Flint Hills Achieves Impressive Outcomes with Dental Program

by HCE Exchange on November 19, 2014

Phillip-Davis-thumbPhillip Davis, Chief Executive Officer

by Pete Fernbaugh

When Phillip Davis first came to Flint Hills Community Health Center in Emporia, Kan., three years ago after spending eight years with Community Health Center of Central Missouri as chief financial officer, he walked into an organization that was suffering from a shortage of funds and staff morale.

Flint Hills was losing money, specifically $200,000 the year before Davis’ arrival, and layoffs were becoming inevitable in spite of the organization’s best efforts to avoid them. The Center’s stability had been threatened by the 2009 recession and the loss of grant dollars from both the federal government and, as the primary provider of health-department services for Lyon County, from the state government.

“It is hard when you lose a grant to let staff go that are tied to that grant,” Davis said. “What I was seeing was these grants were going away, but the staffing remained the same. And so, there were some hard decisions to look at and study.”

In the summer of 2012, Flint Hills laid off six employees in order to get its costs under control. But this unprecedented move for the Center was the gateway to its recovery. Originally operating under a budget of $6 million a year, its budget has now grown to $9 million a year.

The steps it took to reclaim its stability as an organization is perhaps best demonstrated by its dental program.

Confronting performance gaps in dental program

In August, the DentaQuest Foundation bestowed its Safety-Net Solutions “Centers of Excellence” Award on Flint Hills Community Health Center at the annual National Oral Health Conference.

Two years ago, DentaQuest needed five Kansas-based organizations to participate in an in-depth study of their dental programs that would conclude with recommendations on how to improve each program.

“Dental was going well at that time, so it wasn’t that we were failing at it,” Davis said. “But anytime you can get someone to come in and look at operations and give suggestions on how to improve them, we’re open to that.”

DentaQuest sent a consultant in who looked at scheduling, billing, costs, efficiencies, staffing, and performance measures, especially Flint Hills’ no-show rate. The consultant met with the dentists individually and with the dental assistants and hygienists as a group.

A team was then formed that included dental and frontline-staff representatives who were tasked with making recommendations to the Center using July 1, 2011, to Dec. 31, 2011, as their baseline.

Flint Hills promptly implemented the team’s recommendations, and in the final report, based on the July 1, 2013, to Dec. 31, 2013, baseline, it was discovered the Center had achieved a 27.29 percent increase in gross charges with a 32 percent increase in net revenue, which was all the more impressive when compared to an increase of 7 percent in expenses over that same period of time.

Flint Hills also achieved a 17 percent increase in visits, and revenue per visit went from $111 to $125. Cost per visit dropped from $105 to $96.

“We were able to do that with the same number of providers,” Davis said. “A lot of that was scheduling correctly, using the hygienists throughout the system at the level they were needed, and then reducing the no-show rate as well.”

Incidentally, the no-show rate tumbled from 20 percent to 13 percent.

Three keys to the dental program’s turnaround

Davis said there were three keys to Flint Hills’ success under DentaQuest’s guidance: engaging the providers, earning buy-in from the staff, and reducing no-shows.

“Reducing the no-shows was one thing,” he said. “I may know my schedule as a patient for the next month, but six months from now, I’m just guessing.”

Instead of scheduling appointments several months out, Flint Hills began only scheduling one month out, opening a new week for scheduling every Monday. Two days before an appointment, the Center will call the patient and request confirmation by noon of that day. If the patient fails to confirm, that slot is opened up to another patient.

Davis said this required a degree of training for the patients, who weren’t happy about the new policy. Delicate scripting was required to ensure that every team member communicated the same message to irate patients.

“I can tell you that patients were in my office talking to me about this,” Davis said. “But it had to be the same message every time they talked to someone. And that was key, too. The patients couldn’t come to me and I would say, ‘Yeah, we can get you in right now.’ No, because that just undermines everything, so the consistent message that was there improved it. The next time they called in and confirmed their appointments.”

Hoping to avoid a fiscal cliff

Generally, Flint Hills has a healthy payer mix, Davis said, with 9 percent on Medicare, 33 percent on Medicaid, 28 percent private insurance, and 30 percent self-pay. Having opened a new access site in Eureka, the Center is currently working to integrate dental and behavioral health services with primary care at both locations.

Unfortunately, a significant portion of federal funding under the ACA is set to expire at the end of fiscal year 2015, which would be a rather large hit for the organization, Davis said. The state of Kansas has also cut its income tax, so the organization is examining how this change of revenue will affect it.

“Community health centers are very important in filling the gap in coverage for those patients that have nowhere else to go,” he stressed. “We’ve spent years providing high-quality healthcare regardless of who the patient is, and we’re striving to continue doing that, whether it’s a state representative who comes in or an unemployed family of five. They’re going to receive the same high-quality healthcare.”

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