to be decommissioned in 2010-2011. With the anticipated State transition last year from HSIS to a new software program -Health Information System (HIS), the Health Department had been able to project compliance with the mainframe decommissioning. The promise of the new HIS program has not been fulfilled. Orange County first started using the system in mid-June and has identified multiple serious problems that are affecting both service delivery as well as the billing and collections functions. One of the problems identified that does not have a technological solution at this time is that the Health Department can only have one sliding scale identified for the entire department. Currently, Orange County medical services slide services to 0% pay in accordance with Title X requirements for family planning services. The dental clinics have used a sliding fee scale that slides to 20% pay rather than 0% pay. Dental services currently require a $25 minimum fee. The new software will not allow two sliding fee scales. Staff has continued to use the mainframe for self-pay clients until the issue could be resolved by HIS programmers. County staff has been notified that this is a very low priority and will not be addressed this year. 2 In addition to minimizing the loss in revenue from changing the sliding fee scale to 0%, this also places all reimbursable services provided by the Health Department on the same sliding fee scale. From the administrative perspective, this allows for greater efficiencies in sharing staff resources at the front desk by simplifying the financial intake assessment process. The Board of Health took action on this recommendation at its October 27, 2010 meeting by changing the sliding fee scale to 0% to 100% based on 250% of the federal poverty level for all dental clinical services. In addition the Board of Health is recommending that the minimum fee for dental services be increased to $30. FINANCIAL IMPACT: Staff has analyzed the fiscal impacts of two options: 1) Changing the sliding fee scale to 0% pay without changing the minimum charge; and 2) Changing the sliding fee scale to 0% pay and increasing the minimum charge by $5. Analysis of Options 1) The total number of dental encounters from July 1, 2009 through June 30, 2010 billed at 20% pay was 2,002 encounters. The total amount billed for those services was $49,379. This includes the $25 minimum fee plus 20% of any amount owed over that $25. Of those encounters, 1,415 would have qualified for 0% pay, and if only charged $25 as the minimum charge, would have yielded $35,375, a loss of $14,004 from the current budgeted amount. 2) If the minimum charge is increased by $5 to $30, it is estimated that the loss falls to $4,279 from the collection of the additional $5 charged to both the 0% and 20% pay encounters. At the 20% pay level, only the balance left after the $30 minimum fee would be charged to the patient. At levels above 20% pay, charges would likely exceed the $30 minimum and would be charged at the appropriate percentage. RECOMMENDATION(S): The Manager recommends that the Board accept the Board of Health's recommendation that the minimum charge for dental services be increased to $30 and that the County fee schedule be revised accordingly.