Bill Klaproth (host): This is Amos on the go. I'm Bill Klaproth, and joining us today is Dr. Keith Schneider, an oral and maxillofacial surgeon from Shaker Heights, Ohio, to discuss caring for unique patient populations. Dr. Schneider has an interesting patient mix treating not only traditional patient's, but Amish communities and prison populations as well.

Dr. Schneider, thank you so much for joining us today and sharing your unique experiences.

Dr. Kieth Schneider: Oh, thanks Bill. Thanks for having me. Really appreciate it.

Bill Klaproth (host): Thank you so much for being here, Dr. Schneider. Looking forward to talking to you about this. So let's start here. Can you give us a quick overview of your practice, what your patient populations look like, and how you came to care for such a wide range of individuals?

Dr. Kieth Schneider: Sure. Happy to share. so we have a very broad scope, oral maxillofacial surgery practice. We have, five surgeons in three locations. And we're on staff at about eight hospitals as well. we're trying to, You know, hit all these patient populations from all directions. we just really take a lot of pride in caring for everybody.

definitely we're gonna focus on some of the most unique ones today, but we, bridge into pediatrics, taking care of kids as young as like one and two, to, elderly patient's up to a hundred, 110.

Bill Klaproth (host): So you do cover the gambit. When you say you have a broad scope, you mean it?

Dr. Kieth Schneider: Yes, definitely.

Bill Klaproth (host): So as, I mentioned, you have two very distinct patient populations that you treat, the Amish and patient's who are incarcerated. How did you begin working with these very different communities?

Dr. Kieth Schneider: Well, I've always been I guess proud of our background in taking care of patient's, in the hospital. And so a lot of these relationships actually spawned out of all the, hospital presence that we have. so initially I treat a lot of head and neck trauma, at a lot of our regional hospitals as well as our level one trauma center here in Cleveland.

And so I initially started treating a lot of the Amish population there. And really got comfortable and just, wanted to care for them 'cause they're, a community of need. And on the flip side of that, the prisons have a lot of prison fights that happen. so then we sort of met a lot of the prisons through the hospital relationships as well.

Bill Klaproth (host): Well, now that you say that, that kind of makes sense. You would think a prison population, I would imagine there are some fights that go on and somebody that gets punched hard might have a, jaw issue. So I guess that makes, sense. So how do you juggle all of this?

How does your typical day differ between your private practice, the correctional facility, healthcare, And then caring for Amish patient's?

Dr. Kieth Schneider: Yeah. just to touch on the, prison population, we have a relationship with two prisons, in sort of the eastern, part of Ohio. actually a very nice relationship We've. Become contracted with the facilities themselves. I'm in sort of text communication with the staff there. So when they have maybe an acute issue, like such as somebody that got punched in the face.

Or as they like to say, a quote unquote basketball injury, they'll, you know, text me and say, Hey, I have somebody that, we need you to take a look at. And then we coordinate usually getting them to the hospital for head and neck ct. sometimes we'll actually just set them up for a consultation in the office.

we always talk to them and, within the practice as our spa patient's. so it's sort of our code word for the prison population. So if we're speaking out in this sort of, community, in our office if a patient overhears a prisoner, their EARS perk. But if they hear a spa patient, you know, it's sort of soft.

Bill Klaproth (host): Right. Wow, that's really interesting. I would imagine they come with guards And the guards are in the exam room when you're in there working on them.

Dr. Kieth Schneider: Yeah, so, most of the facilities that we treat, all the, inmates come with two guards they're usually, restrained in wrists and ankles. when we see 'em in the practice, we'll also do dental alveolar treatments, so we're moving teeth. Usually it's infected wisdom teeth or any other infection that happens.

And then in the hospital it's the same sort of situation. They come with two guards. they actually come into the operating room with us during the repair. they take the restraints off, we put 'em to sleep And then do the repair.

Bill Klaproth (host): Wow, That is interesting. Do these, spa patient's ever get belligerent with you or have there ever been any incidents like that?

Dr. Kieth Schneider: You know, I've never had a belligerent incident with me personally. sometimes if they're in the hospital for a day or two, they get a little antsy and they can be, feisty with like the nursing staff. But for the most part, they're actually very easy to work with. there's a whole, Gamut of people that are in prison and the people that are in for, drugs and trafficking, things like that, they're actually pretty charismatic people.

They love to chat. the knife and gun club guys, you know, those guys can be a little more rough and tumble. they might have a little bit of a chip on their shoulder, but for the most part, they're really respectful. They love the care. They actually say, thank you, please.

they're pretty nice to work with.

Bill Klaproth (host): All right. Yeah, that's interesting. How does that differ then to the Amish community? Kind of the opposite there.

Dr. Kieth Schneider: So the Amish, a lot of them were treating for some injuries in the hospital and infections, sometimes they don't have the best access to care And so they'll let, infections brew. And then so I'll, meet them first maybe at the hospital with a head and neck infection that needs treatment.

But we've come to really develop a relationship in the Amish community now spawning out of that where they know to, contact us. we work with some dentists that treat the Amish as well. They know that we're, in a relationship with the Amish community. And what I mean by That is, the Amish, they.

contribute dollars to a sort of a community health fund. And so it was very fortunate their community health fund advisor reached out to our practice 'cause they saw our name coming up so frequently and they said, Hey, would you like to create a relationship with our, Amish fund? And so we did.

And so we contracted with, they have two different funds that they'll utilize for quote unquote insurance. so they're really easy to work with as well. A lot of it's paper and pencil. but, we, negotiated so we actually get paid 70% of our fee schedule. which is nice. the Amish people they're very stoic in general.

they don't express a lot of emotion, but they're super kind and very respectful.

Bill Klaproth (host): So how do their views on healthcare, particularly regarding technology and cost, how does that influence the way you plan and deliver treatment?

Dr. Kieth Schneider: we treat the Amish and prisoners for that matter. We treat them with the same respect we treat all of our patient's. I would say the majority of our patient population is, just really nice blue collar workers. really have a high value for services. We treat the Amish patient's the same.

So we provide them the same technology and they are actually very embracing of it. You'd think they're very standoffish, but most of them come via transport vehicle. They have drivers that drive them in. we don't have to hold off on offering them dental implants. A lot of them actually accept dental implants at this point.

they still want state-of-the-art care.

Bill Klaproth (host): So what are some of the, most important cultural considerations when treating Amish patient's?

Dr. Kieth Schneider: so their attire of course, is very conservative. They come in, men in, it's more or less like work suits. females are very well covered. they often come with caps on their hair. we always are just very cordial with. do you mind if you remove your cap or you can leave it in place if you'd like?

We just, you know, always are very respectful of those potential differences. Actually, most of them are just like, yeah, sure, I'll take that off. And, they wanna just sort of go with the flow of things. And so culturally we don't see a lot of variance actually with our normal population.

So they're very easy to bring in and just adapt to our workflow.

Bill Klaproth (host): Okay, so we understand their views on technology and things like that. How do you navigate. Issues such as sedation or anesthesia, you know, current medical practices given their cultural and religious beliefs.

Dr. Kieth Schneider: I suppose just on the technology and communication piece, most of them have some sort of telephone communication to schedule the meeting. so they will have either one, a community phone, where, a number of people will share a line. I think it's what used to be termed like a party line back in the fifties and sixties.

so they'll share a phone, but a lot of the Amish contractors that do like construction, they have cell phones now, so they're actually very easy to get ahold of. so to coordinate appointments has really not been an issue. we actually don't need to collect any dollars from them just with the negotiations we have through their Amish funds.

we bring 'em in, we propose the treatment plan. They're very quick to sign off on it, and most of them do like anesthesia. They're like, I don't really want to feel any pain. and, other's are very stoic though, like I mentioned, and they'll just do local anesthesia for very invasive procedures.

Bill Klaproth (host): That's really interesting. So getting back to the, prison environment, just a few more questions as I think about this. So are there any logistical or ethical challenges when providing care in a prison environment?

Dr. Kieth Schneider: the greatest nuance that we have with treating the, prison population and, our spa patient's is if we're coordinating surgery on a different day, they cannot know any details about that procedure. So, for instance, if I see somebody in the office for, let's say, a jaw fracture, I'll see them, I'll assess them, I'll, give my recommendation, and I'll say, we're gonna coordinate surgery for some time in the near future.

And they'll say, when is it gonna be? And I said, oh, I, I wish I had that detail for you. But, there's a lot of, factors at play with coordinating that visit with the hospital, my staff and, your schedule. And so what happens if they know a time and date they can quote unquote, plot and escape?

So, it's important, to keep that information from them. I've had cases canceled because I had a hospital to reach out to a family member of somebody that was in prison, And the family member contacted the prisoner and said, Hey, I heard you're having surgery in a week. I'm gonna meet you there.

And, that's a complete, breach. And they canceled surgery. They almost canceled me as a surgeon. And it was all because the hospital reached out to them.

Bill Klaproth (host): Yeah, I could see that Oh my goodness. So let me ask you this question, because I am sure you have unique perspectives now on both the Amish population and. Spa patient's, if you will. So across these, different populations, how has this shifted your perspective on access to care or healthcare equity?

Dr. Kieth Schneider: I believe everybody should have the rights to receive healthcare in the same capacity. even our, prisoner population, you know, I'm, I'm very respectful with them. I give them the same, adequate informed consent. Of what we're doing, why we're doing it. my staff's still offering them water and blankets just like we do our other patient's.

but I think that there's a great need for addressing this population, both the Amish And the prisoners. And, I think it's a great adjunct to building practice. you know, collectively, on an annual basis, it's just like having a good referral, like a good referring dentist. I mean, our collections last year on our prison population was, I think in the middle of about $250,000.

And, the Amish, I think we collected about another $150,000. So, as far as a referral, that's a great referral. adjunct to your practice.

Bill Klaproth (host): Yeah, so let's stay on that. So across these different populations, what clinical adaptations have you had to make, whether related to equipment treatment planning, or patient management or billing, or those types of things?

Dr. Kieth Schneider: with our spa patient's, we always bring them in the back door. I would tell you that our other patient's would have no idea that they're there. we sort of bring 'em in the back door. we bring 'em into a specific room. they're there with the guards. we get x-rays if we need to And then bring them back into the room.

so just sort of the logistics of working that out. We have the guards wait in the, parking lot. They, of course they have the prison van there. It's sort of an unmarked white van. And they call the front desk and say, Hey, we're here. And we say, okay, just hold tight.

And then we will go out And we will open the back door and say, all right, come on in. And then we will all bring them in. That's probably the only nuance with sort of the workflow from a billing perspective. actually it's a very simple process. I mean, once we bring them in, I literally explain treatment.

We'll numb them right away and perform care. we don't have to wait for payments or talk to our treatment coordinators, our insurance coordinators. That all just gets done on the back end. The prisons usually will make sure that we're paid within 30 days, which is great. Sort of helps with our revenue cycle.

with the Amish population, of course, we're just rolling out the red carpet for them in the waiting room, just like we do all of our patient's. And, the Amish funds typically pay us by check, usually within 20 to 30 days. So from a collections perspective, they're both very reliable, easy resources to work with.

And, we really enjoy working with them.

Bill Klaproth (host): Yeah, it sounds like it, it is, something different out of the ordinary, if you will, than a regular patient population. So if an OMS is listening to this saying to themselves, This is kind of interesting, I think I would like to. Look into this, maybe I could care for a, different population, other than a regular patient population.

Are there licensure barriers or reimbursement things we should know about that make it more difficult for an OMS to care for underserved or non-traditional populations?

Dr. Kieth Schneider: I would not say that there's any licensure barriers at all with caring for these populations. my recommendations for anybody that would be interested in sort of exploring this would be, from trying to contract with the prisons, the prisons really do like to have a very, I don't know, predictable care source.

because otherwise they're getting sent to, whatever facility or person's available, and they don't get the continuity of care that they would with somebody that's working with them. I would also recommend trying to work them into your practice, not you going to the facility. 'cause I think it's easy enough just to get it into your workflow.

So just coaching your team. Honestly, it's pretty exciting for my team. they love the stories. They look up whatever these prisoners do. Some, I don't wanna know. I try not to know, the, Amish community reaching out to them and. they're gonna be forthcoming. Say, Hey, do you work with my Amish fund?

And if that's the case, then You know it's who's your liaison? Or can you give me a point person that I can contact And then create the relationship that way?

Bill Klaproth (host): So I'm curious. don't think I've ever talked to an Amish person, and I don't think I've ever talked to an inmate before in my life. Have these varied patient interactions that you have, have they shaped your personal philosophy or approach to oral and maxillofacial surgery at all?

Dr. Kieth Schneider: well, I, don't have any personal, I guess interaction with the prisons per se, before this relationship. But, my mom was born and raised on a farm, with a lot of Amish friends, so I've always been sort of friendly with the Amish community. They're just good old timers, you know.

people that really believe in family and good traditions And the land and, caring for each other, and they're very sweet people. so I've always just enjoyed those characteristics about them. I suppose it gives me some pause every day, with, you know, making sure I'm taking care of my family.

And then on the prison side, making sure I'm behaving.

Bill Klaproth (host): Right. Oh my gosh. Okay, so bottom line, Dr. Schneider, if, an OMS is listening to this saying to themselves, okay, I'm really interested in this. I want to do this, where would someone start? What advice would you give to other OMSs interested in expanding their practice to underserved or unique patient populations as you have done?

Dr. Kieth Schneider: I'm open to open communication with me if they wanna reach out and I can, walk them through the ropes if they want. feel free to contact me and, my email address isKeith@ohsurgery.com. I also hold a faculty appointment at Case Western Reserve. I've been there for about 12 years, and that's kms59@k.edu.

Bill Klaproth (host): well there you go. Well, you could hear it directly from Dr. Schneider then and get your questions answered. That's very nice of you to do that, Dr. Schneider. We appreciate it. Anything else you wanna add before we wrap up on your unique, populations that you serve?

Dr. Kieth Schneider: I guess my only closing statement would be, you know. Treat everybody with respect. Love your patient's, be kind. I think that's what we value as practitioners and that's what we look for in ourselves every day to be fulfilled with what we do for people. And I find that with these sort of unique populations as well as all of our patient's.

Bill Klaproth (host): Yeah, very well said. Dr. Schneider, thank you so much for your time. We appreciate it.

Dr. Kieth Schneider: Yeah. Thank you.

Bill Klaproth (host): You bet. Once again, That is Dr. Keith Schneider. And for more information on advocacy issues affecting the OMFS specialty, you can visit amos.org/advocacy. And if you enjoyed this podcast, please share it on your social media and make sure you subscribe so you don't miss a future episode on dental advocacy, leadership, And the future of Oral healthcare.

I'm Bill Klaproth. This is Amos on the go. Thanks for listening.