EL PROBLEMA FERROVIARIO EN LA BIBLIOGRAFÍA DE ÉPOCA: ALGUNAS

ADHA District VIII Trustee

American Dental Hygienists' Association Ann Boyle, DMD

Associate Dean

School of Dental Medicine Southern Illinois University Gerald Ciebien, DDS, MPH

Chairman, Access to Care Committee Chicago Dental Society

Shelly Duncan Vice President

Community Health Services

Illinois Primary Health Care Association Patrick Ferrillo, Jr., DDS

Dean, School of Dental Medicine Southern Illinois University Robyn Gabel, MSPH, MJD Executive Director

Illinois Maternal & Child Health Coalition Steve Geiermann, DDS

Regional Dental Consultant Bureau of Primary Health Care

Health Resources and Services Administration Julie Janssen, RDH, MA

Public Service Administrator Division of Oral Health

Illinois Department of Public Health Greg Johnson

Director

Professional Services Illinois State Dental Society

Lewis Lampiris, DDS, MPH Chief, Division of Oral Health Illinois Department of Public Health Ann Lattig

Senior Public Service Administrator Bureau of Comprehensive Health Services Illinois Department of Public Aid

Pat Law Manager

Bureau of Comprehensive Health Services Illinois Department of Public Aid

Henry Lotsof, DDS Vice President

Doral Dental Services of Illinois Tim Lynch

Manager

Governmental Affairs

American Dental Hygienists Association Laura Neumann, DDS, MPH

Group Associate Executive Director, Professional Services

American Dental Association Matt Powers

Administrator

Division of Medical Programs Illinois Department of Public Aid Indru Punwani, DDS, MSD Head, Pediatric Dentistry University of Illinois at Chicago Mark Rosenberg, MD, FAAP President, Illinois Chapter

Mary Catherine Ring

Chief, Center for Rural Health Illinois Department of Public Health Maria L.S. Simon, DDS, MS

President, Illinois Society of Pediatric Dentistry Pediatric & Adolescent Dental Associates Dave Spinner

Manager

Medical Assistance Dental Program Illinois Department of Public Aid Rodney Vergotine, DDS

Undergraduate Clinic Director College of Dentistry

University of Illinois Debra Whitmer President

Illinois Dental Hygienists' Association

Staff

Gayle Byck, PhD

Senior Research Specialist

Illinois Center for Health Workforce Studies University of Illinois at Chicago

Judith Cooksey, MD, MPH Director

Illinois Center for Health Workforce Studies University of Illinois at Chicago

Julie Mansour, MBA Analyst

Illinois Center for Health Workforce Studies University of Illinois at Chicago

Hollis Russinof, MUPP

Center Manager & Policy Analyst

Illinois Center for Health Workforce Studies University of Illinois at Chicago

Appendix B: Data Sources and Methods

This appendix describes the data sources for the first two study components: (1) describing the supply and distribution of Illinois dentists; and (2) describing dental expenditures, children’s utilization of dental services, and dentists participation in the Medicaid program. In addition, some comments on the

methodology are provided; further details on methodology are available from the Center upon request. The methods for the study component which assessed the problems and strategies in seven Midwestern states are described in that section of the report.

Data Sources

Sociodemographic data on Illinois dentists

A data set of all Illinois dentists was obtained from the American Dental Association (ADA) in February 2000. This data set included both ADA members and non-members. The data set included: address information including zip code, birth date, gender, race, year of graduation from dental school, dental school attended, specialty, and occupation type (e.g., private practice >30 hours per week, hospital dentist, etc.). The only information with a large proportion of missing values was race (28% missing for active dentists).

Zip codes matched to counties

A data set from the United States Postal Service (USPS) was purchased which listed all zip codes and their corresponding county and state (USPS, 2000). The Illinois zip codes and counties were extracted and merged with the ADA file to add county information for each dentist. It should be noted that an exact zip code to county match was not feasible as some zip codes cross county lines, and zip code boundaries do change. It is believed that this limitation does not have a significant impact on the study results.

County population estimates

Population data, total and children <18, for each county was obtained from the Population Estimates Program, Population Division, U.S. Census Bureau. (CO-99-13) Population Estimates for Counties by Age Group: July 1, 1999. Internet release data: August 30, 2000.

Dentist enrollment and participation in Medicaid; and Medicaid/KidCare enrollee utilization of dental care

Data on dentist enrollment and participation in Medicaid, Medicaid/KidCare enrollee utilization of dental care, and procedures performed were provided by the Illinois Department of Public Aid (IDPA) and Doral Dental Services (Doral), the state’s Medicaid dental intermediary. Except for Medicaid/KidCare

enrollment and provider enrollment, all data were for services provided from March 1, 1999 through February 29, 2000, for claims paid through June 30, 2000. Medicaid/KidCare enrollment figures were as of September 1, 1999 (the midpoint of the claims data provided). The list of enrolled providers was dated June 30, 2000. Table B-1 below shows a list of all data files received from IDPA.

The enrollee-level data were provided by county (often by zip code for Cook County), and for the following age groups: 0-3 years, 4-5 years, 6-12 years, 13-18 years, and 19-20 years. The Cook county zip code data were aggregated for this report to provide estimates for the entire county.

IDPA/Doral provided a count of dentists in each county who submitted services, grouped by 1-100

services, 101-999 services, 1000-1999 services, 2000-4999 services, and 5000 or more services; this is the measure of participation used in this study. A service is any procedure billed to and paid for by Medicaid. Thus, service and procedure are used interchangeably.

Procedure-level data were provided statewide for the abovementioned age groups, and were aggregated into the following categories, as provided by the Illinois State Dental Society: (a) Diagnostic (exams, x- rays); (b) Preventive (prophylaxis, fluoride, space maintainers); (c) Restorative (fillings); (d) Restorative (crowns, inlays, onlays, veneers); (e) endodontic; (f) periodontic; (g) Removable prosthodontics; (h) Implants, fixed prosthodontics; (i) Oral surgery; (j) Orthodontics; (k) Miscellaneous (anesthesia, mouth guards, occlusal adjustments); (l) FQHC encounter fee; and (m) EPSDT. The latter two categories were not on the ISDS list, but were clearly designated on the IDPA data.

A conference call was held in September 2000 prior to the second advisory group meeting with representatives of IDPA, IDPH Division of Oral Health, and ISDS to review the data analysis and clarify questions. This call clarified the following points of interest:

• data relevant to utilization were for individual services rather than visits or claims (a visit or claim usually consists of more than one service). This limits the ability to discuss how many Medicaid patient visits occurred, for example, in a county or per dentist;

• an individual provider with multiple locations is listed more than once in the list of enrolled providers. Since, for our study, each site needs to be counted, this overestimates the number of participating dentists in our analysis. Analysis of the list indicated that 385 (19%) of the 2,078 Illinois provider identification numbers were listed more than once; of these, 278 (72%) had only 2 practice sites, and 199 (72%) of this group had both practice sites in the same county. Many of the multiple sites were all in Cook County. Table B-2 shows the breakdown of number and location of practice sites for these 385 providers;

• the procedure-level data should be grouped by category, e.g., preventive, diagnostic, restorative, etc, as noted above.

Table B-1: Data Files Received from IDPA on July 10, 2000

(Unless noted, data is for service provided 3/1/99-2/29/00, for claims paid through 6/30/00) 1. Total Claims Paid

- by county (except zip codes for Cook ) - by age group

2. Percentage of all Medicaid claims that are dental - by county (except zip codes for Cook ) - by age group

3. Number of Unique Medicaid Enrollees Receiving Dental Services - by county (except zip codes for Cook )

- by age group

4. Average Number of Visits per Patient - by county (except zip codes for Cook ) - by age group

5. Proportion of Medicaid Enrolled Children Receiving Dental Services - by county (Cook and Other includes out of state and unknown) - by age group

6. Medicaid Enrollees as of 9/1/99 (includes KidCare enrollees) - by county (except zip codes for Cook )

- by age group

7. Count of Participating Providers as of 6/30/00

- by county (Cook=non-Chicago, Cook(Chicago)=Chicago), State (non-Illinois) 8. Average Number of Services Submitted per Provider Submitting Services

- by county (Cook=non-Chicago, Cook(Chicago)=Chicago), State (non-Illinois) 9. Distribution of Services Submitted by Providers

- by county/state

- claims: 1-100, 101-999, 1000-1999, 2000-4999, 5000+) 10. Mean Dollars Paid Per Encounter

- by county (except zip codes for Cook ) - by age group

11. Total Services Paid by Procedure Code - by age group

12. Total Number of Services Submitted for Each Procedure -by age group

13. Dental Provider Children's Fee Schedule - code, allowed amount

14. Enrolled Providers by Zip Code , as of June 30, 2000 - provider ID, zip code

Table B-2: County Information about Providers with Multiple Sites

Number

of sites Number ofproviders All same county All different county Other

2 278 (72%) 199 79 NA

3 75 (19%) 31 6 38 – 2 of 3 same

4 18 (5%) 4 41 _{5 – 2 same, other 2 different}

4 – 3 of 4 same 1 – 2 same, 2 same

5 7 (2%) 3 0 2 – 2 same, 2 same, 1 different

1 – 3 of 5 same

1 – 2 same, other all different

6 6 (2%) 1 0 3 – 5 of 6 same

2 – 2 same, 2 same, others different

7 1 (0%) 0 0 1 – 5 same, 2 same

TOTAL 385 (100%) 238 (62%) 89 (23%) 58 (15%)

1 _{3 of these 4 provider ID numbers had the same 4 counties: Iroquois, Livingston, Logan, McLean}

Notes on Methodology

• It was not possible to merge the ADA and IDPA data files, so sociodemographic characteristics of Medicaid providers could not be studied.

• Active patient care general practice and pediatric dentists were defined from ADA data as dentists whose specialties were listed as “general practice” or “pedodontics” and who were employed as : (1) private practice >30 hours/week; (2) private practice <30 hours/week; (3) hospital staff dentist; or (4) part-time faculty/part-time dentist6. This subset of dentists was selected since they are the most likely providers of dental care services to low-income children. In addition, as explained below, the ADA data set is believed to be most useful and reliable for private practice dentists as opposed to dentists who work in government or public health settings.

• There was some discussion as to how dentists who work at safety net sites (i.e., community health centers) would be classified in the ADA occupation codes. Personal communication with advisory board members revealed that these types of dentists would probably identify themselves as “other federal services – VA, public health” or “other health organization staff”. There were 144 general and 1 pediatric dentists who were listed as “other federal services”, and 242 general and 3 pediatric

dentists who were listed as “other organization staff”. An attempt was made to determine the practice site of these 390 dentists. However, only 71 of these dentists had office addresses listed, as opposed to home addresses, in the ADA data file, and it was difficult to determine their practice type.

6 _{Excluded occupation codes: full time faculty; armed forces-army, navy, air force, marines; other federal services-VA, public}

health; state or local government; graduate student/resident; other non-dental student; other health organization staff; not in practice-seeking employment; no longer in practice (retired); and other occupation.

Appendix C

Illinois Department of Public Health Division of Oral Health Regions

Rockford