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Special Care North Carolina Style. Special Care Dental Association Meeting Chicago, 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)

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special care north carolina style

Special CareNorth Carolina Style

Special Care Dental Association Meeting

Chicago, April 11, 2014

Bill Milner, D.D.S., M.P.H.

Betsy White, R.D.H.

in the beginning
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
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
1997 carolinas mobile dentistry carolinas health care charlotte
1997 Carolinas Mobile Dentistry, Carolinas Health Care, Charlotte

Dr. Ford Grant arriving from Louisville to take over established geriatric program.

Carolinas Health Care had the financial resources.

Sponsored by NCDS

2000 access dental care
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

Access Dental Care Service Areas
staff involved
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
slide9
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
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
Started With:
  • Skilled Nursing
  • Group Home Day Centers
  • CCRCs (Independent, Assisted Living, Skilled, Memory)
  • Arc of High Point
  • Hospital OR Support
added
Added:
  • VA State Nursing Facility
  • Home Health
  • Adult Day Care
finally
Finally:
  • PACE (Program of All-Inclusive Care for the Elderly)
  • HIV/AIDS (Central Carolina Health Network)
during this time
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
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
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
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
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
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 care www accessdentalcare org
Access Dental Carewww.accessdentalcare.org
  • Bill Milner, DDS bmilner@accessdentalcare.org 336.240.8082
  • Betsy White, RDH bwhite@accessdentalcare.org

336.240.8130