Beth S Desch



Business PlanCHDC Pediatric / Dental Integration Pilot ProgramBeth DeschHealthcare Systems Management LDR 60910/24/15 Table of Contents Executive Summary Page 3 Proposal Page 5 Market Analysis Page 7 Internal Assessment Page 10 Financial Analysis Page 13 Implementation Plan Page 17 References Page 19 Executive Summary The 2015 Pew study reports “Dental care remains the greatest unmet health need among U.S. children. Left untreated, dental disease can lead to emergency room visits, hospitalizations and even death. In 2008, children went to the ER more than 215,000 times for preventable dental issues at a cost of more than $104 million (Pew, 2015).” CHDC’s Pediatric Dental Integration Pilot Program seeks to meet this need at the earliest age. Incorporating dental screenings at each CHDC Well Child medical visits will promote an increased opportunity for better oral health for a lifetime. Early dental intervention can actually save money. “A study in the journal Pediatrics showed that children who have their dental visit before age one have 40% lower dental costs in their first five years than children who do not, due to the cost of dental and medical procedures that may be necessary as a result of poor oral health (American Academy of Pediatric Dentistry[AAPD], n.d., para 2 ).” The CHDC’s Pediatric Dental Integration Pilot Program (PDIPP) will serve and be offered to all CHDC pediatric patients of record ages 6 months -12 years old. Currently children are seen on a regular basis from birth by a pediatrician or pediatric nurse practitioner for medical benchmark growth monitoring. Unfortunately, dental check-up visits are often delayed for years until the child is 3 or 4 years old. This delay produces a higher likelihood of a child needing restorative or emergency related visits. “The American Academy of Pediatric Dentistry (AAPD), American Dental Associates (ADA) and the American Academy of Pediatrics all recommend a dental visit for children by age one ([AAPD], n.d. para.1 ).” CHDC’s PDIPP would consist of incorporating dental screenings, dental prophy, fluoride varnish application, and possibly x-rays with a medical Well Child visit. At the medical well-child visit, either before or after a CHDC Pediatric Nurse Practitioner (PNP) performs their evaluation, the child would see a Public Health Dental Hygiene Practitioner (PHDHP). After the initial pediatric/dental integrated appointment, subsequent visits would be scheduled to coincide with the medical appointment scheduled sequence, either on a 4 month or 6 month basis. The convenience of integrated appointments is a major marketing theme, with a secondary theme of total comprehensive pediatric health care. The success of the PDIPP will strongly depend on the PNP and the PHDHP to promote the program. CHDC is currently well-positioned to develop the PDIPP. The Pediatric department has a vacant exam room which can be used, and CHDC already owns much of the equipment needed. In addition a PHDHP with 23 years of Pediatric Dental experience and a PNP are on staff and interested in promoting the PDIPP. They both share the same ideology concerning this initiative and possess a strong dedication to its success. The intention is to provide an efficient, integrated program by involving the concerned stakeholders in the planning and processes. With strong managerial support the PDIPP has the potential of increasing revenue which will positively affect the cash flow and forever changing the way pediatric/ dental services are delivered for the youngest members of our society. Proposal Service Definition This service is a planned integration of Pediatric Care and Oral Healthcare. The program strives to remedy an unmet need by incorporating dental care into regularly scheduled medical well visit pediatric checkups. The 2015 Pew study reports “Dental care remains the greatest unmet health need among U.S. children. Left untreated, dental disease can lead to emergency room visits, hospitalizations and even death. In 2008, children went to the ER more than 215,000 times for preventable dental issues at a cost of more than $104 million (Pew, 2015).” Currently children are seen on a regular basis from birth by a pediatrician or pediatric nurse practitioner and very often parents are committed to keeping the scheduled medical checkup visits. These regular checkups called Well Child (WC) visits include assessment of all the benchmark growth measurements for children ages 0-16. Well Child visits are scheduled at three-month intervals from birth through two years, transitioning to every 6 months thereafter, while most dental care begins at two to three years of age. This delay produces a higher likelihood of a child needing restorative or emergency related visits. Optimal dental care begins as soon as the first tooth erupts which is approximately 6 months. “The American Academy of Pediatric Dentistry (AAPD), American Dental Associates (ADA) and the American Academy of Pediatrics all recommend a dental visit for children by age one ([AAPD], n.d. para.1 ).” At that first dental visit it is important not only to evaluate the erupting teeth but also to educate parents on proper dental homecare. Children who have an early evaluation and application of fluoride are provided with an increased opportunity for better oral health for a lifetime. Early dental intervention can actually save money. “A study in the journal Pediatrics showed that children who have their dental visit before age one have 40% lower dental costs in their first five years than children who do not, due to the cost of dental and medical procedures that may be necessary as a result of poor oral health (AAPD, n.d., para 2 ).” With the positive evidence for early dental intervention, Community Health & Dental Care (CHDC) is interested in promoting an integrated pediatric/dental pilot program. This program would consist of incorporating dental screening, dental prophy, fluoride varnish application, and possibly x-rays with a medical Well Child visit. At the medical well-child visit, either before or after a CHDC Nurse Practitioner (NP) performs their evaluation, the child will see a Public Health Dental Hygiene Practitioner (PHDHP). The PHDHP is a dental hygienist licensed to work independently without a Dentist present. This service is currently being provided on a sporadic basis as the availability of a PHDHP to go to the pediatric department has limited the effectiveness of a comprehensive approach. It became apparent to the stakeholders, that a true pediatric dental integration program requires a dedicated fulltime PHDHP to be available for every WC visit. This creates continuity of care and a concerted emphasis on oral health care. The CHDC Pediatric Dental Pilot program will be offered at CHDC’s Robinson Street site, Pottstown, Pennsylvania. The pediatric department has an available exam room which will be equipped to perform the dental procedures. To piggyback or precede the WC visits, the hours will need to mirror that of the Nurse Practitioner’s current hours which are: Monday-Thursday from 8am-6pm. No other pediatric/dental integration program exists in the area. The Pottstown area is served by independent pediatricians and groups of family practitioners with pediatric nurse practitioners, none of these offices include integrated dental services. Market Analysis Customer Definition The CHDC Pediatric Dental Integration Pilot Program will serve and be offered to all CHDC pediatric patients of record, ages 6 months -12 years old. CHDC is a Federally Qualified Health Center (FQHC) which serves the tri-county area of Montgomery, Berks and Bucks Counties in southeastern Pennsylvania. The service will be promoted by the CHDC pediatric providers and the PHDHP. Parents will be informed of the new pilot program via informational monitors in the office, messages during phone on-hold times and posters. The integration program capitalizes on the fact that patients are physically present in the office for scheduled well visit, reducing the need for scheduling and keeping subsequent dental appointments. External Market Assessment The CHDC Pediatric Dental Integration Pilot Program (PDIPP) is possible because the existing CHDC facility which houses both pediatric medical and dental department under one roof. Dental screening and fluoride varnish application portions of this service are currently sporadically performed by having a pediatric provider page a PHDHP when needed. The inconsistency of the service occurs when the PHDHP cannot squeeze the pediatric request into their own schedule. The PDIPP will alleviate this issue by dedicating a dental provider solely to the pediatric department. The PDIPP will provide support to specific needs of Pottstown, Pennsylvania. It is a poor community, with 34.7% of children living in families that are below poverty level ($24,250/ family of four)(City-, 2014). The Reading Eagle reports that 66% of Pottstown School students live in families which qualify for the “free or reduced lunch program” ( Mekeel & Cooperstein, 2014, p 2). As an example the qualifying income for the lunch program is $44,863 for a family of four (U.S. Department of health & Human Services, 2015). CHDC meets the requirements as a FQHC because of the underserved status and poverty levels of the Pottstown population. As an FQHC, CHDC receives additional reimbursement to subsidize the low Medicare & Medicaid payments for medical or dental treatment. CHDC is the only dental facility within a radius of 10 miles that participates with State Insurances. This places CHDC in a strategic position to provide dental treatment to most of the children of Pottstown. A possible external threat rests in the hands of legislators. If the State budget does not support the current level of dental reimbursement it would create a financial challenge for the PDIPP. Also if another dental facility would begin to participate in the state insurance programs this might cause a reduction in the number of patients and result in difficulty maintaining a positive revenue stream. This latter possibility is very unlikely since there are restrictions on FQHC locations and a facility would find it difficult to succeed solely on Medicaid funding. No new regulatory issues exist as CHDC is positively situated to perform this service. Presently under our HRSA grant CHDC has dental services as part of their scope of practice. No change is needed to add the PDIPP. Competitors CHDC has one FQHC competitor within a 30 mile radius which offers dental services, ChesPenn Center for Family Health at Coatesville (HRSA, 2015). They provide medical and dental services though not in an integrated method. ChesPenn has the advantage of many sites, supplying a larger patient base and more possibilities for funding. With multiple sites, ChesPenn has more stability from a diverse marketplace and varied stakeholders. This allows compensation of a financially challenged site by other self-supporting sites. Risks involved in a PDIPP are rather low, including, equipment expenses, workflow modification, supplies and salaries. Without dedicated, enthusiastic staff members for the promotion and execution, the project may fail. Promotion The PDIPP is perfectly targeted to the parents of young children. Attending a medical WC visit is challenging enough, but asking parents to schedule an additional appointment for a dental check-up is sometimes beyond what the parents can do. Convenience is the major marketing theme, with a secondary theme of superior, comprehensive overall Pediatric Health Care. Marketing communication will strongly rely on the Pediatric Nurse Practitioner (PNP) and the PHDHP to promote the program. At appropriate WC visits the PNP will recommend a dental exam and arrange for the PHDHP to see the child. At subsequent WC visits combined medical/ dental appointments will be scheduled appropriately timed to see both providers. Proper oral hygiene habits will be explained by the PHDHP and reinforced with take home information sheets. As an added incentive at each dental exam visit the child will receive a new toothbrush and toothpaste to encourage not only repeat visits, but good oral hygiene at home. Stickers or a chance to visit the prize box will be the finale to a successful dental visit. Internal Assessment Strategic Fit One of CDHC’s strategic goals is to increase the pediatric dental patient base and provide dental services to pediatric patients. The PDIPP is a cooperative effort of both the Pediatric and Dental departments, which satisfies the strategic goal of the Dental Department and CHDC as a whole. The PDIPP offers a unique possibility for complete dental/medical integration for the youngest of patients. It is not an initiative available at any health facilities in the area. Presently CHDC does not have a Pediatric Dentist able to perform the restorative portion for complete in-house Pediatric dental service. CHDC refers patients outside Pediatric Dentists for treatment CHDC dentists are unable to perform, such as difficult procedures or uncooperative patients. The PDIPP will mainly concentrate on the preventative aspect of dental disease. Not implementing the PDIPP will require parents to seek other, non-convenient, options for their child’s dental care, most likely resulting in the absence of such care. Market Position CHDC is currently well-positioned to develop the PDIPP. The Pediatric department has a vacant exam room which can be used, and CHDC already owns much of the equipment needed. In addition a PHDHP with 23 years of pediatric practice and a PNP are on staff and interested in promoting the PDIPP. CHDC offers a similar dental screening and fluoride treatment program sporadically, when appropriate providers are available. Although service is hit or miss, when fully functioning it is well-received by parents and also increases dental revenue. The abbreviated form of the PDIPP now in place has evolved over the last years since its introduction in 2010. Initially CHDC pediatric providers were resistant to the program. Through persistence from the dental hygiene department and increased evidence of the importance of comprehensive healthcare, the Pediatric providers have begun to assist in the effort. CHDC has increased the number of dental screenings occurring at WC visits from 1 per week in 2010 to an average of 12 per week in 2015. The increase was accomplished by comparing the PNP scheduled WC visits with available slots in the hygiene schedule and then the PNP suggesting a dental hygiene visit while the patient was already in the office. One of the biggest concerns in developing the PDIPP lies in the uncertainty of reimbursement. CHDC operates on a very tight budget and is currently experiencing negative cash flow. The financial success of the PDIPP depends on the stability of state budgets and the proficiency and dedication of staff involved. CHDC has very little influence on funding at the state or federal levels. The intention is to produce an efficient program by involving the concerned stakeholders in the planning and processes. The PDIPP has the potential of increasing revenue which will positively affect the cash flow issue. Organization The PDIPP will be directed by the PHDHP and the PNP. They both share the same ideology concerning this initiative and possess a strong dedication to its success. The realization of this program rests on the support of both the dental and pediatric departments. To fully implement the program, patient service representatives, and centralized schedulers will be trained. After the initial months of the PDIPP, future WC integrated medical/dental visits will be scheduled for the same time. Coordinating the two departments will involve the scheduling supervisor and the medical patient service representative coordinator. The dental program manager will be a supporting associate in this venture. Patient Service Cycle Medical Patient Service Representative checks in patientPHDHP brings patient to room and performs dental exam, prophy, fluoride, and oral health education PHDHP delivers patient to a pediatric medical exam roomMedical Assistant takes vitals PNP examines patient and assesses for vaccines, tests etc.Medical Assistant returns to administer vaccines and dismisses patientMedical Assistant reminds parent to schedule next appointment (if appropriate include a dental visit) Parents check out with a medical patient service rep who makes the next appointments Financial Analysis Demand Assumptions CHDC currently serves a total of 3319 patients’ ages one to twelve years old. This number is approximately three times the number of scheduled slots the PHDHP will have per year devoted to the PDIPP. The program is designed to incorporate the dental visit with an already scheduled medical visit, capitalizing on the Pediatric timetable of children’s growth benchmark visits. Plus a dental exam should take place every six months, meaning the number of appointment slots available should be double to accommodate the dental standard recommendation for preventative screenings. Number of appointment slots proposed year 1 of PDIPP 1288 = 644 patients twice a year Number of appointment slots needed to accommodate the total patients in the age range= 6638 The demand for the PDIPP is great has the potential for extreme growth. Resource Assumption Facility requirements- one pediatric exam room currently used as storage Human resources - a current PHDHP reallocated to facilitate the PDIPP Information systems - a properly configured PC or laptop Other Resources - a 25%-40% increase in disposable supplies and home care products Capital investments - $350 to repair dental chair, $300 in autoclaveable instruments $ 75 head lamp with extra bulbs, $1500 computer Pricing Assumptions Overall dental prices were increased October 1, 2015, by a consultant group working with CHDC. The PDIPP, as a dental program, is subject to those changes and reevaluation to be finalized January 2016. Actual prices:Child prophy - $ 81Fluoride -$52Bitewings x-rays-$54Sealants -$66 Although these are the prices, CHDC is reimbursed at a lesser contracted rate from all insurances, CHDC actually receives additional monies from HRSA increasing the reimbursement total per encounter to $175. Pro Forma Financial Statement The PNP has ten WC visits in the daily template, a month survey determined an average of seven WC patients actual keep appointments. Projected revenue: 7 pts x 4 days* = 28 pts a week assuming a 46 week work year* = 1,288 pts/year *current PNP works a 4 day work week *assumes 8 holidays and 4 weeks of vacation 1,288 encounters/ year x $175/encounter = $225,400/year revenueProjected expenses:Supplies (researched estimation) per encounter $5 x 1,288 = $6,440 Salary of PHDHP: $80,000 Other benefits: $7,000Total FTE expense: $87,000Startup costs: $2,225Equipment maintenance $2,000/yearHome care products for each patient $1/patient = $1,288Total year 1 Expenses $ 98,953Capital requirements of the program: set up costs: $2,225Total revenue after expenses = $124,222Rate of return = 56%Financial Statement of PDIPP Year 1 Year 2 Year 3Year 4Year 5Pt revenue$225,400$241,500$257,600$273,700$289,800ExpensesSalary & benefits$87,000$88,000$91,000$92,000$94,000Supplies$6,440$7,590$8,832$9,384$10,764Maintenance$2000$2000$2000$2000$2000Home Care Prod.$1,288$1,518$1,766.4$1,955$2,152.8 Total Expenses$98,953$99,108$103,598.4$105,339$108,916.8Operating Marg$126,447$142,392$154,001.6$168,361$180,883.2Net Income% 56% 59% 60% 62% 62%Investment$ (2,225)Implementation Plan Implementation Timetable StepsWhoWhenOrder Resources: part for dental chair, head lamp, computer, toothbrushes, other supplies Dental manager2 months prior to start dateClean out medical exam room Maintenance 1 month prior to start dateReview schedule, plan work flow, paper work, PHDHP & PNPMedical patient service rep manager1 month priorPlace posters, in office monitor ads, phone on-hold message Dental manager1 month priorPaint & clean roomMaintenance3 weeks priorRepair dental chairMaintenanceAs soon as part arrivesSet up room, all supplies, instrumentsPHDHP2 weeks priorComputer configured IT2 weeks priorA run through day PHDHP, PNP, MA, Pt service rep1 week prior Evaluation Objectives: Integration of medical and dental servicesIncrease dental encountersIncrease pediatric dental health awareness Progress on objectives will be quantitatively measured and charted by the PHDHP on a monthly basis. The report will be reviewed with the dental manager and PNP. If objections are not met, an evaluation will be completed and recommendations made for improvements, modifcations or cancellation of the PDIPP. Implementation monitoring: Weekly assessments will to taken on the progress and adjustments needed to meet the goal. All stakeholders will be informed of any modifications needed to the pre-set schedule. ReferencesAmerican Academy of Pediatric Dentistry. (n.d.). Get it done in year one. Retrieved from AAPD website: . (2014.). Pottstown, Pa poverty rate data. Retrieved from:? Health resources & Services Administration. (2015). Find a health center. Retrieved from: , D., & Cooperstein, P., (2014). Reading, Pottstown school districts qualify for meal program. The Reading Eagle. Retrieved from: Pew Charitable Trusts. (2015). States stalled on dental sealant program. Retrieved from: . Department of Health & Human Services. (2015). 2015 Poverty guidelines. Retrieved from: ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download