eLECTRONIC HEALTH rECORD aDOPTION& hEALTH iNFORMATION eXCHANGE

hipaa pRIVACY, sECURITY & bREACH nOTIFICATIONpRIORITY pRIMARY cARE pROVIDERS

cOMMUNITY hEALTH cENTERSb.R.I.E.F. SURVEY RESULTS

CITATIONS

Part tWO

ehr adoption & health information exchange

Since the Meaningful Use program launched in January 2011, the U.S. has seen a significant up-tick in adoption of certified EHR technology (CEHRT). Additionally, HITECH provisioned cooperative agreements with every state and territory to “get wired” for health information exchange (HIE). Although the adoption and use of CEHRT and HIE is not pervasive in the marketplace, the growth is recognizable.

ehr adoption & hIE

2002

17

2011

57Percent of U.S. Physicians who report using “any” EHR technology in 2011, as compared to only 17 percent in 2002

57$30,000,000,000Amount that has been spent by the federal

government since 2009 under the HITECH Act to advance EHR & HIE adoption

2002

17.1

2011

40.2

Percent of primary care physicians in the U.S. who report using basic EHR at the end of 2011, up from 17.1 percent in 2002

40.2

2007

12

2011

34Percent of U.S. physicians who report using “basic” EHR functionality in 2011, a significant increase from just 12 percent in 2007

34

6,879Number of ambulatory practices (3 percent total) participating in HIEs that are operational 85

Number of operational HIEs that were identified in the U.S. in 2011; another 98 were in the planning phase

ehr adoption & hIE

2002

12.4

2011

30.9

Percent of specialists who report using basic EHR in 2011, compared to 12.4 percent in 2002

30.9 88

Percent of operational HIEs that are exchanging

test results, the most common exchange;

demographic information follows at 76 percent for

ambulatory settings

2010

2011

18Percent of U.S. hospitals that were shown to

have adopted basic EHR functionality in 2011, compared to just 11.5 percent in 2010

2010

2011

8.7

Percent of hospitals that adopted comprehensive EHRs in 2011,

compared to only 2.6 percent in 2010

40

Percent growth rate that was seen in the HIE market from

2010 to 2011

hipaa privacy, security & breach notification

Contained in ARRA, HIPAA privacy and security was supplemented with new regulations requiring all physicians covered under HIPAA to notify patients of security breaches of their protected health information. This is known as the HIPAA Breach Notification Rule. In addition to notifying affected individuals, HIPAA covered entities must also report PHI breaches to the Secretary of HHS and, in some cases, to the media. HIPAA breaches can carry stiff penalties regardless of the size of the covered entity. The idea is to strengthen the fabric of public trust that having PHI “out there” in digital form is safe, private and secure.

hipaa privacy, security & breach notification

70,982 Number of HIPAA complaints that have been registered with the HHS Office of Civil Rights since April 2003 16,259

Number of cases investigated since April 2003 resulting in changes in privacy practice & other corrective actions by the covered entities

91

Percent of the above-noted complaints (or 64,449) that were

resolved through investigation &

enforcement, a finding of no violation or ineligibility

for enforcement

500+Number of individuals affected by unsecured protected health information (PHI) breaches that will result in public posting on the HHS website of the breach in accordance with the Interim

Final Rule for Breach Notification

$1,000Amount per violation that is applied for violations deemed secondary to a “reasonable cause” with an annual maximum of $100,000 under the IFR

19Millions of Americans

that have experienced a major HIPAA breach

since effective date of the HIPAA breach

notification IFR in late 2009

$50,000Amount per violation (up to $1.5 million for repeat occurrences) in fines that is applied for breaches deemed the result of willful neglect

hipaa privacy, security & breach notification

40,396 Number of patients on average who were affected per each of the 385 PHI breaches that occured in 2011

Percent of all breaches in 2011 that involved a business associate

59

Percent of all breaches in 2011 that occurred on a laptop or other portable device

39

Percent of all breaches in 2011 that occurred on a desktop PC or server

25

Percent of all breaches in 2011 that resulted from malicious intent such as theft or hacking

60

97Percent increase in total records breached that was realized from 2010 to 2011

3.25Millions of dollars that were paid by CVS Pharmacy, Inc. & Rite Aid Corporation in January 2009 & July 2010, respectively, to resolve violations of the Privacy Rule

$100,000Amount that was reached as a settlement

for HIPAA federal by Phoenix Cardiac Surgery in June 2012

Millions of dollars that were applied in federal penalties to the Alaska

Department of Health & Social Services (Medicaid) for HIPAA violations in July 2012

1.7

According to the National Association of Community Health Centers, the U.S. is faced with nearly 60 million disenfranchised patients who do not have adequate access to primary care services. Approximately 75 percent of the 2,050 rural U.S. counties include a primary care health professional shortage area. HITECH gives priority for needing health IT—or a Priority Primary Care Provider (PPCP). The formal definition of a PPCP is a licensed MD, DO, nurse practitioner or physician assistant with prescriptive privileges who provides primary care services in the area of Family Practice, Internal Medicine, OB/Gynecology and/or Pediatrics practicing in an individual or small practice (10 or less) serving the uninsured, underinsured and medically underserved populations.

priority primary care providers

priority primary care providers

Millions of Americans who lack adequate

access to primary care providers due

to a shortage

60

each individual = 1 million624,434 Number of physicians who

work in direct patient care in the United States

Primary Care Providers (PCPs) are defined as physicians working in family practice, geriatrics, general practice, general internal medicine and general pediatrics.

52

Percent of nurse practitioners practicing in primary care in the U.S. -

approximately 55,625

33.5

Percent of physicians in the U.S. that are

classified as primary care - approximately 209,000

43.4

Percent of physician assistants practicing in

primary care in the U.S. - approximately 30,400

25

Percent increase in the yearly number of

ambulatory visits from 1997 to 2007

48.1

Percent of visits to primary care physicians in office-based practices

priority primary care providers

16.4

Percent of visits to surgical specialists

18.4

Percent of visits to medical specialists

9.3

Average percent of PCPs that practice in a large, rural setting defined as having a population of

10,000 to 50,000

5.2

Average percent of PCPs that practice in a small, rural setting defined as having a population of

2,500 to 9,999

4.3

Average percent of PCPs that practice in a remote, rural or frontier market

defined as having a population less than 2,500

81

Average percent of PCPs that practice in an urban setting (including nurse

practitioners & physician assistants)

250Millions of dollars that are earmarked under the Affordable Care Act & the

Public Health Fund to train professionals in primary care

1.2Billions of visits to physician offices, hospital emergency departments & outpatient centers

Community health centers

Community Health Centers (CHCs) are non-profit ambulatory care clinics designed to enhance the health and well-being of all people, with particular emphasis on those patients who are medically underserved. CHCs offer affordable health care services through well-trained professional staff at accessible locations throughout the country. Delivering a dedicated staff to populations and areas that have too few options, CHCs will play a key role in caring for newly covered Americans under the Affordable Care Act.

Community health centers

Community health centers

1,137 Number of Community Health Centers (CHCs) that are established in the U.S. 8,649 Number of CHC clinic sites

that are available to deliver safety net services

20.2Millions of patients who were served by CHCs in

2011 (including members of ethnic &

minority groups)

1.7Billions of dollars in

Affordable Care Act (ACA) grants that were awarded

to the Health Center Program in FY2011

109Millions of dollars that were awarded to 278 school-based health center programs in

FY2011 & to 45 programs in FY2012 under ACA

650Number of CHCs, roughly, that offer safety net dental

services (of the 1,137 available), supplying 7-8

million of the underserved with dental care

80Millions of Americans

who are disenfranchised for general dental care

9,900 Number of physicians serving patients in CHCs

6,900 Number of mid-level providers serving in CHCs

7.4

Percent of babies with a low birthrate in CHCs, as compared to the national average at 8.16 percent

71

Percent of diabetics treated at CHCs that had

control over diabetes with a hemoglobin A1C < 9

About the b.r.i.e.f. readers

In June, SuccessEHS surveyed around 500 readers of it publication known as The B.R.I.E.F. (Bringing Relevant Information & EHR Facts) to get their thoughts on key issues and topics. Around 22 percent of readers responded. Approximately 71 percent were affiliated with primary care providers, 28 percent with specialty providers, and 2 percent hospital administration. Here are the results.

About the b.r.i.e.f. readers

61.3

Percent of readers that have registered for CMS EHR Incentive

Programs

30.6

Percent of readers that have received Year One AIU Incentives under

Medicaid

34.2

Percent of readers that have performed Year One adopt, implement or upgrade as

required under the Medicaid Meaningful Use program

59

Percent of readers that list ICD-10, Meaningful Use

Stage 1 or Meaningful Use Stage 2 as the number one

stressful matter to health care stakeholders today

25.2

Percent of readers that performed the first year

of 90 continuous days of Meaningful Use in

CY2011

56

Percent of readers that identified the

Patient-Centered Medical Home, Health Information

Exchange or Physician Quality Reporting System as the second most stressful

matter to stakeholders

36.9

Percent of readers that have or will perform 90

continuous days of Meaningful Use in

CY2012

75

Percent of readers that listed Accountable Care

Organizations, Value-Based Modifiers, ePrescribing or HIPAA security as the least stressful matter to health

care stakeholders

20.7

Percent of readers that have been paid for Year

One of the Medicare Meaningful Use program

Percent of readers who use advanced Certified EHR technology to provide

point-of-care alerts when evidence-based clinical events

for wellness, prevention or chronic disease management are outstanding on a patient

50.5

CITATIONSThe American Patient- United Nations, Population and Vital Statistics Report, Series A, Vol. LXIV, January 1, 2012, http://unstats.un.org/unsd/demographic/products/vitstats/sets/Series_A_2012.pdf - Ibid.- L. Murphy, J. Xu, K. Kochanek, National Vital Statistics Reports, Deaths: Preliminary Data for 2010, Volume 60, Number 4, January 11, 2012, http://www.cdc.gov/nchs/data/nvsr/nvsr60/nvsr60_04.pdf - Central Intelligence Agency, The World Factbook, Country Comparison: Life Expectancy at Birth, 2011, https://www.cia.gov/library/publications/the-world-factbook/rankorder/2102rank.html - U.S. Census Bureau, Profile America, Facts for Features, Older Americans Month: May 2012, March 1, 2012, http://www.census.gov/newsroom/releases/archives/facts_for_features_special_editions/cb12-ff07.html - Department of Defense, Military Personnel Statistics, December 31, 2011, http://www.usa.gov/Federal-Employees/Active-Military-Records.shtml#Data_and_Statistics - CDC/NCHS, Data Brief No. 82, Prevalence of Obesity in the U.S. 2009-2010, January, 2012, http://www.cdc.gov/nchs/data/databriefs/db82.pdf - R. Hammond, Brookings, Obesity, Prevention, and Health Care Costs, May 4, 2012, http://www.brookings.edu/research/papers/2012/05/04-health-care-hammond - American Cancer Society, Cancer Facts and Figures 2012, http://www.cancer.org/Research/CancerFactsFigures/CancerFactsFigures/cancer-facts-figures-2012 - L. Murphy, J. Xu, K. Kochanek, National Vital Statistics Reports, Deaths: Preliminary Data for 2010, Volume 60, Number 4, January 11, 2012, http://www.cdc.gov/nchs/data/nvsr/nvsr60/nvsr60_04.pdf- American Heart Association and American Stroke Association, Statistical Fact Sheet, 2012 Update, http://www.heart.org/idc/groups/heart-public/@wcm/@sop/@smd/documents/downloadable/ucm_319585.pdf - Ibid.- Alzheimer’s Association, 2012 Alzheimer’s Disease Facts and Figures, Alzheimer’s & Dementia, Volume 8, Issue 2, 2012, http://www.heart.org/idc/groups/heart-public/@wcm/@sop/@smd/documents/downloadable/ucm_319585.pdf - J. Loyd, USA Today, Many with mental illness go without treatment, Survey Says, January 19, 2012, http://www.usatoday.com/news/health/medical/health/medical/mentalhealth/story/2012-01-19/Many-with-mental-illness-go-without-treatment-survey-says/52653166/1 - Pratt LA, Brody DJ, Gu Q. Antidepressant use in persons aged 12 and over: United States, 2005–2008. NCHS data brief, no 76. Hyattsville, MD: National Center for Health Statistics. 2011- Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Expenditure Projections 2010-2020, http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/Proj2011PDF.pdf - Henry J. Kaiser Foundation, Health Care Costs: A Primer, Key Information on Health Care Costs and Their Impact, May, 2012, http://www.kff.org/insurance/upload/7670-03.pdf - Martin A.B. et al., “Growth In US Health Spending Remained Slow in 2010; Health Share of Gross Domestic Product Was Unchanged from 2009,” Health Affairs, 2012, http://content.healthaffairs.org/content/31/1/208.short - Ibid.- CDC/NCHS, Health, United States, 2011, Tables 138, 140, and 141. Data from the National Health Interview Survey (NHIS).- CDC/NCHS, Health, United States, 2011, Table 99. Data from the National Health and Nutrition Examination Survey (NHANES).- Henry J. Kaiser Foundation, Health Care Costs: A Primer, Key Information on Health Care Costs and Their Impact, May, 2012, http://www.kff.org/insurance/upload/7670-03.pdf - Ibid.- Ibid.

CITATIONSMeaningful Use- Harvard School of Public Health, Mathematica Policy Research, Robert Wood Johnson Foundation, Health Information Technology in the United States: Driving Toward Delivery System Change, 2012, http://www.rwjf.org/files/research/74262.5822.hit.full.rpt.final.041612.pdf- Ibid.- Centers for Medicare & Medicaid Services, Data and Reports, June, 2012, http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/DataAndReports.html - Ibid.- Ibid.- Ibid.- Ibid.- Ibid.- Ibid.- Ibid.- Ibid.- Ibid.- Ibid.- Ibid.- Ibid.- Ibid.- Ibid.- Ibid.

Electronic Health Record Adoption & Health Information Exchange- H. Anderson, Information Security Media Group, $30 Billion: Money Well Spent?, February 3, 2012, http://www.govinfosecurity.com/blogs.php?postID=1185 - Harvard School of Public Health, Mathematica Policy Research, Robert Wood Johnson Foundation, Health Information Technology in the United States: Driving Toward Delivery System Change, 2012, http://www.rwjf.org/files/research/74262.5822.hit.full.rpt.final.041612.pdf - Ibid.- Ibid.- Ibid.- Ibid.- Ibid.- Chilmark Research, 2012 HIE Market Report, June 25, 2012, http://healthinformationexchanges.org/perspectives-on-the-trends-in-the-hie-market/ - Harvard School of Public Health, Mathematica Policy Research, Robert Wood Johnson Foundation, Health Information Technology in the United States: Driving Toward Delivery System Change, 2012, http://www.rwjf.org/files/research/74262.5822.hit.full.rpt.final.041612.pdf- Ibid.- Ibid.

HIPAA Privacy, Security & Breach Notifications- U.S. Department of Health & Human Services, Office for Civil Rights, Enforcement Highlights, May 31, 2012, http://www.hhs.gov/ocr/privacy/hipaa/enforcement/highlights/index.html - Ibid.- Ibid.- U.S. Department of Health & Human Services, Office for Civil Rights, Breaches Affecting 500 or More Individuals, http://www.hhs.gov/ocr/privacy/hipaa/administrative/breachnotificationrule/postedbreaches.html - U.S. Department of Health & Human Services, Office for Civil Rights, Breach Notification Rule, http://www.hhs.gov/ocr/privacy/hipaa/administrative/breachnotificationrule/index.html - Ibid.- H. Anderson, Information Security Media Group, $30 Billion: Money Well Spent?, February 3, 2012, http://www.govinfosecurity.com/blogs.php?postID=1185- Redspin, Breach Report 2011, Protected Health Information, http://www.redspin.com/docs/Redspin_PHI_2011_Breach_Report.pdf - Ibid.- Ibid.- Ibid.- Ibid.- Ibid.- U.S. Department of Health & Human Services, Office for Civil Rights, Annual Report to Congress on HIPAA Privacy Rule and Security Rule Compliance for Calendar Years 2009 and 2010, http://www.hhs.gov/ocr/privacy/hipaa/enforcement/compliancerept.pdf - M. Tremoglie, Legal Newsline, Alaska Fined for HIPAA Violation, July 3, 2012, http://www.legalnewsline.com/news/236619-alaska-fined-for-hipaa-violation - C. Scott, Becker’s Spine Review, Physicians Beware, HIPAA Violations can Affect Your Bottom Line Regardless of the Size of Your Practice, June 13, 2012, http://beckersorthopedicandspine.com/hitmeaningful-useemr/item/12239-physician-beware-hipaa-violations-can-affect-your-bottom-line-regardless-of-the-size-of-your-practice

Priority Primary Care Providers- National Association of Community Health Centers, Access Endangered: Profiles of the Medically Disenfranchised, August 8, 2011, http://www.nachc.org/client//NACHC__Access_Endangered_2011.pdf - Primary Care Workforce Facts and Stats No. 1: The Number of Practicing Primary Care Physicians in the United States. AHRQ Publication No. 12-P001-2-EF, October 2011. Agency for Health Care Policy and Research, Rockville, MD. http://www.ahrq.gov/research/pcwork1.htm- Ibid.- Primary Care Workforce Facts and Stats No. 2: The Number of Nurse Practitioners and Physician Assistants Practicing Primary Care in the United States. AHRQ Publication No. 12-P001-3-EF, October 2011. Agency for Health Care Policy and Research, Rockville, MD. http://www.ahrq.gov/research/pcwork2.htm - Ibid.- Schappert S, Rechtsteiner E: Ambulatory Medical Care Utilization Estimates for 2007, from National Center for Health Statistics Vital and Health Statistics, April, 2011, http://www.cdc.gov/nchs/data/series/sr_13/sr13_169.pdf

CITATIONS

Priority Primary Care Providers continued- Ibid.- Ibid.- Ibid.- Ibid.- Primary Care Workforce Facts and Stats No. 3: Distribution of the U.S. Primary Care Workforce. AHRQ Publication No. 12-P001-4-EF, January 2012. Agency for Health Care Policy and Research, Rockville, MD. http://www.ahrq.gov/research/pcwork3.htm - Ibid.- Ibid.- Ibid.- Patient Protection and Affordable Care Act of 2010, http://www.healthcare.gov/law/resources/authorities/patient-protection.pdf

The Affordable Care Act- Patient Protection and Affordable Care Act of 2010, http://www.healthcare.gov/law/resources/authorities/patient-protection.pdf - Health Care and Education Reconciliation Act of 2010, http://www.healthcare.gov/law/resources/authorities/reconciliation-law.pdf - Constitution of the United States of America, http://www.constitution.org/cs_found.htm - Patient Protection and Affordable Care Act of 2010, http://www.healthcare.gov/law/resources/authorities/patient-protection.pdf and Health Care and Education Reconciliation Act of 2010, http://www.healthcare.gov/law/resources/authorities/reconciliation-law.pdf- Ibid.- Ibid.- Ibid.- Ibid.- Ibid.- Ibid.- C-Span, Oral Argument on Anti-Injunction Act and Health Care Law, March 26, 2012, http://www.c-span.org/Events/Oral-Argument-on-Anti-Injunction-Act-and-Health-Care-Law/10737429097/ - SCOTUS Slip Opinion, National Federation of Independent Business, et al v. Sebelius, Secretary of Health and Human Services, et al., June 28, 2012, http://www.supremecourt.gov/opinions/11pdf/11-393c3a2.pdf - Ibid.- Ibid.

Accountable Care Organizations- Muhlestein, D., Croshaw, A., Merrill, T., & Peña, C. (2012). Growth and dispersion of Accountable Care Organizations: June 2012 update. Retrieved July 5, 2012, from http://leavittpartners.com/wp-content/uploads/2012/06/Growth-and-Dispersion-of-ACOs-June-2012-Update2.pdf- Ibid.- Ibid.

CITATIONS

CITATIONSAccountable Care Organizations continued- Ibid.- Ibid.- Ibid.- Ibid.- Ibid.- Ibid.- Ibid.- Center for Medicare and Mediciad Innovation. (2012). Pioneer Accountable Care Organization model: General fact sheet. Retrieved July 6, 2012, from http://innovations.cms.gov/Files/fact-sheet/Pioneer-ACO-General-Fact-Sheet.pdf- Centers for Medicare and Medicaid Services. (2012). Medicare shared savings program Accountable Care Organizations. Start date: April 1, 2012. Retrieved July 6, 2012, from https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/Downloads/MSSP-ACOs-List.pdf- Centers for Medicare and Medicaid Services. (2012). Advance payment ACO model. Retrieved June 6, 2012, from http://www.innovations.cms.gov/initiatives/aco/advance-payment/- McGinnis, T., Small, D. M., & Center for Health Care Strategies, Inc. (2012). Accountable Care Organizations in Medicaid: Emerging practices to guide program design. Retrieved July 6, 2012, from http://www.chcs.org/usr_doc/Creating_ACOs_in_Medicaid.pdf

Patient-Centered Medical Home- Centers for Disease Control and Prevention, Obesity, Halting the Epidemic by Making Health Easier, At a Glance 2011, May 26, 2011, http://www.cdc.gov/chronicdisease/resources/publications/AAG/obesity.htm#aag - Ibid. -American Diabetes Association, Health Care Reform and People with and at-risk for Diabetes, February, 2011, http://www.diabetes.org/assets/pdfs/advocacy/hcr-and-people-with-diabetes.pdf - Ibid.- Centers for Disease Control and Prevention, Diabetes, Successes and Opportunities for Population-Based Prevention and Control, At a Glance 2011, August 1, 2011, http://www.cdc.gov/chronicdisease/resources/publications/aag/ddt.htm - Norris SL, Kansagara D, Bougatsos C, et al. Screening Adults for Type 2 Diabetes: A Review of the Evidence for the U.S. Preventive Services Task Force. AHRQ Publication No. 08-05116-EF-4, June 2008. http://www.uspreventiveservicestaskforce.org/uspstf08/type2/type2art.htm - Centers for Disease Control and Prevention, Tobacco Use, Targeting the Nation’s Leading Killer, At a Glance, February 22, 2011, http://www.cdc.gov/chronicdisease/resources/publications/aag/osh.htm - Free & Clear, Cancer & Lifestyle: How Employers Can Help Fight Cancer through the Promotion of Healthy Behaviors, 2010, http://www.alerewellbeing.com/_assets/cms_uploads/WP_Cancer_Lifestyle_ACS.pdf - American Cancer Society, Cancer Prevention & Early Detection, Facts & Figures 2012, Atlanta: American Cancer Society; 2012.- NCQA, Standards and Guidelines for NCQA’s Patient-Centered Medical Home (PCMH) 2011, January, 2011.- Patient Centered Medical Home Resource Center, Catalogue of Federal PCMH Activities, Agency for Healthcare Research and Quality, March 2011, http://pcmh.ahrq.gov/portal/server.pt/community/pcmh__home/1483/pcmh_federal_pcmh_activities_v2

Patient-Centered Medical Home continued- NCQA Clinician Directory and Search, July, 2012, http://recognition.ncqa.org/ - The Joint Commission, Primary Care Medical Home Certified Organizations, June 19, 2012, http://www.jointcommission.org/pcmh_certified_providers/ - National Academy for State Health Policy, Building Medical Homes: Lessons from Eight States with Emerging Programs, December, 2011, http://nashp.org/sites/default/files/building.medical.homes_.emerging.states.pdf - National Academy for State Health Policy, Medical Home & Patient-Centered Care, January, 2012, http://nashp.org/med-home-map - BlueCross BlueShield Association, Patient-Centered Medical Home (PCMH), 2012, http://www.bcbs.com/why-bcbs/patient-centered-medical-home/#navtab-2 - A. Bitton, C. Martin, and B.E. Landon, “A Nationwide Survey of Patient-Centered Medical Home Demonstration Projects,” Journal of General Internal Medicine, June 2010 25(6):584-92.- Ibid.

Community Health Centers- Health Resources and Services Administration, Data Warehouse, National Summary, July 12, 2012, http://datawarehouse.hrsa.gov/hitnFactSheet.aspx - Ibid. - Health Resources and Services Administration, The Affordable Care Act and Health Centers, Health Center Fact Sheet, 2012, http://bphc.hrsa.gov/about/healthcenterfactsheet.pdf- Ibid.- Ibid. - Ibid.- Ibid.- J. Breslow, Frontline, Dollars and Dentists, How to Fix a Broken Dental Safety Net, June 27, 2012, http://www.pbs.org/wgbh/pages/frontline/health-science-technology/dollars-and-dentists/how-to-fix-a-broken-dental-safety-net/ - Ibid.- Health Resources and Services Administration, The Affordable Care Act and Health Centers, Health Center Fact Sheet, 2012, http://bphc.hrsa.gov/about/healthcenterfactsheet.pdf- Ibid.

CITATIONS