Analysis of Indiana Dental Medicaid Claims to Validate Actual - - PowerPoint PPT Presentation

Analysis of Indiana Dental Medicaid Claims to Validate Actual Dentist Participation in the State’s Safety Net

Presenting Author: Hannah Maxey, PhD, MPH, RDH Contributing Authors: Connor Norwood, Sierra Vaughn, Yumin Wang, John Williams

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Presentation Objectives

• Describe challenges associated with measuring dental service

capacity in Medicaid programs

• Present innovative method for measuring participation
• Discuss limitation, policy implications and future direction

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Medicaid and Dentists: What we know. . .

• Numerous state Medicaid programs report experiencing

challenges in recruiting a sufficient number of dental providers

• Being enrolled as a Medicaid provider does not equal active

participation

• Most studies focused assessing characteristics of dentists

associated with participation in Medicaid use self-reported measures

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Measuring dentists’ participation in Medicaid

• Recent article:

– Evaluating levels of dentist participation in Medicaid. Warder, Clayton J. et

• al. The Journal of the American Dental Association , Volume 148 , Issue 1 ,

26 - 32.e2

• What: Assessment of secondary data sources examining dentist participation in

Medicaid

– ASTDD Survey – ADA Compendium – InsureKidsNow.org – ADA 2015 – Medicaid/Medicare Services Dental Association

• Findings: “No consistent, comparable, on-going source of data”
• Implications: “Ongoing method to measure meaningful participation needed”

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The current study

• Primary Objective:

– Analyze Medicaid claims for dentists enrolled in Indiana Medicaid to determine whether certain characteristics are associated with:

• Medicaid Participation (clinical engagement)
• Level of participation in Medicaid
• Secondary Objectives:

– Develop method to measure “level of participation” – Assess validity of self-reported Medicaid participation

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Methods: Study Data

• Sources

– Indiana Professional Licensing Agency

• Indiana dental license file
• Licensure survey data (collected during renewal period December 2015-April 2016)

– Indiana Office of Medicaid Planning and Policy

• Enrolled dental providers (National Provider Identifier and Indiana State License

Number) during state fiscal year 2015 (July 1, 2015- June 30, 2016)

• Dental claim count (FFS, CHIP, SCHIP, MCO) associated with Indiana License Number
• f rendering provider for state fiscal year 2015
• Merging

– Indiana license number

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Methods: Study Population

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Methods: Study Population v. All Enrolled

Total Enrolled Survey Sample Total Dentists 1564 1023 Mean Age 48.9 48.2 Mean Claims Count 701.4 656.4 Total Active Dentists 1125 (0.72) 759 (0.74) Claims Category Inactive Provider 439 (0.28) 264 (0.26) Less than 30 Mintues Per Week as a Provider 206 (0.13) 133 (0.13) 30 Minutes to 1 hour per week as a Medicaid Provider 97 (0.06) 67 (0.07) 1 - 2 hours per week as a Medicaid Provider 141 (0.09) 96 (0.09) 2 - 4 hours per week as a Medicaid Provider 151 (0.10) 105 (0.10) 4 - 8 hours per week as a Medicaid Provider 202 (0.13) 147 (0.14) 8 or more hours per week as a Medicaid Provider 328 (0.21) 211 (0.21) Table 1: Total Indiana Medicaid enrolled dentists versus licensure survey sample

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Methods: Variables and Analyses

• Outcome measures

– Medicaid Participation

• Binary measure

– ‘Active’ = 1 or more claim(s) during the fiscal year – ‘Inactive’ = 0 claims during the fiscal year

– Level of Medicaid Participation

• Ordinal measure

– Described in subsequent slides

• Independent measures

– Demographic characteristics (age, race, gender) – Practice characteristics (geography, full-/part-time, Medicaid participation)

• Analytic Methods

– Chi-square tests – Logistic Regression (binary outcome) – Partial Proportional Odds (ordinal outcome)*

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Methods: Level of Medicaid Participation

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Methods: Categorized Levels of Participation Outcome Measures

Medicaid Claim Category Number

• f Claims

Estimated Hours per Week Providing Dental Care to Medicaid Recipients* Total Dentists 1 Inactive 264 2 1 – 49 Less than 30 Mintues Per Week 133 3 50 – 99 30 Minutes to 1 hour per week as a Medicaid Provider 67 4 100 – 199 1 - 2 hours per week as a Medicaid Provider 96 5 200 – 399 2 - 4 hours per week as a Medicaid Provider 105 6 400 – 799 4 - 8 hours per week as a Medicaid Provider 147 7 ≥ 800 claims 8 or more hours per week as a Medicaid Provider 211

Table 2. Categorization and Conversion of Medicaid Claims

* Conversion based on criteria defined by the Health Resources and Services Administration

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Results: Descriptive

• Significant differences

identified

– Age – Dental Specialty – Practice Setting

N Row% N Row% P-Value Total Dentists 759 74.19 264 0.26 Age Category < 35 132 0.13 69 0.07 35 to 55 373 0.36 113 0.11 >55 254 0.25 82 0.08 Job Status Full 517 0.51 170 0.17 Part 242 0.24 94 0.09 Gender Female 224 0.22 91 0.09 Male 535 0.52 173 0.17 Dental Specialty General practice 613 0.60 207 0.20 Dental Public health 18 0.02 3 0.00 Pediatric 74 0.07 14 0.01 Other Type 3 0.00 14 0.01 Oral surgery 51 0.05 26 0.03 Race White 652 0.64 233 0.23 Other Race 107 0.10 31 0.03 Rural/Urban Rural 134 0.13 40 0.04 Urban 625 0.61 224 0.22 Primary Practice Setting Solo Practice 409 0.40 113 0.11 Partnership Practice 110 0.11 34 0.03 Other Type/Setting 55 0.05 30 0.03 Group Practice 185 0.18 87 0.09

Table 3: Demographic and Practice Characteristics of Indiana Medicaid Enrolled Dentists by Participation Status (N=1,023)

0.008 0.2674 0.1329 <0.0001 0.3346 0.3511 0.0023 Not Active Active

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Results: Partial Proportional Odds

Variables 0 vs. > 0 <.5 vs. .5+ < 1 vs. .1+ < 2 vs. 2+ < 4 vs. 4+ < 8 vs. 8+ Primary Practice Setting (Other Practice Setting) Solo Practice Partnership Practice Group Practice Dental Practice Type (other type) Dental Public health General practice Oral and maxillofacial surgery Pediatric Gender (Female) Race (Non-white) Full-Time Job Status (part-time) Age Category (≥ 55 years old) 35-54 years old 1.1(0.80,1.51) 1.37(1.03,1.82)* 1.58(1.20,2.09)*** 2.00(1.50,2.64)*** 1.93(1.44,2.6)*** 2.03(1.43,2.88)*** Less than 35 years old 0.61(0.42,0.89)* 0.87(0.55,1.10) 0.96(0.67,1.35) 1.33(0.93,1.89) 1.83(127,2.64)** 1.66(1.67,2.57)* Table 4. Adjusted odds ratios (AOR) and 95% CI from generalized ordered logistic regression models of clinical engagment in Medicaid (hours/week) by dentists' demographic and practice characteristics 0.69 (0.51, 0.94)** 1.38 (1.11, 1.72)* Source: Authors' analysis of state Medicaid claims count data, 2015 ***: p<.001; ** p<0.01; * p<0.05. AOR and 95% CI Clinical Engagement in Medicaid (hours/week)a If the odds ratio is proportional, a single AOR is shown in the center column. If the odds are non-proportional three AORs are shown, one for each of the three contrasts 29.77 (7.46, 118.81) * 13.42 (4.24, 42.44)* 9.62 (2.90, 31.92)* 55.32 (16.52, 185.30)* 1.24 (0.98, 1.57) 1.40 (0.90, 2.17) 1.14 (0.70, 1.87) 1.13 (0.71, 1.79)

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Results: Participation across age groups

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Discussion

• Using the ordinal measure representing “time based

contribution” results are consistent with literature

• Non-white dentists and those that practice “full-time” are

greater contributors to Medicaid

• Medicaid productivity peak in the 35-55 age group is

consistent with general productivity trends

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Limitations

• Outcome dependent upon the assumption that HRSA criteria

(4,000 claims =1 FTE) is valid

• Survey sample may or may not represent all enrolled
• Additional unmeasured factors may contribute to dentists

participation

• Dentists may provide care to Medicaid recipients and not

submit claims

• Claims data may not be reliable

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Policy Implications/Future Directions

• A standardized method of measuring dentist participation in

Medicaid is needed

• Claims data may be useful in measuring participation
• Future research will focus on analyzing claims data from other

states