Salina Family Healthcare
October 29, 2004
Commissioners:
Enclosed is reading material for this Monday's Study Session in
response to your request for follow-up information on the Salina
Family Healthcare Center sales tax grant request.
This item is scheduled for your discussion as the first item on the
Study Session agenda.
Please call if you have questions.
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CITY MANAGER'S OFFICE
City of
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Salina
TELEPHONE. (785) 309-5700
FAX . (785) 820-8532
TOO. (785) 309-5747
E-MAIL. dennis.kissinger@salina.org
WEBSITE www.salina-ks.gov
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Dennis M. Kissinger
City Manager
300 West Ash. P.O. Box 736
Salina, Kansas 67402-0736
October 15, 2004
Salina Family Healthcare Center
Attn: Marcia Hawkes and Anne Jung
501 South Santa Fe, Suite 200
Salina, KS 67401
re: Sales Tax Grant Request
Dear Ms. Hawkes and Ms. Jung:
Thank you for the preliminary information you have provided in the past related to your dental
services initiative. Based on the City Commission direction to staff at last Monday's study session,
I will need to work with you to obtain more detailed information. This can then be presented to the
Commission in a follow-up report.
I would suggest we meet to discuss the additional information during late October. If possible, I
would like to meet on Tuesday, October 26 or Wednesday October 27. Please call Nancy
Schuessler in the City Manager's Office (309-5700) to arrange a time. If we are able to meet that
week, we can probably schèdule a follow-up discussion with the City Commission for their study
session on November 1 st. If we cannot meet then, the following week is available, and I could
schedule Commission follow-up for later in November.
To assist you in preparing information for our meeting and a follow-up report, I am providing the
following questions:
1.
Is there is a projected time frame for beginning this service?
2.
Is there a "business plan" for the dental service initiative at this time?
. one-time capital cost analysis
. operating cost analysis
. staffing costs and projections
. projections on hours, number of patients, etc.
By that I mean:
,
Salina Family Healthcare Center
Page 2
3.
Besides the request for a city sales tax grant for the dental equipment, what other sources of
funds have been identified for capital and operating costs? Have any funds from these sources
been committed?
4.
Your June 21, 2004 letter indicated the intent to use space on the third floor of Santa Fe
Medical Plaza for dental care/clinic purposes. .What is the rental cost to be for this space? Do
you already rent it? Source of funds for rent payments? How do you respond to those who
may question the expense of a newer medical plaza space instead of using those same funds
for service provision in a less expensive clinic building?
5.
What is the projected cost of remodeling this third floor space for dental operations? Source of
funds?
6.
Is the $175,000 city grant funding for dental operatories, miscellaneous equipment and dental
software 100% of the capital need, or only a portion of it?
7.
If the City Commission chooses not to approve the grant request, or approves a smaller
amount, what is your alternative equipment financing plan? Is the Salina dental care initiative
dependent on this city grant to move forward?
I trust you realize the City Commission recognizes the significant human service needs in Salina and
appreciates the service provided by organizations such as yours. I hope you also understand they
are attempting to address a broad range of municipal service needs and citizen expectations for the
next six-years with a limited amount of funding available from this new revenue source. I look
forward to working with you to assure the Governing Body has the information they need to evaluate
the dental clinic initiative.
Sincerely,
c£L- /L1 ~
Dennis M. Kissinger
City Manager
KEY POI NTS OF REQU EST
~,
. Request for funding from City is a one-time request that will be leveraged
with funding from other sources to cover approximately 53% of startup
capital expenditures.
. Investment by the city will not be diminished if we move to another location.
Equipment purchased with these funds will move with us.
. 100% of operating expenses will be covered through clinic revenue and
FQHC Grant.
. FQHC Expansion Grant Funds will be requested for any additional
equipment needed as we grow and are able to provide more services.
SALINA HEALTH EDUCATION FOUNDATION
DENTAL CLINIC
ing Dental Clinic Operating
Expenses
20%
Investment Startup Funding
1
Awarded October
14,
United Health
of
WHERE WE ARE - WHERE WE'RE HEADED
Services Salina Cares SALINA Family
2003 HealthCARE Center
Proposed 2006
Medical Office Visits -
Sliding Fee Eligible 4,202 33,600
Prescription Drugs $112,892 $150,000+
Purchased for Patients
Dental Visits 33 5,000
By referral In-house
Mental Health Referral to CKMH 800
and CKF In-house encounters
Hospital In-Kind Donations 1.1 million > 1 million
LablX-ray, OP & Inpatient
Care
Budget $679,243 $3.4 million
Office Hours 4 half days per week Monday - Friday
8-5
Monday and Thursday
6 pm until finished
Patients Served 1,163 5,723
numbers, especially in the
interpretive services area
Providers: Part time Provide staff 4 MD Faculty
Paid - MD's, PA's, NP included: 1 LSMFT
2 MD Faculty 12 Resident Physicians
3 3 rd Year Resident 6 FA's orNP's
Physicians 1 Dentist
2PA's 2 LSCSW's
3 Volunteers
Additional Services Family Practice SRS onsite
Offered Specialty Referrals Hospital Care
Limited Dental by Referral OB/GYN
Mental Health by Referral OP Lab and Diagnostics
Dental Health Onsite
Mental Health Onsite
Quality Assurance
1
Volunteers
119 non-Provider
Maintain and increase
WHERE WE ARE - WHERE WE'RE HEADED
Services Salina Cares SALINA Family
2003 Health CARE Center
Proposed 2006
Funding Sources Salina Regional Foundation KDHE Diabetes
ABCD Dental Grant (Proposed)
Patient Care Receivables Federal 300 Grant Funding
Rural Outreach Grant Patient Care Receivables
United Way Salina Regional Foundation
Donations (Proposed)
Fund Raising United Way
Investment Income United Methodist Health
Ministries
State Primary Care Safety
Net - If funded by
legislature
Community Partners Alliance for a Healthy Alliance for a Healthy
Community Community
Ashby House Ashby House
CAPS BPHC
Catholic Charities CAPS
CKF Catholic Charities
CKMH CKF
DVACK CKMH
Health Department DVACK
Heartland Programs Health Department
OCCK Heartland Programs
Rescue Mission HRSA
Salina Regional KAMU
School Nurses Kansas Dental Foundation
The Salina Medical KDHE
Community KU School of Medicine
United Way OCCK
Volunteer Connection Rescue Mission
Salina Child Care Assoc.
Salina Regional
School Nurses
The Salina Medical
Community
United Way
Volunteer Connection
YMCA
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Smoky Hill Family Medicine
Residency Program
Salina Health Education Foundation
501 S. Santa Fe, Suite 200 . Salina, Kansas 67401
785-825-7251 . 785-826-1511
October 27,2004
Mr. Dennis Kissinger
City Manager
City of Salina
300 West Ash
Salina KS 67401
Dear Dennis,
Thank you for the opportunity to respond to City Commission's questions regarding our request for a
grant of $175,000 from the quarter cent sales tax fund. This letter addresses the questions that were
listed in your letter of October 15, 2004. We should be prepared to answer questions for the
Commission on November 1, 2004.
1. Is there a projected time frame for beginning this service?
Our goal is to have the Dental Clinic operational by the last quarter of 2005.
We currently are able to offer up to 20 emergency tooth extractions per month thanks to the
generosity of two oral surgeons here in Salina. We are anticipating grant funding in December.
Once that has taken place we will contract for an additional twelve (12) hours of dental services
in the offices of three local dentists. The dentists will donate their time and we will cover their
office expenses. Services will be by referral from our Clinic.
The time line for opening a dental clinic under the umbrella of our organization will depend on:
1) when the 330 grant is funded; 2) when we receive increased cost reimbursement for Medicaid
and Medicare patients; 3) how quickly the lease contract is finalized, architect drawings are
completed, and construction is completed. In our grant application we committed to have a
dental clinic operational by year two of the grant. With the help of the City, and a commitment
for additional grant dollars from United Methodist Health Ministries, we would hope to have it
operational in a shorter period of time - perhaps in 6 to 8 months.
Salina Health Education Foundation, dba SALINA Family HealthCARE Center
A United Way Funded Program
UnllIed\Yq
Mr. Dennis Kissinger
October 27, 2004
Page 2
2. Is there a "business plan" for the dental service initiative at this time?
Yes there is a basic business plan that was completed as part of our grant application. Important
components are as follows:
Lease space:
Our board made the decision to stay in our current location until 2008. We have signed a
lease to acquire an additional 1,500 square feet of space on the 2nd floor. Construction on
that space will begin next week.
We have an option with the hospital to lease space on the 3rd floor of Santa Fe Medical
Plaza. This is the proposed location for the dental clinic. Lease negotiations on this space
will begin this week. We will discuss changes to Safe Harbor statutes, which were passed
in the last legislative session, with Salina Regional. The change in these statutes may allow
the hospital to lease the space to us as a FQHC (Federally Qualified Health Center) at less
than fair market value.
The board has expressed interest in establishing another not-for profit foundation to acquire
property to house the Clinic by the end of the lease period. Fundraising efforts will need to
be initiated and additional grant funding will be necessary to accomplish this goal. In the
FQHC grant application we have established goals that will require us to locate larger
Clinic space by the end of year three. Because of our dual mission, it will be necessary to
maintain adjacency to the hospital to provide access for the Residents, and as a
convenience to our low income patients who must go to the hospital to obtain free or
discounted laboratory and x-ray exams. The Residency must have the ability to recruit
medical students to the community.
Staffing:
In our proforma submitted with the grant, we have allotted grant funding for a dentist, a
hygienist, two dental assistants, and a clerical person, as well as operating funds for
supplies, etc. We will need to recruit this staff, and will utilize community volunteer
dentists and oral surgeons to assist with the project. The grant is a renewable grant of
$650,000 for each of three years. Once the grant has been in place for 18 months we may
apply for expansion grants to assist with growth. The grant itself is intended to serve as
approximately 25% of our operating budget. Additionally, once credentialing has been
completed, we will receive increased reimbursement from both Medicaid and Medicare
that will offset the discounted fees we offer to low income patients. I have also attached a
letter of commitment we have received from United Methodist Health Ministries offering
additional grant funds.
The balance of our operating budget will be derived from graduate medical education funds
that we receive through the hospital, patient service revenue, donations, United Way and
other grants. We are currently in the last year of a Federal Rural Outreach Grant.
,
Mr. Dennis Kissinger
October 27, 2004
Page 3
Based on the time frame that it took to get Rural Health Cost Based Reimbursement in
place, it will be late-spring 2005 before we begin to receive the higher reimbursement level
for Medicaid and Medicare patients. This reimbursement revenue stream will allow us the
funds to serve the uninsured.
We have researched this component of proposed services and realize that it is very difficult
to make dental services break even. Kansas Association of Medically Underserved (State
Primary Care Association) and the Federal Bureau of Primary Care will offer us technical
assistance in establishing our program. We also have a commitment from the Community
Health Center in Johnson County to provide additional technical resources.
Once staffed for the proposed configuration, we should be able to see approximately 3,000
hygienist visits per year, and about 1,200-1,500 dental visits per year. The dental Clinic
hours will mirror the Clinic's office hours, which are 8:00 A.M. to 5:00 P.M., Monday
through Friday, and 6:00 P.M. to finish on Monday and Thursday evenings.
3. Besides the request for a city sales tax grant for the dental equipment, what other sources of funds
have been identified for capital and operating costs? Have any funds from these sources been
committed?
We received notification on October 14,2004 that we have been awarded FQHC status. A
portion of the grant funds will be utilized to operate the dental Clinic. We are a United
Way Agency, and have a letter of commitment from the United Methodist Health
Ministries for additional funds in the range of$50,000-1O0,000. We have requested grant
funding from the hospital foundation for language assistance. We have numerous
community benefactors who have donated $59,484 year to date.
4. Your June 21, 2004 letter indicated the intent to use space on the third floor of Santa Fe Medical
Plaza for dental care/clinic purposes. What is the rental cost to be for this space? Do you already
rent it? Source of funds for rent payments? How do you respond to those who may question the
expense of a newer medical plaza space instead of using those same funds for service provision in a
less expensive clinic building?
We have an option to lease space on the 3rd floor of Santa Fe Medical Plaza. We will
open discussions with the hospital about lease options next week. Our current lease is for
12,773 useable sq. ft., which will rent for approximately $11,708. This amount may vary
slightly based on bids for remodeling our current space. The construction costs have
been rolled into our lease, and rent was based on existing safe harbor statutes. We have
the option to rent 4,964 rentable sq. ft. on the third floor (Exhibit C) at a cost yet to be
determined. Success of the Clinic hinges on high visibility and easy access as well as
adjacency to the hospital. Our dollars go farther because of utilization of Resident
physicians to staff the Clinic. We must be able to recruit and meet the expectations of
medical students. We will also need to be able to recruit and retain a dentist and staff.
Dentists and their staff typically work only 3-1/2 days per week in very "nice" space!
We must have adequate, not opulent, well-equipped space if we are going to be able to
hire and retain staff. Cost of turnover in this area will sink the Clinic faster than any
other factor. Many of our patients have transportation issues and simply will not follow
f
Mr. Dennis Kissinger
October 27, 2004
Page 4
through on obtaining diagnostic services that are provided at the hospital and/or go to
another location to obtain dental or mental health services if they had to travel to another
location. Provider efficiency is enhanced by the adjacency as well. We can see more
patients because we do not loose productivity from travel time!
5. What is the projected cost of remodeling this third floor space for dental operations? Source of
funds?
We do not have projected costs for the project at this time. The space was formerly used
as the physical therapy department for the hospital and it is hoped that the architect will
design the area to utilize much of the space as it is currently configured. Options for
payments of the remodeling may be; I) accessing $150,000 of the first year grant funds
that can be allocated to capital improvements; 2) rolling the improvements into the lease
(generally the building owner has a build-out allowance); 3) or obtain additional grant
funds. This will be a board of director decision once we have bids.
6. Is the $175,000 city grant funding for dental operatories, miscellaneous equipment and dental
software 100% of the capital need, or only a portion of it?
The estimates outlined in our June letter of June 21, 2004 stated: Projected costs
involved in acquisition of dental operatories (four) are over $98,000. Miscellaneous
equipment is projected to cost $33,000, and dental software approximately $46,000. We
have identified funding sources for the salary of the dental staff.
Our proposal is a rough estimate of the cost of basic equipment needed for the
operatories. As we get additional technical assistance and support, it may be determined
that additional funding may be needed. Grant funds from United Methodist Health
Ministries would be used to supplement the City funds and perhaps fund office and
reception area furnishings. Additional networking and hardware will also be purchased.
We will accept Medicaid and our current billing staff will handle both dental and medical
claims submission - both of which must be done electronically. City will be funding
equipment that can be moved to other locations in the future. Expansion grants will fund
additional operatories in the future.
7. If the City Commission chooses not to approve the grant request, or approves a smaller amount,
what is your alternative equipment financing plan? Is the Salina dental care initiative dependent on
this city grant to move forward?
We are required as part of our FQHC status to provide some level of dental services in
the community. The scope of these services will be dependent on the amount offunding
that we can obtain. Part of the reason I believe that we were successful in obtaining the
FQHC Grant was because of the amazing collaboration within our community. Without
the Residency, the large pool of medical providers who provide care pro bono to our
patients and serve as faculty for our resident doctors, and the enormous contribution of
LabCorp and the Hospital to provide laboratory and other diagnostics at no cost to
qualified patients, we cannot be successful in this endeavor. It is imperative that the
Community at large supports the contributions that are in place within the medical
Mr. Dennis Kissinger
October 27,2004
Page 5
community. The hospital and medical providers cannot be expected to do this single
handedly. The majority of our patients who receive discounted services are employed in
the community and add enormous value to it. The health and dental status of these
individuals directly affects their employability, and in the case of children, their ability to
learn. This must be a continued community effort.
Once again, thank you for the opportunity to present this information to the City. Please contact me if
you have further questions.
Sincerely,
~.~
Marcia Hawkes
CEO
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Salina Family Healthcare Center
UNITED
METHODIST
Health ¡\JINIST RyFund
100 Eas(First Avenue
8
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po. Box 1384
Hutchinson, Kansas 67504-1384
(620) 662.8586
Fax: 1620) 662-8597
www.hea/thfund.or
April 20, 2004
To Whom It May Concern:
We would like to offer our support ofthe application submitted by:
. Salina Health Education Foundation
dbti SALINA FAMILY HEAL TH CARE CENTER
Smoky Rill Family Medicine Residency
501 S. Santa Fe, Suite 200, Salina KS 67401. .
for federal funding authorized under section 330(e) of the Public Service Act. This
important initiative will bring much needed. health care services to the medically
underserved in north central Kansas. .
Our organization is a philanthropy related to the Kansas West Conference of the United
Methodist Church and provides resources for improving health and health care
throughout the StateofKansas~ with an emphasis on the western two-thirds of Kansas .
(where Salina is located). Currently our funding interests are 1) oral heal~ 2) access to
primary care, and. 3) healthy lifestyles of physical activity and good nutrition. I.
participated in a Salina community planning meeting which analyzed community need
and program organization relative to this application and amgeneraIIy infonned about
this proposaL.
As a foundation, we have worked with numerous groups in Saliha, including Salina Cares
and the Smoky HìII Family Medicine Residency. Both agencies have been good partners
in all our work together. Salina is known throughout Kansas as a place of excellent
collaboration andcommuriit)i planning. The work to develop this strong application fot a
community health center start-up is another demonstration of this community's ability to
determine needs, develop a community response to the need and bring many people and
groups together in the process. '
Because of our special'interest in oral health for the past five years, I want to comment on
this aspect of the potential CRC operation. Counter to its sterling reputation as a place of
collaboration, Salina is also known as a community with below average access to oral
.. health services for uninsured and other low-income persons. There are very few
Medicaid and SCRIP dental service providers in the area. This combines with the
statewide absence of Medicaid benefits for adults to produce a very difficult access
situation for oral health services in the proposed service area for this CRC. One project
in Salinafor very young children's dental services access (ABCD) was unable to recruit
any dentists to participate, and we and the other two funders had to tenninate the project
after many months of effort. The new CHC with dental services will playa very
important role in addressing this need for Salina County and neighboring counties.
"
152
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Salina. Family Health Care Center
Community Health Center Application (Section 330[e])
Page 2
Although I cannot make a firm commitment until we have reviewed a submitted grant
proposal, I can express the very strong interest of United Methodist Health Ministry Fund
in providing start-up financial resources (equipment, remodeling, early cash flow,ètc.)
for the dental services component of a new community health center in Salina. Our.
grants for projects like this have been in the range of $50-100,000. Because of the high
need in the area and our interest in development of penn,anent treatment slots, I would
expect our Board to view a Salina request very favorably.
A federally funded community health center will significantly improve access to health
care for the medically underserved in the Salina are~. United Methodist Health Ministry
Fund will be- very open to considering financial support for this effort as described above.
rfy~ti have~ny questions, please feel free to contact me at 800.369.7191. .
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