Delivering Dental Care to Rural DD Patients in Missouri –

Elks Mobile Dental Program

John Dane, DDS, FAAHD, DBSCDDental Director

Truman Medical Center Lakewood April 2014 SCDA Conference

MISSIONTo provide basic dental care to developmentally disabled and physically challenged persons in Missouri without regard to their ability to pay.

GOALSProvide dental services to a most under served dental population

Work in cooperation with Missouri Bureau of Special Health Care Needs and Department of Mental Health

Coordinate efforts with the MO. Elks Association (BPOE)

Breaking Down BarriersFinancialTransportationWilling/trained dentistEquipmentAppointment time

History

• Started in 1969 Missouri Department of Health and Missouri Elks Association (BPOE)

• Elks purchased equipment DOH supplied the operational funding.

• DOH operated program until 1977 – Contracted with Washington University SOD then added TMC/UMKC SOD in 1979

• 1981 TMC became sole provider.

Public/Private Partnership

• Missouri Elks Benevolent Trust Major philanthropic effort

• Missouri Departments of Health and Mental Health

• UMKC/TMC educational and hospital support.

ELKS MOBILE DENTAL PROGRAM Patient Eligibility

1. Children and adults who have developmental disabilities or intellectual disabilities (DD/ID) as identified by the Department of Mental Health, Division of Developmental Disabilities.

2. Individuals, must be screened for their eligibility and their ability to receive treatment in a mobile clinic with the aid of local anesthesia when indicated.

The Missouri Elks urge all eligible individuals currently under the care of a private dentist to continue treatment with him/her.

Dane, J; Elks Mobile Dental Program 2012-13

StaffingDentist-

Dental Assistant

Staff takes on many roles.

Patient carechair sidereceptionadministrationunit repairscontact sponsorsfund raising

Clinics in OperationWell designed coaches

Instrument processingSupply storageVacuum and compressors

Wheelchair accessible

2 chairs minimum

X-ray – digital or film based

Patient records – EDR or paper

Mobile Dental UnitsVarious Clinic configurations over the years

TrailersLess expensive but required someone to move themMore chairs (3)

Self propelled unitsWinnebago type unitsInternational Harvesters Truck Commercial vehicles

Self Propelled Units

Self propelled unitsWinnebago type unitsInternational Harvesters Truck Commercial vehicles

Patient Accessibility

Where to go?

• Best locations are where DD patients already have contacts for services!– Regional Centers for DD– State Schools for DD– Sheltered Workshops– Group homes– Elks Lodges

Missouri has several counties with 1 or no dentists.

Missouri Elks Lodges

Lodges are in rural locations

Qualified LocationsMust have Electrical Connections – 220volt 50 amp service

Must have water – usually a garden hose faucet will do

Sanitary Sewers – grey water disposal.

Schedule

• Patients from every county in MO are seen (114)• Stops are from 2-10 weeks in length• 3 unit schedules, 41 locations in the State of

Missouri• Based on demand – 30 visits• Moving units in a “circle”• Certain stays based on weather and time of year.

Contacting Customers

• List from Mo Dept of MH• Data base of patients seen• Post cards, letters – parents/guardians• Agency contacts• Case Worker contacts• Web page• Emails• Newspaper articles/radio spots

Where do the staff stay?

Financials 2013

• Personnel - $209,658 (72%)• Travel/per diem - $49,315 (17%)• Supplies – $20,546 (7%)• Repairs - $6,599 (2.2%)• Office supplies $6,038 (2%)• Total $290,276

Dane, J; Elks Mobile Dental Program 2012-13

State Funding

DHSS/Elks Mobile Unit Contract

$0.00$100,000.00$200,000.00$300,000.00$400,000.00$500,000.00

2003 2004 2004 2006 2007 2008

Fiscal Yr. Oct-Sep

Contract totals

Dane, J; Elks Mobile Dental Program 2012-13

Medicaid cuts for adult dental services effected the Program

Medicaid reimbursement for care

$-$20,000.00$40,000.00$60,000.00$80,000.00

$100,000.00

2004 2005* 2006* 2007* 2008*

Fiscal Yr. Oct - Sep

Dol

lars

*2005 MDCD Cuts

FinancialsYear Patient Visits Value of Care

2002 2925 $325,783

2003 2523 $416,221

2004* 1781 $280,573

2005 2065 $420,228

2006 3438 $707,727

2007 3507 $751,571

2008 (decreased funding)

3507 $425,113Dane, J; Elks Mobile Dental Program 2012-

13

Fund Raising

• Direct Lobbying with State Legislature• Funding from Local Board of Services for MR• Grants from local philanthropy• Hope Waivers

State Dental Board

• Missouri Dental Board has regulated Mobile Dental Units since the 1980’s – requiring that dentists delivering care in nursing homes have a plan for follow up services

• Complaints from local providers about school based programs

• Several hearings with dental board regarding mobile services

Pearls

• Keep mobile units simple• Be sure your plumbing is warm or dry• Dental equipment doesn’t like 20 miles of bad road• Be clear about your mission.• Work within the limitations of your practice• Keep your sponsors and agencies happy • Let people know about the value of the care you

deliver • On board restrooms are not worth the trouble