Delivering Dental Care to Rural DD
Patients in Missouri –
Elks Mobile Dental Program
John Dane, DDS, FAAHD, DBSCD
Dental Director
Truman Medical Center Lakewood
April 2014 SCDA Conference
MISSION
To provide basic
dental care to
developmentally
disabled and
physically
challenged persons
in Missouri without
regard to their
ability to pay.
GOALS
Provide 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
Barriers
Financial
Transportation
Willing/trained
dentist
Equipment
Appointment 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 201213
Staffing
DentistDental Assistant
Staff takes on many
roles.
Patient care
chair side
reception
administration
unit repairs
contact sponsors
fund raising
Clinics in
Operation
Well designed coaches
Instrument processing
Supply storage
Vacuum and
compressors
Wheelchair accessible
2 chairs minimum
X-ray – digital or film based
Patient records – EDR or
paper
Mobile Dental
Units
Various Clinic configurations
over the years
Trailers
Less expensive but
required someone
to move them
More chairs (3)
Self propelled units
Winnebago type
units
International
Harvesters Truck
Commercial vehicles
Self Propelled Units
Self propelled units
Winnebago type
units
International
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
Locations
Must 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 Travel/per diem Supplies –
Repairs Office supplies
Total
$209,658 (72%)
$49,315 (17%)
$20,546 (7%)
$6,599 (2.2%)
$6,038 (2%)
$290,276
State Funding
DHSS/Elks Mobile Unit Contract
Contract totals
$500,000.00
$400,000.00
$300,000.00
$200,000.00
$100,000.00
$0.00
2003
2004 2004
2006
2007 2008
Fiscal Yr. Oct-Sep
Dane, J; Elks Mobile Dental Program 201213
Medicaid cuts for adult dental services
effected the Program
Medicaid reimbursement for care
Dollars
*2005 MDCD Cuts
$100,000.00
$80,000.00
$60,000.00
$40,000.00
$20,000.00
$2004
2005*
2006*
2007*
Fiscal Yr. Oct - Sep
Dane, J; Elks Mobile Dental Program 201213
2008*
Financials
Year
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)
Dane, J; Elks Mobile Dental Program 201213
3507
$425,113
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