carol tobias, busph apha 2012
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Planning for oral health services: Utilization and cost of dental care for people living with HIV/AIDS
Carol Tobias, BUSPHAPHA 2012
Presenter Disclosures
(1) The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months:
Carol Tobias
No relationship to disclose
The SPNS Oral Health Initiative (2006-2011)• 15 programs funded to expand access to HIV oral
health care• 8 rural programs, 7 urban programs• Service models– 4 mobile vans– 7 co-located medical and dental services– 1 program in a dental hygiene school– 3 Satellite clinics
SPNS Sites
Eligibility Criteria• At least 18 years of age• HIV positive• Out of oral health care for prior 12 months,
except for emergency care to relieve pain or infection
Services Provided
Over the course of the study:• Patients made over 15,000 clinic visits• They received over 37,000 services• 917 (42%) completed a Phase 1 treatment plan
*Phase 1 Treatment Plan = Prevent and treat active disease
The ones that got away…
375 (17%) patients had only one visit
CategoryTypes of Dental ServicesExplanation
% Receiving Service
Diagnostic care Exams, x-rays, etc. 98%
Preventive care Cleanings, fluoride, patient ed. 63%
Restorative care Restorations, fillings 50%
Periodontal care Non-surgical and surgical care 42%
Oral surgery Extractions, simple and surgical 29%
Removable Prosthodontics
Partial and complete dentures, repairs 21%
Endodontic services Root canals, pulpal procedures 11%
Fixed Prosthodontics Bridges 3%
What does it cost to provide this care?
It depends on …….• The services covered• The price paid for a service, or the cost• How many patients are new to dental care vs.
already engaged • What other resources are available? (Medicaid,
private insurance, foundation funds)
Pricing Methods• Used utilization data from the SPNS initiative • Grouped sites according to services provided (basic,
intermediate, comprehensive)
• Used 3 different fee schedules (FL Medicaid, Delta Dental, ADA usual and customary)
• Applied fee schedules to services provided during the first 12 months of care (at different levels of coverage)
• Did the same thing for the second 12 months of care
Definitions
Level of Care# of sites Covered Services
Basic Care 14 Diagnostic services, preventive services, restorations excluding crowns, periodontal care excluding surgery, adjunctive services
Intermediate Care
12 Basic care PLUS periodontal surgery, oral surgery, removable prosthodontics
Comprehen-sive care
8 Intermediate care PLUS crowns, endodontics, and fixed prosthodontics.
Average Cost/Person in First 12 months of Treatment
Comprehensive care
Intermediate care Basic Care$0
$200 $400 $600 $800
$1,000 $1,200 $1,400 $1,600 $1,800 $2,000
$603
$383 $217
$1,271
$965
$541
$1,829
$1,435
$833 Low CostMedium CostHigh Cost
Low cost = Miami/Dade County fee schedule; Medium cost = Delta Dental; High cost = ADA usual & customary
Average Cost/Person for First 12 Months of TreatmentService % of Pts receiving service Annual cost (medium)Diagnostic Care 98% $153Preventive Care 63% $60Restorative Care (exc. crowns) 59% $205Crowns 6% $112Periodontal Care 42% $106Endodontic Care 11% $107Oral Surgery 29% $134Removable Prosthetics 21% $291Fixed Prosthetics 21% $88Adjunctive NA $18 TOTAL $1271
Change in Costs – Year 2*
Comprehensive Care Intermediate Care Basic Care$0
$200
$400
$600
$800
$1,000
$1,200
$1,400 $1,271
$965
$541
$393
$237 $126
Year 1Year 2
*Using the medium cost schedule
Difference in cost – Years 1 and 2*
Diagnosti
cs
Preventive
Restorati
ons
Periodontal
R. Prosth
estics
Oral Su
rgery
Adjunctive
0
50
100
150
200
250
300
350
Year 1Year 2
Cost
per
per
son
* Using intermediate level of care and medium cost schedule
Things to think about• Who are your dental providers – CHCs,
university clinics, private practices, HIV clinics?• What will they accept for payment rates?• What is the trade off between depth of
coverage and numbers served?• Other payers?• Geographic considerations
Other ResultsTo access the Public Health Reports journal supplement on Innovations in Oral Health Care for People Living with HIV/AIDS, go to:
http://www.publichealthreports.org/issuecontents.cfm?Volume=127&Issue=8
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