Emergency Department Diversion Dental Program

State: FL Type: Model Practice Year: 2014

:

A recent PEW report indicates that more than 115,000 dental-related ED cases were reported in Florida in 2010. These dental-related ED visits produced more than $88 million dollars in charges, most of which were uncompensated.Since June 2011, the Florida Department of Health (FDOH) in Brevard County and its Adult Dental Program have worked closely with local hospitals to establish an alternative to ED visits for dental patients. The ED diversion dental program is a referral based program for individuals who present to an ED with acute dental pain, needing emergent treatment by a dentist. Once these individuals are treated by a dentist, targeting the source of the problem, there is no longer a need for repeat visits to an ED.

:
Brevard County Health Department
:
Emergency Department Diversion Dental Program
Brevard County is located along 70 miles of the pristine Atlantic Coastline known as the Space Coast and centrally located in the state. According to the Florida Public Health Institute; 10,767 adults visited emergency departments in Brevard County between 2008 and 2010. Statistics in Brevard County indicate that 16.3% of the adult population did not seek dental treatment due to cost. In addition, the unemployment rate has risen to 9.5%, which further diminishes the health care dollar. The Center for Disease Control (CDC) reports that emergency department (ED) visits have been increasing in numbers since 1996. It also states that low income adults are more likely to pursue treatment from an ED for dental related issues rather than a private practice dental office due to cost, in turn causing longer wait times and overcrowding. A recent PEW report indicates that more than 115,000 dental-related ED cases were reported in Florida in 2010. These dental-related ED visits produced more than $88 million dollars in charges, most of which were uncompensated.Since June 2011, the Florida Department of Health (FDOH) in Brevard County and its Adult Dental Program have worked closely with local hospitals to establish an alternative to ED visits for dental patients. The ED diversion dental program is a referral based program for individuals who present to an ED with acute dental pain, needing emergent treatment by a dentist. Once these individuals are treated by a dentist, targeting the source of the problem, there is no longer a need for repeat visits to an ED. Dental problems generally begin small, but due to the inability to pay for services, the problems are left untreated until there is no other recourse but the ED for immediate assistance. In the past, individuals would be placed on antibiotics to keep the problem temporarily under control. The patient would then be sent home, only to have the problem return again in a matter of weeks, thereby causing them to return to the ED for additional assistance. Now there is an alternative solution; when a patient seeks help from a local ED for a dental issue, they are given a prescription for antibiotics and a referral to the dentist at the FDOH in Brevard County. Through the ED dental program, these individuals receive an appointment to be treated by a dentist who can treat the source of the problem, consequently stopping return ED visits for dental related issues. Our primary goal was to create a program where individuals could receive dental treatment thereby avoiding return visits to local EDs for dental pain. Planned services include intervention, evaluation and treatment of acute dental issues. In addition, this enables us to reduce the need for the underinsured dental patient to seek relief from self-medication, which may lead to long term drug dependency and continued emergency department visits. Prior to treating patients, the decision was made to utilize existing FDOH staff from our children’s dental program; i.e. dental assistants, dentists, medical records personnel and clerical support staff. Treatment will be based through-out FDOH in Brevard County clinic locations; Melbourne, Rockledge and occasionally Viera. The ED diversion dental program added $20,000 annual revenue to the FDOH in Brevard County, saving approximately $185,000 of non-collectable revenue to hospitals per year and an estimated 500 hours of valuable Emergency Department time to treat true emergencies. It also saved approximately $185,000 to the low income adult residents of Brevard County.Since it’s inauguration in June 2011 the following services have been provided: 1201 adult patients referred by ED 613 dental examinations 693 dental x-rays 646 extractions The primary factor that led to the success of this dental program was a combined desire and need to assist low income adult members of our community get out of dental pain. Another factor to the success of this program is flexibility. In the beginning, patient flow was easily manageable but before long it became obvious that the demand for low-income dental services for the uninsured adults in our community was larger than our original data showed. Referrals for emergent dental services grew rapidly. The program has had growing pains, but we have been happy to work hard to accommodate the need for these services. After trying several different scheduling plans we were able to find one that enabled us to treat the most adult patients without reducing the services provided in our children’s dental clinic.
Brevard County is centrally located in Florida and is commonly known as the Space Coast. It is 70 miles in length and 20 miles wide and spans over 1,500 square miles. The Florida Department of Health (FDOH) in Brevard County has 4 clinic sites located in the northern, central, and southern parts of the county. The mission of the FDOH in Brevard County is to provide quality medical and dental care to low-income residents, which are below 100% of the Federal Poverty Guidelines. Brevard County has a very diverse population of 550,000; approximately 82,000 residents are with healthcare/dental benefits, including Federal or State funded insurance plans.Dental problems frequently begin small, but due to the inability to pay for services, the problems are left untreated until there is no other recourse but the ED for immediate assistance. In the past, individuals would be placed on antibiotics to keep the problem temporarily under control. The patient would then be sent home, only to have the problem return again in a matter of weeks, thereby causing them to return to the ED for additional assistance. Now there is an alternative solution; when a patient seeks help from an ED for a dental issue, they are given a prescription for antibiotics and a referral to the dentist at the FDOH in Brevard County. Through the ED diversion dental program, these individuals receive an appointment to be treated by a dentist who can treat the source of the problem, consequently stopping ED visits for dental related issues. There are very few dentists in Brevard County that accept Medicaid for dental treatment for adults; that in combination with the fact that Medicaid covers very few dental services for adults, are some primary reasons why adults experiencing dental pain wait until there is no other recourse but to visit emergency departments. According to the Florida Public Health Institute; 10,767 adults visited emergency departments in Brevard County between 2008 and 2010. Statistics in Brevard County indicate that 16.3% of the adult population did not seek dental treatment due to cost. In addition, the unemployment rate has risen to 9.5%, which further diminishes the health care dollar. The Center for Disease Control (CDC) reports that emergency department (ED) visits have been increasing in numbers since 1996. It also states that low income adults are more likely to pursue treatment from an ED for dental related issues rather than a private practice dental office due to cost, in turn causing longer wait times and overcrowding. A recent PEW report indicates that more than 115,000 dental-related ED cases were reported in Florida in 2010. These dental-related ED visits produced more than $88 million dollars in charges, most of which were uncompensated. Since June 2011, the Florida Department of Health (FDOH) in Brevard County and its Adult Dental Program have worked closely with local hospitals to establish an alternative to ED visits for dental patients. The ED Diversion Dental Program is a referral based program for individuals who present to an ED with acute dental pain and needing emergent treatment by a dentist. Once these individuals are treated by a dentist, targeting the source of the problem, there is no longer a need for repeat visits to an ED. The ED diversion Dental Program has saved approximately $86,000 to the low-income adult members of Brevard County providing the services below: 1201 adult patients referred by ED 613 dental examinations 693 dental x-rays 646 extractions In 1994, the FDOH in Brevard County established a Volunteer Adult Dental Clinic (VADC), to provide dental services to low-income adult residents of Brevard County. The clinic established partnerships with local dental providers to participate in the adult dental clinic and provide care at no cost to the client. VADC has had an overwhelming success and continues to provide access to dental treatment such as exams, x-rays, fillings, and extractions for the low-income residents of Brevard County. The only flaw in this program is the lengthy wait time to be seen by a volunteer dentist; this is because of the sporadic clinic schedule and a long waiting list of patients in need. In 2011, the VADC treated the dental needs of approximately 600 residents in Brevard County who were low income and financially qualified below 100% of the Federal Poverty Guidelines. The VADC offers dental services to all eligible adult residents of Brevard County. The clinic is staffed by volunteer dentists, specialists and paid staff from the Health Department. The VADC and its affiliate programs continue to provide dental care for routine to acute and chronic dental problems, oral hygiene education, diagnosis, treatment and follow-up care and limited laboratory services for biopsies. Services are provided by FDOH in Brevard County staff from the Melbourne, Viera, Rockledge and Titusville sites with support provided by countless volunteering private providers, local hospitals and the Board of County Commissioners. Additionally, volunteer specialists such as oral surgeons, prosthodontists, endodontists and periodontists donate their time both in our clinic facility as well as in their private offices. All services are provided at no cost to the low income client. As the demand for emergent services increased, the FDOH in Brevard County and its’ VADC partnered with a local hospital to provide emergency department (ED) diversion for clients who present at their doors for routine or acute pain management of dental related problems. This partnership recognizes that many clients deem the ED as the portal to health and dental care and the client cannot be denied service. After a medical clearance has been established by a health care provider and the client is not categorized as emergent/urgent life threatening, the client can be referred directly to the dental clinic for care. Currently, the clinic provides services to 20 or more clients per week. This clinic is funded solely by local hospitals and the FDOH in Brevard County. The partnership between the ED diversion dental program and the FDOH in Brevard County and its’ Volunteer Adult Dental Clinic (VADC) is an innovative and an extremely successful combination; this is because the inabilities of one program are the abilities of the other. The VADC was used as a model practice and extension of the ED diversion dental program. It was our goal that these two programs work together and fill gaps in dental coverage. The VADC has the ability to refer patients to specialty providers and provide long term dental treatment for routine treatment or acute pain; but because it is volunteer provider based there is a very long waiting list to be seen; it does not have the ability to treat urgent dental problems. The ED diversion dental program has the ability to treat urgent dental problems through a single ED visit by providing immediate antibiotics and a dental appointment for treatment one week later, but is only able to offer patients two dental appointments in order keep wait times for appointments low.
One of our primary goals was to provide low-income individuals access to urgent dental treatment opposed to repeat visits to an emergency department (ED) for medication that will only temporarily mask the problem and in turn, reduce wait time in local EDs for true emergencies. Accomplishing this goal would also reduce the number of low income individuals who turn to self-medicating to relieve dental pain by providing access to treatment (urgent and long term).This program continues to be an overwhelming success. Services provided include; intervention, x-rays, evaluation, and treatment of acute dental issues. In addition, this enables us to reduce the need for the low income dental patient to seek relief from self-medication, which may lead to long term drug dependency and continued ED visits. Another benefit is, while individuals are in the dental clinic it gives us the opportunity to introduce them to all services (medical and dental) provided by the FDOH in Brevard County. The Florida Department of Health (FDOH) in Brevard County and its Adult Dental Program worked closely with local hospitals to establish an alternative to ED visits for dental patients. In order to implement our mutual goal. Planning meetings were held between the community partners. The decision was made to utilize existing FDOH staff from its’ dental program; i.e. dental assistants, dentists, medical records personnel, and clerical support staff. Treatment would be based through-out FDOH in Brevard County clinic locations; Melbourne, Rockledge, and occasionally Viera. It was intended that this dental program be a referral based program for individuals who present to an ED with acute dental pain, needing emergent treatment by a dentist. The ED provides a financial screening on individuals to determine if they meet the criteria for this program; below 100% of the Federal Poverty Guidelines. The ED prescribes these individuals an antibiotic if needed and then faxes a referral to the FDOH dental program. Once these individuals are treated by a dentist, targeting the source of the problem rather than masking the problem with pain medicines, there is no longer a need for repeat visits to an ED. In June of 2011, the first ED diversion dental patient received treatment at the Rockledge site. To date over 600 patients have received dental treatment rather than returning to the ED. This is a very beneficial and ongoing program. The partnership between the ED diversion dental program and the FDOH in Brevard County and its’ Volunteer Adult Dental Clinic (VADC) is an innovative and an extremely successful combination; this is because the weaknesses of one program are the strengths of the other. The VADC was used as a model practice and extension of the ED diversion dental program. It was our goal that these two programs work together and fill gaps in dental coverage. The VADC has the ability to refer patients to specialty providers and provide long term dental treatment for routine treatment or acute pain; but because it is volunteer provider based there is a very long waiting list to be seen, it does not have the ability to treat urgent dental problems. The ED diversion dental program has the ability to treat urgent dental problems through a single ED visit by providing immediate antibiotics and a dental appointment for treatment one week later, but is only able to offer patients two dental appointments in order keep wait times for appointments low.Through the combined efforts of the FDOH in Brevard County and hospitals, the ED Dental Program was established. This program provides service to low income adult members of Brevard County as an alternative to visiting a hospital emergency department. When these individuals are treated by a dentist, the source of the problem is targeted and there is no longer a need for repeat ED visits thus enabling ED staff time to treat true medical emergencies. The FDOH in Brevard County has entered into its third year of partnership with local hospitals to provide ED diversion for dental related issues. This program has added $20,000 annual revenue to the FDOH in Brevard County, saving approximately $370,000 of non-collectable revenue to local hospitals so far, and provided a savings of $86,000 to the low income adult members of Brevard County. Local hospitals contribute $20,000 per year to the FDOH in Brevard County to provide one four-hour dental clinic per week/10-12 appointment slots, to low income adult patients diverted from their ED. Treatment will be based through-out FDOH in Brevard County clinic locations; Melbourne, Rockledge and occasionally Viera. Local hospitals save approximately $185,000 in uncollectable fees and an estimated 500 hours of valuable Emergency Department time to treat true emergencies per year. The Adult Dental Director from FDOH in Brevard County and the Community Benefit Senior Project Specialist meet on a regular basis to discuss ideas on improving the program. Reports are also provided to our partner quarterly to show the progress and success of the ED diversion dental program.Tangible benefits: Added revenue to the Brevard County Health Department $20,000 per year Revenue saved to local hospitals for providing temporary antibiotic pain relief for indigent dental clients $185,000 per year Totaling over $205,000 per year Intangible benefits: Having the ability to introduce low-income clients to other affordable public health, medical, and dental programs offered by the FDOH in Brevard County Long-term pain relief for suffering low-income adult dental patients by having the cause of their dental pain treated by a dentist rather than temporarily masked by pain medications Saving an estimated 500 hours of valuable emergency department time for true, possibly life threatening emergencies per year
Objectives 1: Provide low income individuals access to urgent dental treatment opposed to repeat visits to an emergency department (ED) for medication that only temporarily masks the problem. Objective 2: Reduce repeat visits in local EDs for dental related issues; thereby decreasing wait times for true medical emergencies. Objective 3: Reduce the number of low income individuals who turn to self-medicating to relieve dental pain by providing access to treatment (urgent and long term). Objective 4: Provide information on other services (medical and dental) offered at the Florida Department of Health in Brevard County.Methods used to monitor and collect data on Objectives 1 and 2: The ED diversion dental program tracks and monitors program usage through the Health Management System (HMS) already in place. Statistics provided quarterly by HMS are reported to our local hospital partner and are used to compared and determine program effects and how improvement can be accomplished for decreasing avoidable emergency department. The Health Management System and Ad-hoc Portal Report System are used for data collection to track, document, and monitor the following activities for low income individuals who access the ED diversion dental program. The following data will be collected using a Microsoft Excel Worksheet: • Increased access to ED dental program is measured in numbers of individuals served. Adherence to treatment plans is assessed. Reduction of emergency department admissions and hospitalizations is compiled with hospital input. Year-end statistics will be compiled and reported, along with suggestions for improvement. Patient survey at the completion of each clinical visit to collect data as to what the patient would have done had the ED diversion dental program not been available. Some of the questions asked on the survey and most common answer are: Where would you have received dental treatment had this dental program not been available? Emergency room/Don’t know Are you experiencing dental pain? Yes How long has it been since you were treated by a dentist? 2 to 5 years What is your primary reason for not seeing a dentist regularly? Money Are you satisfied with the treatment you received? 95% Yes Patient experience and satisfaction are evaluated by survey which asks program patients how satisfied they were with their care and staff. These surveys are offered at completion of service and include their experience and satisfaction with care, treatment plan(s) and staff. Survey questions will help enhance our understanding of patient needs. The data gathered from these surveys is also used to evaluate effectiveness of the program. Based on information collected, we can refine our strategies, identify strengths and weaknesses, and make improvements. For example: in the beginning the no-show rate averaged about 50% failed appointments. To correct this problem we decided to overbook the time slots that patients generally missed. By making these changes, our no-show rate has drastically dropped to 15% failed appointments.
The primary lesson learned concerning the practice was that the demand for urgent dental services to low-income adults in our community was larger than our original data showed. In addition, the local recession led to many local residents losing their jobs along with their health and dental insurance benefits. Referrals for our dental program grew rapidly. The program has had growing pains in gearing up for this demand, but we were happy to work hard to accommodate the need for these services. We increased the number of clinics we provided per week and expanded clinics to more locations throughout the county, enabling us to treat more individuals without there being travel difficulties.An open line of communication is imperative to maintain a successful partnership with all organizations involved. The FDOH in Brevard County and local hospitals attend quarterly meetings to discuss the program and possible improvements. This collaboration has enabled us to modify several things such as the referral process to help ensure that individuals are using the services offered and avoid intentional misuse of the ED or dental program. It has also enabled us to change the way we schedule patients to ensure that we have to capability to treat the most patients. The ED diversion dental program is not better than its parent program; the Volunteer Adult Dental Clinic (VADC), which was established in 1994, it is just different. The partnership between the ED diversion dental program and the FDOH in Brevard County’s VADC is innovative and an extremely successful combination; this is because the weaknesses of one program are the strengths of the other. The VADC was used as a model practice and extension of the ED diversion dental program. It was our goal that these two programs work together and fill gaps in dental coverage. The VADC has the ability to refer patients to specialty providers and provide long term dental treatment for routine treatment or acute pain; but because it is volunteer provider-based, there is a very long waiting list to be seen; it does not have the ability to treat urgent dental problems. The ED diversion dental program has the has the ability to treat urgent dental problems through a single ED visit by providing immediate antibiotics and a dental appointment for treatment one week later, but is only able to offer patients two dental appointments in order keep wait times for appointments low. This is the third year of a reoccurring contract with local hospitals to provide ED diversion for dental issues. We are continually networking with other local agencies to help ensure the sustainability of this program and improve access to dental care throughout Brevard. These agencies include the Space Coast Volunteers in Medicine, Project Dentists Care and the Brevard County Dental Society, and local hospitals. The FDOH in Brevard County is committed to the success of the ED diversion dental program and to providing urgent dental treatment to low-income members of Brevard County.
Colleague in my LHD|E-Mail from NACCHO|NACCHO website
 
Processing...


Driving Walking/Biking Public Transit  Get Directions