Our Vision Healthy Kansans living in safe and sustainable environments.

Transcription

1 Our Vision Healthy Kansans living in safe and sustainable environments.

2 Daniel Lassley Bureau of Oral Health Kansas Department of Health and Environment

3 Improve Access to Dental Care by Strengthening the Kansas Dental Workforce HOW? Provide Data on the Strength of the KS Dental Workforce in Kansas Bring Together an Advisory Group for On-Going Discussions about Dental Workforce Issues Provide Funds to Create Programs to Increase the Numbers of Dentists and Dental Hygienists Serving Kansas Underserved Communities

4 Dentists, Dental Hygienists, Extended Care Permit Hygienists, Dental Assistants Private Practices, Safety Net Clinics, Outreach Sites

5 1,404 Dentists Licensed and Active in KS 1,187 General Dentists (Non-Specialists) Kansas Law Regulates Dentistry through the Kansas Dental Practice Act 4 Year Graduate Program but Kansas has no In-State Dental School

6 1,656 RDHs Actively Practicing in Kansas Must be Supervised by a Dentist, Although Not Necessarily on Site Scope of Practice: Cleaning, Scaling & Root Planing, Sealants, Preventive Procedures Fl Varnish, Oral Hygiene Instruction

7 Five Dental Hygiene Programs in Kansas in Addition to UMKC and Concorde (KCMO) Hygienists are Licensed by the Kansas Dental Board in Accordance with the Kansas Dental Practice Act

8 Experienced Dental Hygienists May Obtain an Extended Care Permit (ECP) ECP I (43) Schools, FQHCs, LHDs ECP II (81) Patients with Special Needs, Elders ECPs Perform Hygiene Services in Public Health Settings (NO Expanded Scope of Practice) Without a Dentist Seeing the Patient ECPs Have a Sponsoring Dentist who Reviews their Charts, But May Not Ever See the ECP s Patients

9 Assist Dentist Chairside under Direct Supervision Generally not Regulated by Kansas Dental Board.except for: Scaling Assistants Assistants that have been trained to clean teeth above the gumline. Other than Scaling Assistants, No Educational Program is Required to Work as a Dental Assistant in Kansas.

10 Access to Dental Professionals is Crucial to Good Oral Health. Dentists are Hard to Find in Certain Geographic Areas and for Certain Population Groups: Frontier and Rural Areas Children on Medicaid Uninsured and Low Income Populations Cannot Afford Care People with Disabilities Racial and Ethnic Minorities

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12 264,430 Kansas Children on Medicaid or Healthwave 411 Dentists are Enrolled Medicaid Providers who had a Paid Claim Last Year 153 Treated 100 or more Medicaid Patients Why so Few? Low Reimbursement Patients are Difficult No Shows, High Trt Needs

13 25% of Kansas Kids Have Untreated Dental Decay Highest in NW (54%), NC (64%) and SW (46%) 55% of Kansas Kids Have Experienced Dental Decay by 3 rd Grade 34% had Dental Sealants Higher Decay Rates in Low Income Families African American Children had Fewer Sealants

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15 No Complete Dental Benefit for Most Adults on Medicaid Medicaid Only Covers Eligible Groups Children, Pregnant Women, People with Disabilities Very Limited Dental Benefits in Medicare State Budget Cuts Ended Dental Benefits for Elders and Disabled on HCBS Waivers.

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17 Recruit Dentists to Kansas, Especially in Underserved Areas and the Safety Net Encourage Kansans, Especially Students from Rural Areas and Minority Groups to Look at Dental Careers Promote ECP Workforce Data Collection Programs to Support Retention Dental Professionals in Underserved Areas

18 Bureau of Oral Health KDHE Kathy Weno Project Coordinator Daniel Lassley Program Manager Ashley Streeter Program Assistant Oral Health Kansas Dental Workforce Cabinet, ECP Outreach Tanya Dorf Brunner, Marcia Manter Office of Local and Rural Health - KDHE Robert Stiles Primary Care Office Barbara Huske Loan Repayment, Underserved Designations Kansas Association for Medically Underserved Safety Net Clinic Workforce Coordinator

19 University of Kansas Medical Center Kim Kimminau, Anthony Wellever Workforce Research Wichita State - Advanced Education in General Dentistry Program Continuing Dental Education, Dental Career Outreach Program UMKC School of Dentistry Continuing Dental Education, Dental Career Outreach Program Community Health Center of SE KS ECP Hygiene Outreach Program Kansas Dental Association Access Pilot Programs, Dentist Supports

20 Completed in Sept 2009 Telephone Survey of Dentists and ECP Hygienists Community Focus Groups about Dental Access Issues Creates a Project Baseline, Data Suggests Policy

21 Dentistry is an Aging Profession. in Kansas Average Dentist Age : 50 KS Dentists are overwhelming white and male 91.2% white, 76% male 64% of Kansas Dentists are Kansas Natives 69% are UMKC Graduates Reason for Practicing in Kansas: Family, Quality of Life

22 Dentists choose to slow down by reducing hours over time rather than full retirement. They are slow to plan for retirement, only 2% planned to retire in % have never thought about what to do with their practices when they retire. As Frontier and Rural providers are older, they (Frontier %, and Rural % ) report planning to retire in next 3-5 Years. Those who have retirement plans usually involve taking on an Associate or selling their practice. This may not be realistic. 48.5% of those recruiting for a dentist say it has been difficult Of those practices currently for sale, 69.7% have been for sale over one year.

23 82% of Dentists Employ Hygienists 56.9% of Dentists Employ 2-4 Hygienists 9.4% are Currently Recruiting for a Hygienist 19% of Dentists Employ a Scaling Assistant 18% of Dentists Employ ECPs 15.9% of Dentists Sponsor ECPS 43.6% of Dentists Unaware of ECP

24 ECPs practice in 53 counties (approximately one-half of all KS counties) ECPs practice in all five urban counties ECPs practice in 48% of rural counties Top ECP Practice Sites: Early Childhood Centers (Head Start), Schools (K-12), Safety Net Clinics and Long Term Care Facilities ECPs are Concentrated in the Safety Net Clinics 62.1% of Safety Net Clinic Dentists Employ ECPs 55.2% of Safety Net Clinic Dentists Sponsor ECPs Most ECPs work 8 hours a Week or Less

25 Perceptions about Access Vary Based on Practice Type and Location Dentists have a Chair-Side View ECPs Awareness Based on Community Practice Both ECPs and Dentists Support More Community Water Fluoridation Strong Disagreement about the Importance of the Development of New Dental Provider Models

26 Frontier Sm. Rural Lrg. Rural Urban Commercial Insurance Medicaid

27 38 Dentists in that work in Safety Net Clinics Safety Net Clinic Dentists are Younger Average Age is More Racially Diverse 77.4% White 52% are Female 58 Dentists who Participated in the Kansas Mission of Mercy in Manhattan No Significant Difference from Total Sample Qualitative Comments Documented

28 Conducted Five Focus Groups: Hays, Dodge City, Wichita, Lawrence and Topeka Invited Participants that has Experience in Dental Recruitment or Access to Care Dentists, ECPs, Safety Net Clinic Administrators, Dental Educators, Community Service Providers, Workforce Development Kansas Dental Charitable Foundation Video Facebook Visualizing Oral Health in Kansas Be a Fan!

29 Geographic Location Shaped the Discussion Rural - Dodge City, Hays Distance to Providers and Specialty Care Dentist Recruitment to Rural Areas, Scarcity of Providers ECPs Need for More RDHs and Dentists Awareness Wichita, Lawrence, Topeka Number of Patients Needing Care is Overwhelming Lack of Prevention Water Fluoridation Success of Community Based Services Schools Collaboration among Community Partners and Coalitions to Provide Care and do Advocacy

30 Rural Dental Access Research 2011 KU Medical Center Researchers Looking at optimal ways to seed projects and provide care for rural and frontier populations Information for Funding Rural Projects Complete by July 2011

31 Primary Objective: Use GIS to inform dental workforce issues Identify population-specific areas of high need Go beyond county level shortage analysis Additional Aims: Focus on primary care dentists Additional analysis of ECP Additional analysis of high volume Medicaid dentists Overlay rural Kansans reported routine travel distance/time for services

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34 Location Average Time (Min.) Frequency/Yr Groceries Chain Store Auto Repair Church Movie Theater Outlets Pharmacy Veterinarian Chiropractor Optometrist Dentist

35 Identify alternative GIS units useful in pinpointing shortage crisis areas Finalize adjacency maps Complete the 8 community sub-study Map rural residents distance reported to various key resources, including dentistry Use the findings from Dental Workforce I study to inform the identification of shortage crisis areas; e.g., which dentists from DWI report retirement or practice is for sale planning

36 Funding for State Loan Re-Payment, ECP, Dental Recruitment, and Dental Camp Funding for Creative Access Projects for Dentists, Hygienists, Community Groups and Clinics at the Discretion of the Workforce Cabinet Project Evaluation

37 Kathy Weno Project Coordinator Ashley Streeter Dental Club Project Daniel Lassley Dental Recruitment Program Manager Tanya Dorf Brunner Dental Workforce Cabinet Meeting Facilitator

38 Our Vision Healthy Kansans living in safe and sustainable environments.