KCMO Pilot Program Seeks to Divert Dental Cases from ER


KANSAS CITY, Mo. – Truman Medical Centers and four safety-net sites are preparing to launch a three-month pilot project aimed at reducing the number of dental cases treated in the emergency room.

Organized through the regional Oral Health Access Committee, the “direct referral” pilot could reserve as many as 75 slots per week at the clinics for emergency cases sent from Truman.

Planners finalized some of the details at a meeting last week and said they expect to start the pilot in January.

“It would be great for us and great for patients,” said Dr. Jeff Hackman, clinical director of Truman’s Emergency Department. “I hope we can pull it off.”

The goal would be to treat patients no later than 12 to 24 hours after they arrive at the emergency room, said committee co-chair Dr. Michael McCunniff, chairman of the Department of Dental Public Health & Behavioral Science at the University of Missouri-Kansas City (UMKC).

The UMKC dental clinic would participate along with the Seton Center and Samuel U. Rodgers Health Center through its downtown and West Side clinics.

The cases the committee is addressing, McCunniff said, typically occur after-hours with the patient needing an abscessed tooth removed.

Getting patients seen quickly, McCuniff said, should lessen the likelihood of no-shows when emergency room staff make a referral to a dentist.

What the pilot also seeks to avoid, said Scott Lakin, director of the Regional Health Care Initiative, is the situation where emergency room patients get a list of providers and then are left to figure out the next steps on their own.

“You have people that have a real need for services going from clinic to clinic seeing if there is an opening,” he said.

That’s especially difficult, he said, for a safety-net population that sometimes has limited access to transportation.

Another goal, Lakin said, would be establishing dental homes for the patients, in the hopes that they could avoid emergencies through preventive care.

Officials said the cost of the pilot could be as low as $30, which would cover the monthly costs of a signing up with a scheduling website that all participants could access.

One change of practice contemplated through the pilot, according to the organizers, is to reduce the amount of pain medication patients receive in the emergency room.

If emergency room staff provides several-days-worth, officials said, the patients are more inclined to skip follow-up referrals, and then return to the emergency room in pain when their medication is gone.

“In other words,” said committee co-chairman Dr. Mike Jurkovich, dental director for Sam Rodgers, “they didn’t get 20 Vicodin through the ER, they maybe got two. And, they are going to be out of pain tonight, but when they wake up tomorrow, they are going to want to be (at an appointment) at 8 o’clock.”

Officials said they would also have to test how to maintain patient privacy in making referrals through the website. Further down the road, they said, they would like to figure out a way to share a patient’s entire electronic medical record.

The participants said they would also have to experiment with managing no-shows even through the emergency referrals.

But McCunniff and Jurkovich said there likely would be enough demand in the waiting room to fill unused slots. “There is always more need than there are resources,” Jurkovich said.

Jurkovich also said it would good to see if the pilot could put a dollar figure on the amount of savings achieved by Truman as the result of diverting patients from the emergency room or hospitalization.

Given that the main challenge in launching the pilot is getting up to speed on the scheduling website, the participants said it should not be difficult to launch.

“If you told us to start scheduling people tomorrow,” Hackman said, “we could make it happen.”

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