Loading...
HomeMy WebLinkAboutAgenda - 04-15-2003-9aORANGE COUNTY BOARD OF COMMISSIONERS ACTION AGENDA ITEM ABSTRACT Meeting Date: April 15, 2003 Action Agenda Item No, SUBJECT• Proposal to Change Dental Clinic Service Delivery DEPARTMENT: Health PUBLIC HEARING: (Y/N) No ATTACHMENT(S): Draft Dentist Class Specification INFORMATION CONTACT: Rosemary Summers, Health Director, extension 2411 TELEPHONE NUMBERS: Hillsborough 732-8181 Chapel Hill 968-4501 Durham 688-7331 Mebane 336-227-2031 PURPOSE: To consider a proposal to change the manner in which Orange County Health Department Dental Clinic services are delivered to patients by realigning currently budgeted resources. The realignment consists of: • Reducing the County's reliance on the UNC School of Dentistry for professional dentist coverage by authorizing a Dentist position in the Health Department, • Funding the cost for the Dentist position by realigning existing funds for dentist contract services and by reducing the currently authorized full time Dental Hygienist position to part- time 20 hours • Amending the Classification and Pay Plan to add the class of Dentist at salary grade 83. BACKGROUND: Since 1981, the Orange County Health Department has offered clinical dental services to low-income children and adults in Orange County. Originally funded with astart-up grant from the Robert Wood Johnson Foundation, the clinic has provided a constant source of dental care for children and families who would otherwise not be able to afford dental services. Clinic services are offered 2.5 days per week at the Whiffed Human Services Center in Hillsborough and 2 days per week at the clinic located at Carr Mill Mall in Carrboro. Clinic patients range from those who have Medicaid or other third-party insurance coverage to self-paying patients who have no insurance coverage. Self-pay patients are charged fees for the services they receive. Fees are charged on a "sliding fee scale" and are based on the patient's ability to pay. Each year, the demand for services increases. For example, in fiscal year 2001-02, nearly 4,100 patients received services - an increase of 2% percent from the previous fiscal year. It is 2 important to note that during this same period, the department was also without a dental hygienist for part of the year, which limited the services that the Clinic could offer. At least 300 of the new self-pay patients qualified for services at the 80 percent or less level of the sliding fee scale. With the slowing economy, staff anticipates that requests for services will increase. The chart below offers a snapshot of clinic patients receiving services last fiscal year: Of The Total Patients Served Medicaid Visits 1,294 Other Insurance Visits 818 Self Pay Patients With Income Levels Eligible for Sliding Fee Scale Paying 20 to 80% of Full Charges 1,743 Self Pay at 100% of Full Charges 100 No Charge Follow-up Visits 137 Program Objectives and Services The objectives of Orange County's dental health program have remained constant since the County established it more than 20 years ago - to reduce the incidence of tooth decay, periodontal disease, loss of teeth, pain and infection and oral cancer -through dental assessments/screenings, dental health education, prevention, sealant promotion and treatment to the residents of Orange County, focusing on low-income and underserved residents. One of the major services identified to meet this objective includes providing routine dental treatment including fillings, extractions and cleanings to residents of Orange County, primarily to patients who are Medicaid eligible and/or low income. While the program serves residents of all ages, major emphasis has always focused on providing dental health services for children. Current Staffing Clinic staffing currently consists of County and UNC School of Dentistry staff including an attending dentist, dental residents, the dental health program director, a dental hygienist, dental assistants and dental office assistants. The dental health program director, hygienist, dental assistants and dental office assistants are County employees while the Department contracts with the UNC School of Dentistry for the services of a dental resident, attending (licensed) dentist, and oversight by a dental faculty member. In accordance with the contract, UNC subsidizes half the cost of the attending dentist with the County paying the other half of that cost. The County pays UNC for all costs associated with the dental residents and for the oversight by the dental faculty member. While the contractual arrangement has served the community well for more than 20 years, reductions in state budget allocations for the School of Dentistry coupled with a shortage of licensed dentists has directly impacted the County's ability to offer consistent services for patients. For example, the inability to regularly secure a licensed dentist has resulted in the Dental Clinics' failure to provide services for approximately 20 days in the last fiscal year and 13 days thus far this fiscal year. As a point of reference, the average number of patients seen in one day of clinical service time is 30. The loss of 20 clinic days last year represents 600 patient visits and 390 patient visits in 2002-03. Not only does this negatively impact the dental health of the patients, but it also reduces the amount of revenue that the clinic is able to produce. As stated earlier, for several years, UNC School of Dentistry has subsidized the cost of providing dentist coverage for Orange County. Over the years, and particularly in the past two years, there has been steady erosion of that support. The School has indicated that as of July 1, 2003, due to on-going State budget cuts, it can no longer provide financial support to the Health Department for part-time faculty on an ongoing basis. This would result in an increase in the County's cost for a licensed dentist. In addition to the difficulties experienced with coverage by a licensed dentist, the Health Department has experienced a difficult time in recruiting and retaining a dental hygienist for the clinical practice. The hygienist position has been vacant since January 2002 - a period of more than 12 months. The Department has used services provided by temporary dental agencies and hygienist students to ensure that patients receive dental hygiene services. At times, patient appointments have been rescheduled because a hygienist was not available to provide services. Continuity of patient care to both children and adults has been difficult to maintain with these challenges. More often than not, children who receive clinical services require more than one visit in order to complete their care plan. Not having a consistent dentist can compromise the completion of the care plan in a timely way. The Board of Health recognizes that there is a pressing need for the Health Department to find a way to offer dental health continuity to patients. To that end, the Health Department Strategic Plan for 2001-04 identifies service continuity as a major goal. Proposed Realignment of Personnel and Budget Over the last few months, the Health Director has collaborated with Budget and Personnel staff to determine the "best fit" of personnel and budget to meet the goals of providing care for Orange County residents that have limited or no access to dental services. This realignment is being requested ahead of the regular budget process in order to recruit from the Dental School's Graduate Program Resident class scheduled to graduate in May 2003. As such, the Health Director, with the concurrence of the Board of Health, requests that the Board of County Commissioners: • Create a Dentist position to serve children and adult patients in both clinical locations and serve as clinical director and supervisor of the County's dental program. • Reduce the existing full time Dental Hygienist position to part time and use the cost savings to help fund the Dentist. • Maintain the current UNC School of Dentistry contracts for o Pediatric Resident one day per week for 35 weeks o Pediatric dentist for 17 days (remaining 17 weeks) for pediatric care of very young children 4 o A Graduate Program Resident (GPR) dental resident 4'/2 days per week The Board of Health believes that the items outlined above would allow the Health Department to enhance the continuity of care for children and enable their care plans to be completed in a timely way with the same dentist in attendance while working within the existing budget for dental clinic services. Position Classification Personnel has completed a salary survey of Dentist positions in other North Carolina counties. Based on the data, Personnel recommends the new class of Dentist be established at salary grade 83 in the pay plan. Grade 83 has a salary range from $67,069 to $106,646. It is anticipated that hiring a Dentist will require a salary of about $95,000. FINANCIAL IMPACT: The table below compares the current and proposed costs for the provision of dentist services in the dental clinics. The table takes account of the savings identified by reducing the hours of the Dental Hygienist position. If the dentist position is not approved, the dental clinics could not maintain service levels without retaining the full-time hygienist. Current Budget Continuation of Contract Proposed Budget FY 02-03 FY 03-04 FY 03-04 Contractual Part-time 86,450 Contractual Part-time 89,043 Dental Position* $112,637 Dentists Dentists Resident iJNC 45,176 Resident C 45,176 Resident UNC 45,176 Pediatric Resident 1,650 Pediatric Resident 1,750 Pediatric President 1,750 Pediatric Attendin 2,550 Pediatric Attendin 6,800 Pediatric Attendin 6,800 Subtotal $135,82 Subtotal 142,769 Subtotal $166,363 6 Full-time Hygienist 49,521 Full-time Hygienist 58,445 Reduce full-time hygienist 37,200 position to part-time 20hrs/week Total $185,34 Total $201,21 Total $203,563 7 4 * Includes 1FTE Dentist salary (95,000), benefits (16,637), malpractice insurance (l,uuu) The budget-to-budget comparison indicates that this change can be accomplished within approximately the same funding as present. It is anticipated the slight difference in funding could be offset through reducing the revenue lost due to cancelled appointments. RECOMMENDATION(S): The Manager recommends that the Board: • Establish a permanent full time Dentist position to serve children and adult patients in both clinical locations and serve as clinical director and clinical supervisor of the County's dental program effective June 1, 2003. • Reduce the current full time Dental Hygienist position to part time 20 hours. • Amend the Classification and Pay Plan to add the new classification of Dentist at salary arade 83. C8052-4/03 DENTIST GENERAL DEFINITION OF WORK: Performs professional work providing dental care and treatment to adults and children in a public dental health program. Work is performed under general supervision. Supervision is exercised over dental residents, dental hygienist and dental assistants. TYPICAL TASKS: Manages the daily operations of the dental clinic; Provides routine dental care for adults and comprehensive services for children. Examines and determines dental needs of clients; prepares treatment plans; and provides clinical procedures, including emergency dental care; Makes valid assessments of conditions and if warranted, makes referrals to specialists; Prescribes medications to treat patients; Manages children's behavior during dental procedures; Documents dental records to manage risk, provide continuity of care and assure quality of care; Supervises dental residents, dental hygienist and dental assistants; Serves as a preceptor for UNC School of Dentistry students and evaluate and determine the dental health status of Orange County residents; Serves as a consultant in public health dentistry to the dental clinic staff, Health Director and other staff in the Orange County Health Department; Provides oral health presentations to communities, school and professional groups; Conducts oral screenings in child care centers and homes, elementary and middle schools, area industry and senior adult centers/homes; Participates with dental societies, state dental public health staff and local civic/community groups in planning and implementing community wide events to promote dental and oral health; Performs related work as required. KNOWLEDGES. SKILLS AND ABILITIES: Comprehensive knowledge of modern dentistry and recent developments in the field of dentistry; ability to treat both adults and children as a general practice dentist; ability to deal with combative children in a calm, effective manner; ability to deal with culturally diverse populations in the provision of dental clinical services; ability to prepare and deliver lectures on dental health education to professional and community groups; ability to establish and maintain effective working relationships with patients, representatives from the UNC School of Dentistry, and representatives from civic/community groups; ability to supervise both professional and sub-professional employees. EDUCATION AND EXPERIENCE: Requires graduation from an approved school of dentistry and one year of clinical dentistry experience. SPECIAL REQUIREMENTS: Possession of license to practice dentistry in North Carolina.