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 bmilner@accessdentalcare.org 336.240.8082

•Betsy White, RDH bwhite@accessdentalcare.org

336.240.8130