Oklahoma State Tulsa City County Health Department Dapartment STD Lab and Overflow Visits of Health August 2017 EXECUTIVE SUMMARY: Issue Oklahoma State Department of Health (OSDH) is paying for the cost of STD lab for Tulsa County residents. Issue Rogers, Creek and Osage counties are seeing Tulsa County residents and incurring the costs and administrative expenses of those clients. Specifics: I Each county has county millage or sales tax to support their public health departments and public health services. I County millage/sales tax is intended to support public health services for the residents of that county. 0 The county receiving the overflow incurs the costs of the staff, medications and other administrative costs I OSDH spends over $172,000 quarterly for STD lab testing for Tulsa County residents. 2017 lab costs for clients were $691,674. 0 In 2017, OSDH spent $25,672.07 in STD medications supporting Tulsa County residents. 0 There is overflow to and from Tulsa surrounding counties. STD visit cost is based on a Medicaid calculation of $49.27 per visit. Medication is not included. The net STD visits are: 244 visits less 109 visits from OSDH counties into Tulsa net visits of 135 $49.27 2 $6,651.45. The 2017 figures are to date: 0 Rogers 20.7% or 53 visits I Tulsa saw 0.9% or 1 visit ($49.27) 0 Creek 32.8% or 170 visits I Tulsa saw 1.6% or 47 visits 0 Osage 0% or 0 visits . Tulsa saw 0.2% or 5 visits (246.35) 0 Wagoner 13.2% or 21 visits I Tulsa saw 1.9% or 56 visits 0 The following information is for all visits inclusive of STD visits. These visits may include anything from family planning to immunizations to STD, etc. For many of these visits the cost is recovered through billing insurance companies. There would be lost revenues for those visits that are not covered or for which OSDH is not contracted. It would take a significant drill down of data to obtain that level of detail. Total visits are: 0 Rogers 8.5% or 822 visits I Tulsa saw 1.3% or 1450 visits 0 Creek 19.0% or 2,362 visits I Tulsa saw 1.8% or 1,671 visits Tulsa City County Health Department STD Lab and Overflow Visits August 2017 Osage 4.4% or 24 visits . Tulsa saw 0.15% or 142 visits 0 Wagoner 5.2% or 334 visits - Tulsa saw 2.2% or 2,392 visits Vital records pays for space and personnel in the Tulsa office. it costs more to have the VR records in Tulsa than in OKC due to higher salary and rental costs. OSDH has multiple contracts with and pays a much higher IDC rate to Tulsa than ICD rate. Recommendations: 1. OSDH will bill for STD lab on a basis starting November 1, 2017. 2. Tulsa pays for the services for their citizens. OSDH will bill the Medicaid rate of $49.27 for 3. nurse visit/office visit for each STD visit in the 3 counties listed above starting November 1, 2017. Billing will be on no less than a quarterly basis. Rates may change depending on the Oklahoma Health Care Authority fee schedule. The four counties will post information at their doors and registration encouraging Tulsa County residents to seek services at one of the Tulsa sites. An information card will be developed to provide to those clients. OSDH counties will not refuse to see a client if they choose not to go to another site. As part of the Office of Chief Operating Officer reductions, the Tulsa VR department will be reduced by approximately $65k. Tulsa has received faster internet to process records faster and with the physicians coming onto Rover there is less of a need for a dedicated person. Tulsa City County Health Department STD Lab and Overflow Visits August 2017 TOTAL CUSTOMER TEST COST TESTS AMOUNT $5.55 9 5 49.95 Total 9 49.95 55 986 $5,472.30 16.69 38 634.22 Total 1,024 63:10652 5.55 2 11.10 Total 2 11.10 5.55 133 738.15 $16.69 10 166.90 Total 143 905.05 5.55 23 127.65 Total 23 127.65 $44.25 22 973.50 $11.20 10 112.00 Total 32 $1,085.50 6.79 7 47.53 8.23 7 57.61 $13.62 7 95.34 $44.25 2,846 $125,935.50 $30.35 3 91.08 $11.20 1,196 $13,395.20 Total 4,066 139,622.26 $44.25 22 973.50 Total 22 973.50 TU RHC $44.25 430 $19,027.50 $30.36 3 91.08 $11.20 189 2,116.80 Total 622 $21,235.38 $44.25 58 2,566.50 $11.20 21 235.20 Total 79 2,801.70 THD TOTAL I 2ND QTR 2017 $172,918.61 THD ANNUAL ESTIMATE $691 $74.44 Tulsa City County Health Department Rogers County Out-of-Area Service Delivery STD Lab and Overflow Visits August 2017 Year 2015 Client's County of Residence Total Rogers Missing Tulsa Other County of Service 7178 2 1172 1125 9477 Rogers Frequency Tulsa Frequency 1272 18 85807 7662 94759 Year 2016 Client's County of Residence Total Rogers Missing Tulsa Other County of Service 7752 8 1016 885 9661 Rogers Frequency Tulsa Frequency 1484 66 96881 8793 107224 Year 2017 Client's County of Residence Total Rogers Missing Tulsa Other County of Service 8195 4 822 666 9687 Rogers Frequency Tulsa Frequency 1450 79 98700 7774 108003 Rogers Tulsa Other Missing County of Service 2015 Rogers 75.7 12.4 11.9 0.02 Tulsa 1.3 90.6 8.1 0.02 2016 Rogers 80.2 10.5 9.2 0.1 Tulsa 1.4 90.4 8.2 0.06 2017 Rogers 84.6 8.5 6.9 0.04 Tulsa 1.3 91.4 7.2 0.1 Combined Rogers 80.2 10.4 9.3 0.05 Tulsa 1.4 90.8 7.8 0.05 Tulsa City County Health Department STD Lab and Overflow Visits August 2017 Creek County Out-of-Area Service Delivery Year 2015 Client's County of Residence Total Creek Missing Tulsa Other County of Service 11159 11 2939 1226 15335 Creek Frequency Tulsa Frequency 1793 18 85807 7134 94752 Year 2016 Client's County of Residence Total Creek Missing Tulsa Other County of Service 10291 5 2611 903 13810 Creek Frequency Tulsa Frequency 1970 66 96882 8307 107225 Year 2017 Client's County of Residence Total Creek Missing Tulsa Other County of Service 9436 2 2362 612 12412 Creek Frequency Tulsa Frequency 1671 79 98703 7555 108008 Client's County of Residence Creek Tulsa Other Missing County of Service 2015 Creek 72.8 19.2 8.0 0.1 Tulsa 1.9 90.6 7.5 0.02 2016 Creek 74.5 18.9 6.5 0.04 Tulsa 1.8 90.4 7.8 0.1 2017 Creek 76.0 19.0 4.9 0.02 Tulsa 1.6 91.4 7.0 0.1 Combined Creek 74.3 19.0 6.6 0.04 Tulsa 1.8 90.8 7.4 0.05 Tulsa City County Health Department STD Lab and Overflow Visits August 2017 Osage County Out-of-Area Service Delivery Year 2015 Client's County of Residence Total Osage Missing Tulsa Other County of Service 1117 2 61 141 1321 Osage Frequency Tulsa Frequency 165 19 85793 8779 94756 Year 2016 Client's County of Residence Total Osage Missing Tulsa Other County of Service 1036 0 85 121 1242 Osage Frequency Tulsa Frequency 150 66 96862 10140 107218 Year 2017 Client's County of Residence Total Osage Missing Tulsa Other County of Service 1124 3 24 126 1277 Osage Frequency Tulsa Frequency 142 79 98734 9048 108003 Client?s County of Residence Osage Tulsa Other Missing County of Service 2015 Osage 84.6 4.6 10.7 0.1 Tulsa 0.2 90.5 9.3 0.02 2016 Osage 83.4 6.8 9.7 0 Tulsa 0.1 90.3 9.5 0.1 2017 Osage 88.0 1.9 9.9 0.2 Tulsa 0.1 91.4 8.4 0.1 Combined Osage 85.3 4.4 10.1 0.1 Tulsa 0.15 90.8 9.0 0.05 Tulsa City County Health Department STD Lab and Overflow Visits August 2017 Wagoner County Out-of-Area Service Delivery Year 2015 Client's County of Residence Total Wagoner Missing Tulsa Other County of Service 3387 1 380 623 4391 Wagoner Frequency Tulsa Frequency 2090 18 85811 6843 94762 Year 2016 Client's County of Residence Total Wagoner Missing Tulsa Other County of Service 3829 0 407 582 4818 Wagoner Frequency Tulsa Frequency 2454 66 96882 7822 107224 Year 2017 Client's County of Residence Total Wagoner Missing Tulsa Other County of Service 5498 334 564 6396 Wagoner Frequency Tulsa Frequency 2392 79 98705 6832 108008 Client's County of Residence Wagoner Tulsa Other Missing County of Service 2015 Wagoner 77.1 8.7 14.2 0.0 Tulsa 2.2 90.6 7.2 0.02 2016 Wagoner 79.5 8.5 12.1 0 Tulsa 2.3 90.4 7.3 0.06 2017 Wagoner 86.0 5.2 8.8 0 Tulsa 2.2 91.4 6.3 0.1 Combined Wagoner 81.5 7.2 11.3 0.01 Tulsa 2.2 90.8 6.9 0.05 Tulsa City County Health Department STD Lab and Overflow Visits August 2017 2017 STD Drugs for Clients Paid from OSDH State Appropriations Tulsa CHD FY17-STD Medication Costs Mg Doses sent Total Cost Bicillin LA 1.2 MU 2ml 675 $33.75 100mg?14ct 72 $307.44 Sterile water 17 $6.80 Lidocaine 1% 30m] MDV 173 $129.75 Ceftriaxone SDV 250mg 1523 $883.34 Azithromycin 500mg tab 2630 $15,043.60 300 $2,280 230 $6,858.60 Gentamicin 80mg?2ml via] 53 $128.79 Total cost $25,672.07 Tulsa City County Health Department STD Lab and overflow Visits August 2017 Contracts I PO PROGRAM AREA CONTRACT PERIOD Year AMOUNT FUND 34090 21696 Child Guidance 07/01/17~06/30/18 OF 37,200.00 400CV88 450,000.00 198KFX8 Total Child Guidance 487,200.00 34090 21680 Protective Health Services 07/01/17-06/30/18 OF 622,375.15 210WCX8 Total PHS 622,375.15 34090 21278 Children First 07/01/17-06/30/18 OF 33 1,461,369.00 198KFX8 245,722.00 400DK78 250,000.00 4OOGC88 TotalCI 1,957,091.00 34090 20430 Maternal&Child Health Service 07/01/17-06/30/18 OF 21,612.00 19SGF78 64,835.00 198GF88 21,612.00 4OOGF78 64,835.00 4OOGF88 328,734.00 400CC88 498,290.00 400CM88 166,097.00 400CM98 105,965.00 198KFX8 64,698.00 400AR78 194,095.00 400AR88 106,528.00 198AR78 319,586.00 198AR88 Total MCI-I 1,956,887.00 34090 18785 Chronic Breast&Cervical 6/30/2017?06/29/18 OF 43,715.00 1983188 34090 18329 Vital Records 07/01/17-06/30/18 392,841.34 210TFX8 Total All Programs $5,450,109.49