Sarah Wovcha, JD, MPH, Executive Director Minneapolis, MN Mission: - - PowerPoint PPT Presentation

Sarah Wovcha, JD, MPH, Executive Director Minneapolis, MN

Reducing Oral Health Disparities in Rural Communities through Telehealth Innovations

 Mission: Since 1919 Children's Dental Services is dedicated to improving the

• ral health of children from families with low incomes by providing accessible

treatment and education to our diverse community.

Children’s Dental Services History

 Grew out of 1919 Minneapolis charitable women’s organization to

serve destitute orphans when health safety nets were non-existent

 First in Minnesota to apply dental sealants in 1966  First in nation to provide on-site services in Head Start centers  Over 10,000 rural patients and 50 rural partners annually request

CDS’ care

Children’s Dental Services

• Target population: low-income children

ages birth to 26 and pregnant women of all ages

• Largest provider of on-site dental care in

Minnesota schools and Head Start centers

• Quadrupled in size since 2000 due to the

growing numbers of patients requesting services

• Provides care targeted to the following

patient groups:

• Blind
• disabled
• Autistic
• HIV positive
• Drug addicted
• Homeless
• East African
• Latino
• Southeast Asian
• Native American

Service Area and Statistics

633 sites 36,748 patients 63,000 visits 94,000 procedures

2017 Patient Demographics

 Note: 80% of sliding scale patients receive free care

Cultural Competency

• CDS provides culturally targeted and translated dental services and education
• CDS is particularly well equipped to serve multilingual, culturally-diverse families

60% people

• f color

90% female

26

languages

spoken

125 staff

Barriers to Providing Services

 Swelling population of underserved patients  High numbers of untreated immigrants/refugees  Lack of funding-Minnesota’s Medical Assistance reimbursement rates

among the lowest in nation (CDS 2017 uncompensated care write off exceeded $6.4 million)

 Difficulty hiring and retaining dentists (DDS)  Results: As of 2015 only 37.2% of Minnesota children receiving

Medical Assistance were able to see dentist

Solutions Embraced by Children’s Dental Services

• Portable, site-based care, particularly in school settings
• Supporting dental clinicians to practice “at top of their licenses”
• Utilization of mid-level providers such as

Advanced Dental Therapist (ADT)

• Use of telehealth (teledentistry)

Portable Dental Care Program

 Enables full range of care to

be provided on-site in community- and school- based settings

 Equipment small enough to

fit nearly anywhere

 Ideal for telehealth settings

HRSA Grant 16-012

Minnesota Rural Teledentistry Network

Aitkin County Health and Human Services Carlton County Public Health and Human Services Chisholm Independent School District #695 Ely School District #696 Eveleth Gilbert Independent School District #2154 International Falls School District #361 Lakes and Pines Community Action Council Little Fork-Big Falls School District #362 Meeker County Social Services Department Mesabi East School District Mountain Iron-Buhl Public Schools #712 Princeton Public Schools #477 South Koochiching-Rainy River School District #363 Southwestern Minnesota Opportunity Council

• St. Louis County Schools #2142

Virginia School District #706 Western Community Action

Grant period: 9/1/2016 – 8/31/2020 Objectives: CDS will expand a telehealth network across rural Minnesota, linking SBHCs, Head Starts and community public health entities at 17 sites in underserved counties. Anticipated Outcomes: Children and pregnant women (2,000 in year 1 and 3,000 each in years 2-4) annually will have improved access to

• ngoing care and improved oral and
• verall health.

Teledentistry Network Sites

Need for Teledentistry

 33 million Americans live in dental

deserts

 DHPSA – Dental Health Provider

Shortage Area

 61% of MN counties are designated

as DHPSAs

17 Rural MN

Counties

14 Counties: DHPSAs 2 Counties: Partial DHPSAs 1 County: 3,903 residents per dentist

Teledentistry Utilization and Effectiveness

• Remote provision of dental care/advice using information technology

rather than direct contact with patient

• Accomplished via telecommunication technology, digital imaging and

the Internet

• Supported by Minnesota Department of Health (MDH) and Health

Resources & Services Administration (HRSA) funding Reduces patient travel Provides care in underserved areas Results comparable to in-person treatment Decreases number of appointments needed to complete care

Minnesota Telehealth Legislation

 2017 Minnesota Statutes  256B.0625 COVERED SERVICES  Subd. 3b.Telemedicine services.  (a) Medical assistance covers medically necessary services and

consultations delivered by a licensed health care provider via telemedicine in the same manner as if the service or consultation was delivered in person. Coverage is limited to three telemedicine services per enrollee per calendar week. Telemedicine services shall be paid at the full allowable rate.

Teledentistry Protocol

Hygiene services (including x-rays and patient assessments) provided at Rural Site A Providers at CDS headquarters in Minneapolis review x-rays and treatment plan

On-site exam services no longer required at Rural Site A Restorative services provided at Rural Site A

Essential Equipment Laptop or Tablet with High-Definition Screen

 Affordable and accessible  Light-weight, rugged, highly-transportable  Allows Dental Charting and Data Entry to be

saved and reviewed instantaneously

Dell Latitude E6410 laptop $292

Essential Equipment Portable X-ray and Digital Sensors

 Small pieces of equipment which take high-quality dental

radiographic images

 Allows clinician to stay by patient’s side while taking films  Reduce radiation exposure by up to 60% when compared to

exposure from film-based radiography (per American Dental Association)

 Images are instantly processed and saved to the patient’s file

NOMAD Pro Digital X-ray System $6,400 GENDEX GXS-700 Digital Sensor $4,000

Essential Equipment USB Intraoral Camera

 Used to obtain images of the inside of the patient’s

mouth, including soft tissue and chewing surfaces, which are unable to be captured via x-rays

 Photos are a superior tool for patient education and

consultation on various treatment options

 Images are clear and magnified  Sometimes a child is too young to tolerate x-rays

but will allow intraoral photos to be taken

GENDEX GX C-300 Intraoral Camera $1,410

Essential Equipment Dental Software

 CDS utilizes the Open Dental software program

 Compliant with federal Electronic Health Record

(EHR) and HIPAA requirements

 Highly secure, providing virus protection, data

encryption, and tamper resistance

 Allows providers to send and receive information

(records, radiographs, intraoral photos) instantaneously, safely, and in an environmentally-friendly way

 Provides a variety of applications for practice and

patient management

Open Dental XVWeb Software $175 monthly plus additional fees per location and workstation

Essential Equipment Wi-Fi Hotspot

 Allows Teledentistry system connectivity in remote regions  Overcomes fire walls present in community locations  More secure than using host-site security connection, enhances privacy

protection

 Easy to transport and cost effective

• Review clinical data, radiographs, photos,

and observations from clinicians

• Communicate with patients and families

remotely

• Plan and provide follow-up treatment

Dentists and Advanced Dental Therapists

Comprehensive exam (Dentist) – visual inspection of mouth and x-rays coupled with probe of each tooth’s surface, compared with dental and medical history Limited exam (ADT) – visual inspection of mouth and x-rays coupled with probe

• f each tooth’s surface

Assessment (Hygienist) – visual inspection of mouth for noticeable decay

Exam Types

Aver erag age e Tim ime e to F

• Fol
• llo

low-up up Car are

Random Sample of 500 patients 250 received telehealth 250 received in-person exams *Number of patients requiring follow-up care is similar for both telehealth and in-person exams

 Dentist following conventional exam:

3.2 weeks

 Dentist following telehealth exam:

2.4 weeks

 Dental Therapist following conventional exam: 1.8 weeks  Dental therapist following telehealth exam

.8 week

Exam Completion Costs

32 dentist hours to complete 52 conventional exams 32 hygienist hours plus 15 hours dentist hours to complete 52 telehealth exams

52 exams Dentist $80/hour

Complete exams OR read x-rays

Hygienist $27/hour

Take x-rays, send to ADT/Dentist

ADT $50/hour

Complete exams OR read x-rays

Cost Analysis of Teledentistry Exams by Provider

Telehealth exam conducted by DDS: $11.27 savings/exam x 10,000 rural patients=$112,700 Telehealth exam conducted by ADT: $.27 savings/exam x 10,000=$2,700

• $80 x 32 = $2,560; $2,560/52 = $50.96/exam

Dentist (DDS) completes in-person exams

• ($27 x 32) + ($80 x 15) = $2,064; $2,064/52 = $39.69/exam

Hygienist completes assessment (telehealth), dentist analyzes/creates treatment plan

• ($27 x 32) + ($50 x 15) = $1,614; $1,614/52 = $31.04/exam

Hygienist completes assessment (telehealth), ADT analyzes/creates treatment plan

• $50 x 32 = $1,600; $1,600/52 = $30.77

ADT completes in-person exams

Rural Teledentistry Project Number of Patients Served

3,166 patients served in 17 rural counties

Patient can speak with dentist in urban hub Reduced travel time Decreased time between diagnosis and treatment Reduced number of appointments Increased access to dental care

References

http://www.pewcenteronthestates.org/report_detail.aspx?id=61628 http://www.normandale.mnscu.edu/academics/deans/pdfs/ADEAPres entation1.pdf https://www.revisor.mn.gov/statutes/?id=150a.105 http://www.dentalboard.state.mn.us/Portals/3/ Licensing/Dental%20Therapist/ADT-CMA%2012-410approved.pdf

Please direct questions to: Sarah Wovcha, JD, MPH Executive Director Children’s Dental Services 636 Broadway St. NE Minneapolis, MN 55413 612-636-1577

swovcha@childrensdentalservices.org

Thank you

Thank you to HRSA for funding and supporting the Rural Minnesota Teledentistry Network