Slide 1: Ryan White CARE Act Dental Reimbursment Program (DRP) 2002 Data

Image: Dentist with Patient in Chair / HRSA logo

Slide 2: Program Overview

• The Dental Reimbursement Program (DRP) under Part F of the Ryan White CARE Act is intended to help accredited dental schools, dental hygiene schools and post-doctoral dental education programs cover their non-reimbursed costs of providing oral health care to individuals with HIV.
• The data illustrated here are those for which 2002 program funds were awarded to cover the non-reimbursed oral health service costs incurred during the 2000 - 2001 service year.
  
• A total of 66 institutions applied for reimbursement, and their data are illustrated in these slides

Slide 3: Purpose

• To assist with covering the rising non-reimbursed costs faced by dental education institutions providing care to individuals with HIV.
  
• To improve access to oral health care for individuals with HIV.
  
• To ensure that dental and dental hygiene students and dental residents receive proper training in the management of oral health care for individuals with HI

Slide 4: Characteristics of Applicants

• The 66 DRP applicants who submitted data were located in 25 states, the District of Columbia, and Puerto Rico. Of these programs a) 26 were Dental Schools (Institutions of higher learning that educate and train students in the field of dentistry and provide oral health services to patients, including those with HIV); and b) 40 were Postdoctoral Dental Education Programs (Schools of dentistry, hospitals, or public or private institutions that offer training in the specialties of dentistry, advanced education in general dentistry, or are sites of general dental practice residencies.)

Slide 5-7: Program Attributes

• DRP applicants provided services in on-site dental clinics and multiple off-site facilities that are organizational components of their parent institutions or separate community-based organizations.
  
• DRP grantees have dental clinics that are located in close proximity to Infectious Disease Clinics and they collaborate on the care of HIV-positive patients.
  
• A few DRP grantees have clinics that are dedicated to specific populations, such as children, the elderly, or disadvantaged populations, and most offer a broad range of oral health services.
• Most DRP applicants are involved in a number of collaborative activities with other health programs and agencies, such as State and local agencies and other Ryan White CARE Act funded programs. Many are also involved with other community-based agencies in the development of the Statewide Coordinated Statement of Need (SCSN).
  
• Outreach is an integral part of most DRP participating programs, with special emphasis on dental care for medically compromised individuals and patients with special needs. Some offer mobile dental units to substance addiction programs, homeless shelters and public health clinics. Many others participate in patient and provider education programs affiliated with AIDS Education and Training Centers (AETCs). Some offer free dental screenings to children while others participate in referral relationships with community-based agencies and local practitioners.
  
• DRP applicants pride themselves on their emphasis on providing care to special populations such as the poor who rely on public assistance, those who have been denied services elsewhere, and pregnant women.
• Many adjust their services to overcome fundamental barriers to accessing care.
• Many applicants are provide care in mobile clinics and locations in mostly underserved areas. Others provide much needed oral health care services for traditionally underserved rural populations, while others provide transportation services, extended clinic hours, Saturday appointments and 24-hour on-call residents for dental emergencies.
  
• A couple of DRP applicants have started offering unique services designed to connect affiliated sites and thereby extend services to providers and patients. Telemedicine programs, distance learning and videoconferencing capabilities are being developed within community-based sites.
  
• Many institutions have staff reflective of the diverse population of the patients they treat and others provide translation services to overcome language barriers.
  
• An important component of many programs is the availability of dental specialists. Some offer specialized services such as trauma care for patients with maxillofacial injuries. Others provide lymph node biopsies for HIV-related TB, lymphomas and other opportunistic infections, as well as comprehensive cancer surgery and coordination of radiation and chemotherapy.

Slide 8: Patient Characteristics

• Dental Reimbursement Program applicants reported serving 26,327 individuals with HIV.
  
• 10,928 individuals received care from Dental schools, while 15,399 received care from Postdoctoral programs.
  
• Of the total number of individuals reported receiving care, 17,803 or over one-half (68%) were served by programs in three states (NY, CA, MA).
  
• About one half of all reported DRP patients (13,295 or 50.5%) received care in programs located in NY state, and the majority of these were cared for in Postdoctoral dental programs.

Slide 9: Gender Distribution of Individuals Served

Image: Pie Chart

Data:
Males: 68%
Females: 2%
Transgender: <1%
Unknown/Unreported: <1%

• Overall, 17,830 or 68% of the individuals served were males while 8,431 or 32% were females and the remaining 66 individuals were identified as transgender (0.2%) or gender unreported/unknown (<0.1%).
• Programs in three states (TX, NJ, and SC) reported that half of their patients (45%, 58%, 53%, respectively) were females.

Slide 10: Age Distribution of Individuals Served by the DRP Program

Image: Bar Chart

Data:
0 - 12 years of age: 3%
13 - 19 years of age: 2%
20 - 24 years of age: 4%
25 - 44 years of age: 56%
45+ years of age: 33%
Unknown/unreported: 2%

• Most individuals (56%) who received care were 25 - 44 years of age.
  
• Programs in SC and DC reported serving large proportions of children in the 0-12 year age group (68% and 54%, respectively).
  
• Programs in TX, CA, MI, MO and OR reported serving higher proportions of individuals over 45 years of age (50%, 49%, 44%, 75% and 43%, respectively).

Slide 11: States with Programs Serving the Highest Number of Children and Adolescents

Image: Bar Chart

Data:
Colorado (N=4): 100%
Connecticut (N=6): 50% were 13-19 years of age and 50.0% were 0-12 years of age
District of Columbia (N=194): 11.3% were 13-19 years of age and 88.7% were 0-12 years of age
South Carolina (N=85): 100%

• Of all persons cared for, about 5% were children and adolescents of age 0-19 years, with children age 0-12 years making up 63% of these persons.
  
• Programs differ markedly in the number of children and adolescents served.
• Programs in SC and DC reported a significant percentage (68% and 61%, respectively), of their total case load in these age groups.
  
• In SC and DC, children 0-12 years make up the great majority (100% and 88.7%) of youth for whom care was provided.

Slide 12: Ethnic Distribution of Individuals Served

 Image: Pie Chart

Data:
Hispanic: 31%
Non-Hispanic: 59%
Unknown: 11%

• In 2001, the Office of Management and Budget (OMB) redefined ethnicity as a demographic element separate from race.
  
• About 31% of all patients served by the DRP are of Hispanic or Latino/a ethnicity.
  
• Seven in ten (70%) patients served in FL and about two in five (41%) served in NY were of Hispanic ethnicity.

Slide 13: Race Distribution of Individuals Served

Image: Pie Chart

Data:
Native Hawaiian or other Pacific Islander: .03%
American Indian or Alaska Native: 3%
Multiple races: 5.5%
Unknown/Unreported race: 10.3%

Slide 14: Populations Served

Data:

• About one-half (48%) of the patients who reported their racial identification were from racial minority groups, and the overwhelming majority (85%) of these were African-Americans or Blacks.
  
• The vast majority (89%) of the patients served were over 25 years of age.

Slide 15: Pregnant HIV+ Individuals Served

Image: Pie Chart

Data:
Dental Schools: 19.1%
Postdoctoral Programs: 80.1%

• A total of 141 pregnant women with HIV were cared for by DRP participating institutions.
  
• The majority (80.9% or 114) of these women were cared for by postdoctoral dental education programs.
  
• DRP institutions in NY cared for the majority of the pregnant HIV+ women (104 or 73.7%).

Slide 16: Number of Visits for Most Frequently Provided Oral Health Services*

Image: Bar Chart

Data:

• DRP applicants provided 152,490 oral health care service visits.
  
• Dental schools provided 45% (68,908) of these service visits, and 55% (83,582) were provided by postdoctoral programs.
  
• Seven types of procedures (Restorative, Diagnostic, Prosthodontic, Oral Surgery, Preventive, Periodontic & Oral Health education) account for 82% of the total service visits provided, and Restorative and Diagnostic are the most common.

*Since patients may receive oral health services over multiple visits , the number of service visits exceeds the HIV+ patient caseload.
** Other service visits include, Emergency, Oral medicine and Anesthesia/sedationn.

Slide 17: Specific Use of DRP Funds

Image: Bar Chart

Data:
Equipment: 70%
Staff salary: 52%
Student education: 50%
Staff training: 44%
Patient education: 42%
General operations: 42%
Curriculum development: 24%
Other: 3%

• A majority of applicants reported using DRP funds to support direct patient services and student training, both key DRP components.
  
• Most institutions reported using DRP funds for dental equipment, instruments and supplies, as well as for clinic staff salaries and training, both of which strengthen infrastructure for health service delivery

Slide 18: Reimbursed vs. Non-ReimbursedOral Health Care

Image: Pie Chart

Data:
Some Reimbursement: 58.1%
No Reimbursement: 41.6%
Unknown: 0.10%

• Nearly one-half (42%) of the patients served by the DRP had no other sources of reimbursement to cover the cost of their care.
  
• Programs in some states reported much higher percentages of non-reimbursed care compared to others: For example, GA-100%; IL-95%; MD- 87%; FL-81

Slide 19: Reimbursed Care by Source of Reimbursement*

N=410,808

Image: Pie Chart

Data:
Medicaid (Non-HMO): 58%
Medicaid (HMO): 10%
Self-Pay: 9.7%
Private Insurance: 7%
Medicare: 2%
Public Insurance: 2%
Unknown: 3.4%
Other: 11.20%**

• Of all patients with some reimbursement source, about six in ten (58%) patients had some care reimbursed by Non-HMO Medicaid.
  
• Among programs located in TX and IL, almost all their patients with some reimbursement source (100% and 95%, respectively) had some care covered by Non-HMO Medicaid.
  
• Programs located in TX, OR, AL, KY, and VA reported that higher proportions of patients with some reimbursement source were more likely to have “Other” sources of reimbursement (100%, 76%, 75%, 64% and 64% respectively).

*Due to rounding, percentages may not add up to 100
** Includes Governmental, Correctional system, CBO, and other Ryan White CARE Act Funding

Slide 20: Fiscal Characteristics

Data:

• Total non-reimbursed oral health care costs reported by all participating Dental Reimbursement Program applicants was $13,118,760.
  
• Dental schools reported approximately $4.2 million in non-reimbursed costs.
  
• Postdoctoral dental programs reported approximately $8.9 million in non-reimbursed costs.
  
• Applicants in New York state reported the highest amount of non-reimbursed costs, about $6.7 million.
  
• The sum of non-reimbursed costs reported by all participating applicants in each of four states (New York, California, Florida, and Massachusetts) totaled more than $1 million

Slide 21: Average Non-reimbursed Oral Health Care Cost, 1997-2002

Image: Trend Chart

Data:
1997: $130,325
1998: $150,872
1999: $164,172
2000: $194,893
2001: $175,209
2002: $198,769

• Notably the number of program applicants has decreased by 42% since 1997, yet the average non-reimbursed cost has continued to increase.
  
• Overall, the average non-reimbursed cost of oral health provided has continued to rise from $130,325 in 1997 to $198,769 in 2002
  
• This increase is principally due to increasing costs reported by Postdoctoral programs

Slide 22: Training Characteristics - A Key Element of the DRP: Training Hours

Image: Bar Chart

Data:

• A total of 4,616 education curriculum hours were dedicated by DRP institutions to HIV care issues.
  
• Most of these hours (60%) were provided to Post-doctoral residents.
  
• The majority of these training hours (86%) were provided as part of the required, as opposed to elective, curriculum.

Slide 23: Training Characteristics:Number of Providers Trained

Image: Bar Chart

Data:
Dental students : 4067
Post-doc Residents: 1526
Dental hygiene students: 379

• Nearly half of all students (44.7% or 5,972) enrolled in DRP institutions gained clinical experience providing services to HIV+ patients.
  
• About seven in ten of these students (68.1% or 4067) were Dental students.
  
• As a proportion of students enrolled in each of the programs, more post-doc residents reported gaining clinical experience, compared to Dental students (67% vs. 41%)

Slide 24: Training Characteristics:Hours of Clinical Care Provided

Image: Bar Chart

Data:
Dental students: 11,041
Post-doc residents: 25,981
Dental hygiene students: 239

• Students and residents in DRP-supported programs spent a total of 37,261 clinic hours (an average of 70 hours) providing clinical care to HIV+ patients.
  
• The majority of these hours (69.7% or 25,981) were provided by post-doc residents. On the average, post-doc residents provided 42 hours of care.
  
• Dental students provided an average of 24 hours or a total of 11,041 hours of clinical HIV-related clinical services.

Slide 25: Other Funding

Data:

• About three in five (59.1%) Dental Reimbursement Programs reported that their parent institutions received funding from other CARE Act programs in 2002 (to support the provision of all HIV services, not necessarily oral health services).
  $9,633,021 from Title I
  $1,889,029 from Title II
  $5,320,711 from Title III
  $2,657,327 from Title IV
  $375,000 from Special Projects of National Significance (SPNS)
  $562,645 from AIDS Education and Training Centers (AETC) progra