john w. mcfarland, d.d.s

The National Primary The National Primary OralOral

Health Care ConferenceHealth Care ConferenceSan Diego 2007San Diego 2007

Welcome EveryoneWelcome Everyone

National Network for National Network for Oral Health Access Oral Health Access

(NNOHA)(NNOHA) John McFarland DDSJohn McFarland DDS PresidentPresident

NNOHANNOHANational Network for Oral National Network for Oral

Health AccessHealth Access The organization of Migrant, The organization of Migrant,

Homeless, and Community Health Homeless, and Community Health Center dental providersCenter dental providers

Why NNOHAWhy NNOHA From 1985 to 1990 CHC’s lost 75 dental From 1985 to 1990 CHC’s lost 75 dental

programs. programs. In 1985 there were 250 CHC’s with In 1985 there were 250 CHC’s with

dental. By 1990 there were 175.dental. By 1990 there were 175. NNOHA was formed as an organization NNOHA was formed as an organization

to stop the continuing loss of CHC to stop the continuing loss of CHC dental programs and start building new dental programs and start building new dental programsdental programs

NNOHA is the only organization of CHC NNOHA is the only organization of CHC dentists and hygienists, by us, for us.dentists and hygienists, by us, for us.

NNOHANNOHA NNOHA needs your support, and quite NNOHA needs your support, and quite

franklyfrankly You need NNOHAYou need NNOHA Please join by requesting an Please join by requesting an

application form from us here in application form from us here in Atlanta, orAtlanta, or

Please join by requesting an Please join by requesting an application form on the list serve or application form on the list serve or here in San Diego.here in San Diego.

$25.00 per dentist or hygienist, $25.00 per dentist or hygienist, $250.00 per Health Center$250.00 per Health Center

NNOHA List ServeNNOHA List Serve Send an e-mail to:Send an e-mail to: [email protected]@ohsu.edu Place nothing anywhere except in the Place nothing anywhere except in the

message area.message area. In the message area place the In the message area place the

following:following: Subscribe [email protected] [email protected]

MISSIONMISSION The mission of the National Network The mission of the National Network

for Oral Health Access (NNOHA) is to for Oral Health Access (NNOHA) is to improve the oral health status of the improve the oral health status of the underserved through advocacy and underserved through advocacy and support for Health Centerssupport for Health Centers

Strategic PerspectiveStrategic Perspective

We must work to insure that We must work to insure that oral health services, including oral health services, including prevention and treatment, must prevention and treatment, must be an integral component of be an integral component of primary health care and defined primary health care and defined as such in legislation and as such in legislation and regulation.regulation.


Start new dental programs in Start new dental programs in CHC’s that do not have dentalCHC’s that do not have dental


Expand dental programs to sites Expand dental programs to sites in CHC’s with multiple sites that in CHC’s with multiple sites that do not have dental.do not have dental.


Expand existing sites which do Expand existing sites which do have dental to meet the oral have dental to meet the oral health needs of the patients health needs of the patients served by that site within the served by that site within the CHCCHC


Build NNOHA infrastructure at Build NNOHA infrastructure at the local level through local the local level through local dental entities within primary dental entities within primary care associations.care associations.


Provide a forum for CHC dentists Provide a forum for CHC dentists and hygienists.and hygienists.


Provide guidance to CHC dental Provide guidance to CHC dental providers in managing and providers in managing and operating their programs.operating their programs.


Provide input from CHC dentist’s Provide input from CHC dentist’s in the development of HRSA’s in the development of HRSA’s dental clinical measures.dental clinical measures.

NNOHA ACTIVITIES 2007NNOHA ACTIVITIES 2007 Substantial funding through a Substantial funding through a

cooperative agreement with HRSAcooperative agreement with HRSA Creation of NNOHA Advisory Creation of NNOHA Advisory

CommitteeCommittee NNOHA Website NNOHA Website www.nnoha.orgwww.nnoha.org NNOHA ListserveNNOHA Listserve Annual ConferenceAnnual Conference Oral Health Pilot Collaborative Oral Health Pilot Collaborative

http://www.nnoha.org/

Why Is Oral Health ImportantWhy Is Oral Health Important

95% of all Americans are afflicted by oral 95% of all Americans are afflicted by oral diseasedisease

Oral cancer is more common than leukemia, Oral cancer is more common than leukemia, melanoma of the skin, Hodgkins disease, melanoma of the skin, Hodgkins disease, and cancers of the brain, liver, bone, and cancers of the brain, liver, bone, stomach, thyroid gland, ovaries, or cervix.stomach, thyroid gland, ovaries, or cervix.

Each year over 164 million hours are missed Each year over 164 million hours are missed from work and 52 million hours from from work and 52 million hours from school due to dental problems.school due to dental problems.

Why Is Oral Health ImportantWhy Is Oral Health Important

Dental related illness accounts for 6.1 Dental related illness accounts for 6.1 million days of bed disability and 12.7 million days of bed disability and 12.7 million days of restricted activity annuallymillion days of restricted activity annually

Lost work due to dental problems equates to Lost work due to dental problems equates to 164,000 American workers off the job for 164,000 American workers off the job for the entire yearthe entire year

Populations served by health centers are Populations served by health centers are particularly at risk for oral disease and particularly at risk for oral disease and have the highest disease level.have the highest disease level.

Why Is Oral Health Care Why Is Oral Health Care ImportantImportant

82% of those in poverty will require a 82% of those in poverty will require a dental visit in the near futuredental visit in the near future

33% of those in poverty saw a dentist in 33% of those in poverty saw a dentist in a given year versus 61% of those not a given year versus 61% of those not in povertyin poverty

Prevalence of dental disease in the Prevalence of dental disease in the uninsured / underinsured population uninsured / underinsured population is 3 times the national averageis 3 times the national average

Why Is Oral Health Care ImportantWhy Is Oral Health Care Important

12% of those in poverty had 12% of those in poverty had significant dental findings versus significant dental findings versus 5% of the non poverty population5% of the non poverty population

97% of homeless population need 97% of homeless population need dental caredental care

Migrant populations have 3 times Migrant populations have 3 times the incidence of dental decay than the incidence of dental decay than the average populationthe average population

Percentage of Adults With Percentage of Adults With Untreated Caries by Family Untreated Caries by Family

Income (GAO 2000)Income (GAO 2000)

05

101520253035404550

19-64 YO 65+ YO

$0-$10K$10K-$20K$20K-$35K$35K +

Why Is Oral Health Care Important Why Is Oral Health Care Important Particularly To ChildrenParticularly To Children

Tooth decay is the single most common Tooth decay is the single most common chronic disease of childhoodchronic disease of childhood

Almost half of US children age 5-17 Almost half of US children age 5-17 have experienced tooth decay in have experienced tooth decay in their permanent teeth.their permanent teeth.

25% of children and adolescents 25% of children and adolescents (typically from families with low (typically from families with low incomes and minority populations) incomes and minority populations) experience 80% of all dental decay experience 80% of all dental decay occurring in permanent teethoccurring in permanent teeth

Why Is Oral Health Care Important Why Is Oral Health Care Important Particularly To ChildrenParticularly To Children

1% of child patients suffer from Early Childhood Caries 1% of child patients suffer from Early Childhood Caries (Baby Bottle Tooth Decay) by age 5 and are from families (Baby Bottle Tooth Decay) by age 5 and are from families typically seen by health centerstypically seen by health centers

Children ages 2-5 and between 100% and 200% of poverty Children ages 2-5 and between 100% and 200% of poverty quidelines have 4.5 times the rate of dental disease than quidelines have 4.5 times the rate of dental disease than the national averagethe national average

Why Is Oral Health Care Important Why Is Oral Health Care Important Particularly to ChildrenParticularly to Children

Among migrant children age 10-14, Among migrant children age 10-14, dental is the most common health dental is the most common health problem, and age 15-19, it is the problem, and age 15-19, it is the second most common health problemsecond most common health problem

Percentage of Children With Percentage of Children With Untreated Caries by Family Untreated Caries by Family

Income (GAO 2000)Income (GAO 2000)

0

5

10

15

20

25

30

35

40

45

2-5 YOPrimaryTeeth

6-12 YOPrimaryTeeth

6-14 YOPermanent

Teeth

15-18 YOPermanent

Teeth

$0K - $10K$10K-$20K$20K-$35K$35K+

Is There An Oral Health Access Is There An Oral Health Access Problem (Or Crisis)Problem (Or Crisis)

One in ten children aged 5-11 years has One in ten children aged 5-11 years has never visited a dentist within the past never visited a dentist within the past 12 months.12 months.

43% of Americans age 2 and older have 43% of Americans age 2 and older have not visited a dentist within the past not visited a dentist within the past 12 months12 months

50% of homebound elderly have not 50% of homebound elderly have not seen a dentist in ten yearsseen a dentist in ten years

Percentage of Population Who Percentage of Population Who Made a Dental Visit in the Made a Dental Visit in the

Preceding Year (GAO 2000)Preceding Year (GAO 2000)

0

10

20

30

40

50

60

1977 1987 1996

0-200% PovertyLevel200% -400%Poverty Level400% + PovertyLevel

Is There An Oral Health Access Is There An Oral Health Access Problem (Or Crisis)Problem (Or Crisis)

Dentist per population ratio is decreasing Dentist per population ratio is decreasing from 60 dentists per 100,000 population from 60 dentists per 100,000 population in 1991 to 57 dentists per 100,000 in 1991 to 57 dentists per 100,000 population in 2000 (and projections are population in 2000 (and projections are to 53 dentists per 100,000 in 2020).to 53 dentists per 100,000 in 2020).

Number of students graduating from Number of students graduating from dental schools has decreased from dental schools has decreased from 5,765 in 1982 to 4041 in 19985,765 in 1982 to 4041 in 1998

Is There An Is There An Oral Health Access Health Access Problem (Or Crisis)Problem (Or Crisis)

Only 25% of Medicaid eligible Only 25% of Medicaid eligible children actually receive oral health children actually receive oral health servicesservices

Only 71% of Community Health Only 71% of Community Health Centers have dental programs Centers have dental programs (678/952) and health centers are (678/952) and health centers are only able to treat 2.34 million only able to treat 2.34 million patients per yearpatients per year

Is There A Funding Problem in Is There A Funding Problem in Dental CareDental Care

120 million Americans do not have dental 120 million Americans do not have dental insurance as opposed to 43 million insurance as opposed to 43 million without medical insurancewithout medical insurance

Upon retiring, 85% of Americans have no Upon retiring, 85% of Americans have no dental insurancedental insurance

There are no dental benefits under There are no dental benefits under MedicareMedicare

Is There A Funding Problem in Is There A Funding Problem in Dental CareDental Care

There are limited dental benefits for There are limited dental benefits for adults under Medicaidadults under Medicaid

Uninsured patients must pay out-of-Uninsured patients must pay out-of-pocket, and for low income patients pocket, and for low income patients the expense of dental care is generally the expense of dental care is generally prohibitiveprohibitive

Three Main Dental IssuesThree Main Dental Issues

1.1. Lack of access to dental careLack of access to dental care2.2. Inadequate funding for oral health especially Inadequate funding for oral health especially

in unserved and underserved populationsin unserved and underserved populations3.3. Declining provider poolDeclining provider pool

SolutionsSolutions

CONTINUE TO EXPAND DENTAL CONTINUE TO EXPAND DENTAL PROGRAMS IN COMMUNITY PROGRAMS IN COMMUNITY HEALTH CENTERSHEALTH CENTERS

• Increase the number of Centers Increase the number of Centers with dental programs to increase with dental programs to increase from 58% in 1998 to 90% in 2010.from 58% in 1998 to 90% in 2010.

• Expand existing dental programsExpand existing dental programs inin health centershealth centers

SolutionsSolutions

Increase funding to the National Health Service Corp Increase funding to the National Health Service Corp loan repayment and scholarship programs to enable loan repayment and scholarship programs to enable health centers to compete for a shrinking supply of health centers to compete for a shrinking supply of dentists and hygienistsdentists and hygienists

Increase or initiate state loan repaymentIncrease or initiate state loan repayment programs for programs for dentists and hygienistsdentists and hygienists

SolutionsSolutions

Strengthen Medicaid and CHIP revenues which are Strengthen Medicaid and CHIP revenues which are vital revenue streams for health center dental vital revenue streams for health center dental programs and other providers treating programs and other providers treating underserved populationsunderserved populations

Collaborations principally between local, county, Collaborations principally between local, county, and state initiatives with private and public and state initiatives with private and public entitiesentities

Status of Health Center Dental Status of Health Center Dental Programs NationallyPrograms Nationally

• 963 dentists in health centers 2000963 dentists in health centers 2000• 280 hygienists in health centers 2000280 hygienists in health centers 2000• 1,300,000 dental patients 20001,300,000 dental patients 2000• 3,000,000 dental visits 20003,000,000 dental visits 2000• 450 centers out of 731 have dental 2000450 centers out of 731 have dental 2000


• 1,230 dentists in health centers 20021,230 dentists in health centers 2002• 383 hygienists in health centers 2002383 hygienists in health centers 2002• 1,644,917 dental patients 20021,644,917 dental patients 2002• 3,787,923 dental visits 20023,787,923 dental visits 2002• 539 centers out of 843 have dental 2002539 centers out of 843 have dental 2002

Status of Health Center Dental Status of Health Center Dental Programs Nationally ContinuedPrograms Nationally Continued

2,702 Encounters per dentist 20062,702 Encounters per dentist 2006 1,379 Encounters per hygienist 20061,379 Encounters per hygienist 2006 2,711 Encounters per dental team 20062,711 Encounters per dental team 2006 2.380 Encounters per dental user 20062.380 Encounters per dental user 2006 $138.64 per dental encounter 2006$138.64 per dental encounter 2006 $333.43 per dental user 2006$333.43 per dental user 2006

Source www.bphc.hrsa.gov/udsSource www.bphc.hrsa.gov/uds

NNOHANNOHA

Thank youThank you

Functional StatementFunctional Statement

A significant documented disparity A significant documented disparity exists between the oral health exists between the oral health status of those individuals who have status of those individuals who have ready access to oral health care ready access to oral health care services and those who do not. It is services and those who do not. It is the intent of this organization to the intent of this organization to reduce or eliminate this disparity reduce or eliminate this disparity through establishment of an through establishment of an effective network of dental clinical effective network of dental clinical leaders in community, migrant , leaders in community, migrant , and homeless health programs. and homeless health programs. Strategies will be developed to Strategies will be developed to ameliorate these differences and ameliorate these differences and enhance the quality of life.enhance the quality of life.

Requests for NNOHARequests for NNOHA

What are salaries for dentists, What are salaries for dentists, hygienists, and dental assistantshygienists, and dental assistants

What are the productivity What are the productivity expectations for dentists, hygienistsexpectations for dentists, hygienists

I need aI need a Policy and Procedure ManualPolicy and Procedure Manual Continuous Quality Improvement ManualContinuous Quality Improvement Manual Protocol ManualProtocol Manual


Salaries Dentists – From Ken Bolin,Salaries Dentists – From Ken Bolin, CCHN, Others – Mean $86,400CCHN, Others – Mean $86,400

Salaries Dental Directors – Salaries Dental Directors – Approximately $10,000 higher than Approximately $10,000 higher than dentist salariesdentist salaries

Salaries Dental Hygienists – Mean Salaries Dental Hygienists – Mean $54,000$54,000

Salaries Dental Assistants - Mean Salaries Dental Assistants - Mean $22,600$22,600


Productivity Expectation DentistProductivity Expectation Dentist Regional Program Guidance Regional Program Guidance

Memorandum 87-8 2300 Memorandum 87-8 2300 encounters per yearencounters per year

Productivity Expectation HygienistProductivity Expectation Hygienist Regional Program Guidance Regional Program Guidance

Memorandum 87-8 1400 Memorandum 87-8 1400 encounters per yearencounters per year


MANUALSMANUALS Request manuals on NNOHA list serveRequest manuals on NNOHA list serve Oral Health Clinical Resources go to Oral Health Clinical Resources go to

www.cchn.orgwww.cchn.org

john w. mcfarland, d.d.s

Documents

nnoha nnoha

oral health needs

oral health care important

oral health services

oral health status

dental problems

oral health access problem

dental visit