Special Care North Carolina Style Special Care Dental Association Meeting Chicago, April 11, 2014...
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Transcript of Special Care North Carolina Style Special Care Dental Association Meeting Chicago, April 11, 2014...
Special CareNorth Carolina Style
Special Care Dental Association MeetingChicago, April 11, 2014
Bill Milner, D.D.S., M.P.H.Betsy White, R.D.H.
In The Beginning:
• 1985 North Carolina Dental Society Coalition on Aging • 1989 Apple Tree Model (clinical, education, advocacy, research)• Advantages of Non-profit Model - $1.5 million for trucks/equipment • Support of 30 different disability groups
Really Mobile Dentistry - 1990
• All in the trunk of the Taurus.• Friday Long-Term Care Dentistry• 6 Facilities• Hygienist, Assistant• Autoclave at Health Department• Saturday Morning Billing
• Dr. Ford Grant arriving from Louisville to take over established geriatric program.
• Carolinas Health Care had the financial resources.
• Sponsored by NCDS
1997 Carolinas Mobile Dentistry, Carolinas Health Care, Charlotte
2000 Access Dental Care
• Rolled private practice into stand alone non-profit (not associated with hospital)• Covers NC Piedmont (Concord – Raleigh, 1.5 hour radius drive)• 60 Facilities• 2 Teams
Access Dental Care Service Areas
• Skilled Nursing Facilities • Continuing Care Retirement Centers• VA Nursing Facility• Group Home Day Centers• Local Arc (Assoc. of Retarded Citizens)• Adult Day Health Care Center• PACE (Programs of All-Inclusive Care for the Elderly)• Central Carolina Health Network (HIV/AIDS)• Home Health• Operating Room for Extreme Behaviors
Staff Involved
• 3 Office Staff• 3 Certified Assistants• 2 Hygienists• 1 Full-Time Dentists• 2 Part-Time Dentists• (Except for 1 DDS, No one with less than 5 years at ADC.)• Operating budget – 85K/month
Access Dental Care Totals from August, 2000 – July, 2013
Clinical
64 Facilities Served 57 Active Facilities 12,965 Patients Served 1,017 Patients with Intellectual/Developmental Disabilities 452 Operating Room Patients (Most are persons with profound
intellectual disabilities.) 74,073 Patient Visits 118,021 Patient Services
1. 70% Diagnostic/Preventive 54,516 Diagnostic (exams, x-rays) 28,521 Preventive (cleanings, fluoride treatment, sealants) 2. 12% Restorative (14,234 fillings) 3. 11% Oral Surgery (12,856 extractions and other surgery) 4. 4% Removable Prosthetics (5,209 denture procedures -
dentures, partials, relines, repairs) 5. 1% Perio (2,106 treatments – scaling/root planing, surgery) 6. <1% Fixed Prosthetics (449 crown and bridge units) 7. <1% Endodontic (130 root canals)
Financial $10,787,671 Gross Production over thirteen years. $1.5 million of Foundation/Grant funding for capital expenses
2010 2011 2012 Gross Production $964,676.12 $1,037,885.84 $1,131,015.37 Net Income (Including Retainers)
$909,502.11 $915,388.44 $961,037.63
Uncompensated Care $55,174.01 $122,497.40 $169,977.74 Average gross production per appointment was $157.00 in 2012 80% are Medicaid recipients
Education, Advocacy and Research numbers are not included
North Carolina Safety Net ProvidersDescription of existing special care and community providers (addition of each is a slide overlay)
• Pediatrician Infant Topical Fluoride Programs• Private Practitioners (Office and On-site)• Public Health Preventive Programs – Preschool/School Based• Health Department Dental Clinics• Non-Profit Community Care Clinics• UNC School of Dentistry• Intellectual/Physical Disability State Centers• Hospital Residency Programs
North Carolina Medicaid Program
• Comprehensive Dental Medicaid (Child and Adult)• 45% of UCR• Advocate for Facility Visit Fee• Advocate for Mobile Special Care Credentialing • Established Close Relations• ADC Study of Long-Term Care Practitioners
Started With:
• Skilled Nursing
• Group Home Day Centers
• CCRCs (Independent, Assisted Living, Skilled, Memory)
• Arc of High Point
• Hospital OR Support
Added:
• VA State Nursing Facility
• Home Health
• Adult Day Care
Finally:
• PACE (Program of All-Inclusive Care for the Elderly)
• HIV/AIDS (Central Carolina Health Network)
During This Time:
• Expanded Slowly Without Compromising Quality of Care • Community Based Approached – 5 NC Programs• Never in Debt• Foundation Based Capital Funding• Service Based Operating Funding
Finances Questions
• North Carolina Medicaid Fee-for-Service • Private Pay• Retainer Fee (20 year old model)• Capitated Fee (PACE) - credit Berkey• Per-Day-Fee (Health Network)• Proposed Capitated Insurance Policy
Future Financial Picture
• North Carolina Medicaid Reform• Loss of Adult Medicaid• Insurance Policy Loop-hole• Skimming Prevention – NC/SCDA action• Disability Advocacy
Programming - Looking For A Niche
• Recent providers wanting to start programs• Assisted Living• Corporate• Hygiene/Limited Care
• More DDS/RDH resumes • Disability Accessible Offices• Special Care Fixed Office Expertise
Rules of the Road:
• Always available for emergencies.• Facility liaison a must.• Minimum of 12 patients on schedule.• Everyone drives the truck, loads and unloads.• Clinical care a team effort.
Treatment Considerations:
• Total Comprehensive Care• Initial Permission• Permission for treatment after exams, prophy and x-rays.• Orders for premeds – ABX and Sedation• Worked with malpractice insurance provider on form language.• No excuse for not getting care.
Access Dental Carewww.accessdentalcare.org
•Bill Milner, DDS [email protected] 336.240.8082
•Betsy White, RDH [email protected]
336.240.8130