1. John McFarland DDS President
The National Primary Oral Health Care Conference Nashville Welcome Everyone National Network for Oral Health Access (NNOHA)
Because of the myriad of issues we deal with as safety nets, we felt it was important to explore partnerships to enhance our ability to meet the needs of the underserved.
John McFarland DDS
President

2. NNOHA National Network for Oral Health Access
The organization of Migrant, Homeless, and Community Health Center dental providers

3. Why NNOHA From 1985 to 1990 CHC’s lost 75 dental programs.
In 1985 there were 250 CHC’s with dental. By 1990 there were 175.
NNOHA was formed as an organization to stop the continuing loss of CHC dental programs and start building new dental programs
NNOHA is the only organization of CHC dentists and hygienists, of us, by us, and for us.

4. NNOHA NNOHA needs your support, and quite frankly You need NNOHA
Please join by requesting an application form from us here in Nashville
Or join by obtaining an application on the NNOHA website at
$25.00 per dentist or hygienist, $ per Health Center

5. NNOHA List Serve Send an e-mail to: majordomo@ohsu.edu
Place nothing anywhere except in the message area.
In the message area place the following:
Subscribe

6. NNOHA Board Officers John McFarland, DDS, President, CO
David Rosenstein, DMD, Vice President, OR
Juris Svarcbergs, DMD, Secretary, NJ
Renee Rosas, DDS, Treasurer, TX

7. NNOHA Board Region I Region II Region III
Margaret Drozdowski-Maule, DMD, CT
Ellen Gould, RDH, MPH, MA
Region II
Janet Bozzone, DMD, MPH, NY
Neal Demby, DMD, MPH, NY
Region III
Dan Brody, DMD, WV
Scott Wolpin, DDS, MD

8. NNOHA Board Region IV Region V John Patterson, DDS, MS
Amy Renee Lalick-Tomes, DDS, MI
Steve Geiermann, DDS, IL
Chris Shea, MUP, MI

9. NNOHA Board Region VI Region VII Region VIII Greg Baber, DDS, TX
Allen Patterson, FACMPE, MHA, TX
Lisa Jacob, DDS, MS, TX
Region VII
Pat Mason-Dozier, DDS, MO
Bob Russell, DDS, MPH, IA
Region VIII
Mike Downing, DDS, MT

10. NNOHA Board Region IX Region X Wayne Cottam, DMD, MS, AZ
Irene Hilton, DDS, MPH, CA
Huong Le, DDS, CA
Region X
Martin Lieberman, DDS, WA

11. NNOHA ACTIVITIES 2009
Hosted Oral Disease Prevention Summit in Washington DC and published white paper
Job Bank hosted and enhanced on NNOHA Website (200 openings)
Meeting with HRSA , BPHC (Dr. Mary Wakefield, Jim Macrae, Marcia Brand)
National Primary Oral Health Annual Conference
Strengthened NNOHA membership, 818 members and 65 organizational memberships
Summarizes successful prevention strategies for high risk populations.
Mary Wakefield, Jim Macrae, Marcia Brand, Don Weaver, Jay Anderson, Colleen, John

12. NNOHA ACTIVITIES 2009
NNOHA Practice Management Resources (Health Center Fundamentals) initial chapters
NNOHA list serve
NNOHA Quarterly Newsletter online and in print
Survey with Baylor College of Dentistry re salaries, provider satisfaction, and recruitment and retention strategies at CHC
Working with vendors to strengthen EMR and EDR integration.

13. MISSION
The mission of the National Network for Oral Health Access (NNOHA) is to improve the oral health status of the underserved through advocacy and support for Health Centers

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

15. Strategic Perspective
Work towards starting new dental programs in CHC’s that do not have dental

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

17. Strategic Perspective
Expand existing sites which do have dental to meet the oral health needs of the patients served by that site within the CHC

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

19. Strategic Perspective
Provide a forum for CHC dentists and hygienists.

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

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

22. Oral Health Issues 95% of all Americans are afflicted by oral disease
Oral cancer is more common than leukemia, melanoma of the skin, Hodgkins disease, and cancers of the brain, liver, bone, stomach, thyroid gland, ovaries, or cervix.
Each year over 164 million hours are missed from work and 52 million hours from school due to dental problems.

23. Oral Health Issues
Dental related illness accounts for 6.1 million days of bed disability and 12.7 million days of restricted activity annually
Lost work due to dental problems equates to 164,000 American workers off the job for the entire year
Populations served by health centers are particularly at risk for oral disease and have the highest disease level.
Safety net clinicians practice in a non-traditional model. We frequently use a multidisciplinary approach. Unlike private practice, our focus is the community rather than solely the patients who come for care. Community-oriented prevention must be part of our practice.
Dental disease, in the populations we serve, is significant in all categories (caries, perio, cancer, and trauma). This is due to a number of factors including poor dental education, neglect, lack of access and socio-economic factors.
Our training did not focus on the balance between what is ideal for each tooth versus what is ideal for each patient’s condition and resources. For example, a crown may be the ideal restoration for a broken tooth, but in light of stretched fiscal and personnel resources, a cusp-protected amalgam may be functional and very appropriate. We must look beyond the individual tooth to the individual.
Health centers care for unique populations, as well as individual patients. We must be as concerned about community water fluoride levels as we are about individual patient health status. To maximize our effectiveness, we utilize outreach, transportation, translation and social work services whenever appropriate when caring for these patients, as well as getting intimately involved in those BPHC sponsored "Collaboratives" which have an oral health component.
Safety net providers need to interface with the social needs of their patient population. This means frequently addressing compliance issues that are commonly less burdensome in other health delivery systems.

24. Oral Health Issues
82% of those in poverty will require a dental visit in the near future
33% of those in poverty saw a dentist in a given year versus 61% of those not in poverty
Prevalence of dental disease in the uninsured / underinsured population is 3 times the national average
These issues represent challenges to the organizational system that, when successfully addressed, bring order to chaos and make efficient use of limited resources. Often, these challenges are not given sufficient attention.
Many clinicians in safety nets feel that such "system issues" are given too little attention resulting in their day-to-day worklife including a higher degree of disorder than they prefer. This perceived higher level of chaos existing within many safety nets is of interest. Does it derive partially from the nature of the patient populations we serve; many of whom have a high degree of uncertainly and chaos in their daily lives regarding housing, employment, and obtaining the basic necessities of life. This uncertainty can be compounded when coupled with poverty, single parent families, domestic violence, and substance abuse.
Regardless, this realization does not negate our need to address these challenges to the organizational system regularly through quality and utilization management with a realistic goal of maintaining and improving them. Consistency within the health center is one less demand upon our patients.

25. Oral Health Issues
12% of those in poverty had significant dental findings versus 5% of the non poverty population
97% of homeless population need dental care
Migrant populations have 3 times the incidence of dental decay than the average population

26. Percentage of Adults With Untreated Caries by Family Income (GAO 2000)

27. Oral Health Issues Children
Tooth decay is the single most common chronic disease of childhood
Almost half of US children age 5-17 have experienced tooth decay in their permanent teeth.
25% of children and adolescents (typically from families with low incomes and minority populations) experience 80% of all dental decay occurring in permanent teeth
Here is a list of a few of the things we have to deal with on a daily basis.

28. Oral Health Issues Children
1% of child patients suffer from Early Childhood Caries (Baby Bottle Tooth Decay) by age 5 and are from families typically seen by health centers
Children ages 2-5 and between 100% and 200% of poverty quidelines have 4.5 times the rate of dental disease than the national average

29. Oral Health Issues Children
Among migrant children age 10-14, dental is the most common health problem, and age 15-19, it is the second most common health problem
30 million children or roughly 1 in 3 American children were enrolled in Medicaid in 2007.
6.5 million children on Medicaid age 2-18 have untreated decay

30. Percentage of Children With Untreated Caries by Family Income (GAO 2000)

31. Oral Health Access Problem
One in ten children aged 5-11 years has never visited a dentist within the past 12 months.
43% of Americans age 2 and older have not visited a dentist within the past 12 months
50% of homebound elderly have not seen a dentist in ten years

32. Percentage of Population Who Made a Dental Visit in the Preceding Year (GAO 2000)

33. Oral Health Access Problem
Dentist per population ratio is decreasing from 60 dentists per 100,000 population in 1991 to 57 dentists per 100,000 population in 2000 (and projections are to 53 dentists per 100,000 in 2020).
We must set budget priorities and budget development (system, equipment, personnel).
Keep an updated Wish List for those unexpected occasions when unallocated resources are uncovered and must be spent within a day. Have the purchase orders ready for signatures within the hour!

34. Oral Health Access Problem
Only 25% of Medicaid eligible children actually receive oral health services
Only 70% of Community Health Centers have dental programs (756/1080) and health centers are only able to treat 3.07 million patients per year. US population = 307 million.

35. Funding Problems in Dental Care
120 million Americans do not have dental insurance as opposed to 43 million without medical insurance
Upon retiring, 85% of Americans have no dental insurance
There are no dental benefits under Medicare
Develop clinical outcome measurements that allow assessment of progress in meeting health center and community needs assessments. Develop chart and clinical outcome reviews to insure that all charting is done in a systematic, risk avoidance manner yielding and documenting positive outcomes.
Conduct ongoing chart review that is not limited to outcomes documentation; insure that all dentists, hygienists, and expanded function assistants participate.
Take the lead in oversight activities. Share results and information. In collaboration with staff, formulate necessary action plans and agree to implement within a timely manner. Nothing is sacred. When new models are found and proven more efficient, make changes.
Serve as primary reviewer for dental incident reports. Act as advisor to the personnel department. Take a lead role when disciplinary action is necessary.
Participate in patient satisfaction activities and align programs with results.
By doing all this, you are continuously preparing for your JCAHO/Primary Care Effectiveness Review (PCER).

36. Funding Problems in Dental Care
There are limited dental benefits for adults under Medicaid
Uninsured patients must pay out-of-pocket, and for low income patients the expense of dental care is generally prohibitive

37. Three Main Dental Issues
Lack of access to dental care
Inadequate funding for oral health especially in unserved and underserved populations
Declining provider pool
We develop and suggest new strategies to reach our communities’ vision of oral health. Consider financial implications of all new strategies and programs Seek grants and research possibilities to fund new programs. Rigorously evaluate new programs. Collaborate whenever possible. Expand your network.

38. Solutions
CONTINUE TO EXPAND DENTAL PROGRAMS IN COMMUNITY HEALTH CENTERS
Increase the number of Centers with dental programs to increase from 58% in 1998 to 90% in 2010.
Expand existing dental programs in health centers
We frequently work with our Board of Directors and the community to develop a periodic community dental needs assessment that is integrated and coordinated with the overall health center needs assessment .
How many of us monitor and update our dental health professional shortage area designation?

39. Solutions
Increase funding to the National Health Service Corp loan repayment and scholarship programs to enable health centers to compete for a shrinking supply of dentists and hygienists
Increase or initiate state loan repayment programs for dentists and hygienists

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

41. Status of Health Center Dental Programs Nationally
963 dentists in health centers 2000
280 hygienists in health centers 2000
1,300,000 dental patients 2000
3,000,000 dental visits 2000
450 centers out of 731 have dental 2000

42. Status of Health Center Dental Programs Nationally
2,299 dentists in health centers 2008
892 hygienists in health centers 2008
3,070,000 dental patients 2008
7,350,000 dental visits 2008
756 centers out of 1080 have dental 2008 (70%)

43. Status of Health Center Dental Programs Nationally Continued
2,672 Encounters per dentist 2008
1,351 Encounters per hygienist 2008
2,677 Encounters per dental team 2008
Encounters per dental user 2008
$ per dental encounter 2008
$ per dental user 2008
Source

44. NNOHA
Thank you

46. Status of Health Center Dental Programs Nationally
1,230 dentists in health centers 2002
383 hygienists in health centers 2002
1,644,917 dental patients 2002
3,787,923 dental visits 2002
539 centers out of 843 have dental 2002

47. Status of Health Center Dental Programs Nationally
1,416 dentists in health centers 2003
477 hygienists in health centers 2003
1,885,359 dental patients 2003
4,460,429 dental visits 2003
572 centers out of 890 have dental 2003

48. Status of Health Center Dental Programs Nationally
1,586 dentists in health centers 2004
547 hygienists in health centers 2004
2,150,664 dental patients 2004
5,126,657 dental visits 2004
603 centers out of 914 have dental 2004

49. Status of Health Center Dental Programs Nationally
1,739 dentists in health centers 2005
643 hygienists in health centers 2005
2,340,710 dental patients 2005
5,562,632 dental visits 2005
678 centers out of 952 have dental 2005

50. Status of Health Center Dental Programs Nationally
1,911 dentists in health centers 2006
714 hygienists in health centers 2006
2,557,003 dental patients 2006
6,149,694 dental visits 2006
698 centers out of 1002 have dental 2006

51. Status of Health Center Dental Programs Nationally
2,108 dentists in health centers 2007
806 hygienists in health centers 20067
2,808,418 dental patients 2007
6,704,522 dental visits 2007
742 centers out of have dental 2007

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

53. Requests for NNOHA
What are salaries for dentists, hygienists, and dental assistants
What are the productivity expectations for dentists, hygienists
I need a
Policy and Procedure Manual
Continuous Quality Improvement Manual
Protocol Manual

54. Requests for NNOHA
Salaries Dentists – From Ken Bolin, CCHN, Others – Mean $86,400
Salaries Dental Directors – Approximately $10,000 higher than dentist salaries
Salaries Dental Hygienists – Mean $54,000
Salaries Dental Assistants - Mean $22,600

55. Requests for NNOHA Productivity Expectation Dentist
Regional Program Guidance Memorandum encounters per year
Productivity Expectation Hygienist
Regional Program Guidance Memorandum encounters per year

56. Requests for NNOHA MANUALS Request manuals on NNOHA list serve
Oral Health Clinical Resources go to