Muskegon Family Care: New Advances in the Treatment of Adult Patients Monday, August 8, 2005 Dr. Amy Renee Lalick Dental Director Muskegon Family Care Muskegon, MI

Where Is Muskegon? Population 40,510 Area in Square Miles: 18.99 miles Founded in 1861 North of Holland, MI, West of Grand Rapids and Lansing, MI On the Shores of Lake Michigan

*Dental Clinic at our Oak Street campus One of 2 FQHC’s in Muskegon County Serving Muskegon, Newago, and Ottawa Counties We also have patients from Kent county The only Dental clinic accepting limited new adult patients 2 sites- Getty and Oak *Dental Clinic at our Oak Street campus *6 dental chairs *6 Dentists- 2FTE, 4 part-time *5 FTE Hygienists *4 FTE Dental Assistants *3 front desk staff *1 Dental Financial Specialist

State of Michigan Medicaid October 1, 2003, Medicaid coverage for Adult Dental was cut for those 21 and over Full services still available for children Scheduled for October 1, 2005, Adults 19 and over will have their dental benefits cut

What Now? We are left with a large problem Where do adults go for dental care? After extracting teeth, what do we do? What happens if Adult benefits are ever reinstated?

Adult Needs Comprehensive Care including: Preventative Care Restorative Care Prosthodontics Oral Surgery Alternatives to extractions Emergency Care

The MFC Solution Continue to see our existing adult patients as Sliding Fee patients Add only 20 new adult patients per month Separate Sliding fee scales created for dentures, and Endodontic procedures Additional Operatory in new Getty Street Medical Building Continue to see as many children as possible

Adult Restorative and Preventative Programs Since October 1, 2003 we have seen 1098 patients for restorative visits, and 1726 patients for preventative visits This is not the actual number as many patients have had multiple visits

Restorative & Preventative, Cont. Adult patients get one 45min appointment with the Dentist a month Patients are also eligible for 1 visit with the hygienist At last meeting, we had only seen 149 restorative and 114 preventative patients

Big Increases! Additional hours of operation Increased the number of providers More people are trying to become new patients Young adult patients are losing their benefits, by turning 21 Sneaking in a few of our children’s parents The codes for these adult patients have been checked for past errors, and the figures from the last presentation were lower than they should have been Some existing patients have lost their insurance

Dentures Since October 1, 2003, We have fabricated CD’s or RPD’s for 107 Patients As of December 2004 only 72 prosthetics had been fabricated

Dentures, Cont. Patients are on a sliding fee scale for Dentures Patients are given an estimate for their dentures when the need is diagnosed Patients have had charity organizations such as Love Inc., Mental Health foundation, and Michigan Rehab help with the patient’s fees Local churches have also helped out patients with fees Local labs have also donated cases for our patients

SFS: Dentures SFS 0% patients pay out of pocket $500 per CD or RPD Patients at 100%SFS pay the base fee of $800 per CD or RPD Patients also pay the regular SFS co-pay for extractions, restorations, and any periodontal care Patients are required to pay for Dentures before anything is sent to the lab Fee Percentage 800 100 770 90 740 80 710 70 680 60 650 50 620 40 590 30 560 20 530 10 500 0

Endodontics Program modeled after our Denture program Patients are on the SFS, they pay the fee associated with their percentage Payment must be received before treatment is started

Endo, Cont. The SFS is different for Anterior teeth, Premolars, and Molars Patients are given the estimate for their SFS percentage Patients are also asked to sign an Endo Consent form Post-operative instructions, and any complications are on the Endo Consent form

SFS: Endo Anterior Teeth, Premolars Percentage Fee 0 $196 10 $216 20 $236 30 $256 40 $276 50 $296 60 $316 70 $336 80 $356 90 $376 100 $391 Percentage Fee 0 $227 10 $250 20 $273 30 $296 40 $319 50 $342 60 $365 70 $388 80 $411 90 $434 100 $453

SFS: Endo Molar Percentage Fee 0 $309 10 $340 20 $371 30 $402 40 $433 0 $309 10 $340 20 $371 30 $402 40 $433 50 $464 60 $495 70 $526 80 $557 90 $588 100 $618

Outcomes: Endo Since October 1, 2003, 61 Root Canals have been completed 10 One(1) hour blocks are reserved a month for Endo These are distributed between 2 dentists They are used for starting or completing RCT Additional spots are made in the other dentists schedules case by case

New Building Opened on June 27, 2005 1 new operatory for dental Dental treatment started in July 2005 Hygienists rotating through the clinic Plan to have Dentists rotate though starting in 2006

New Building, Cont. Dental room furnished with donated equipment including Patient Chair, Cabinet, Assistant Chair, Provider Chair, and some trays Other equipment purchased for future use outside the clinic… Portable!

New Building Used mainly to capture MFC Medical patients Preference is being placed on our children Will also see Pregnant women Planning on using this chair for future referrals from MFC Medical and for the Diabetes Collaborative

New Building, Cont. MFC was approved for the PA58 on July 18, 2005 This gives our hygienists the ability to work without a Dentist on location They can see new patients without an exam or assignment from a dentist

New Building, Procedure New patients (children) are seen at the new clinic for a Hygiene screening, and a prophy They are referred to the main dental clinic for an exam and x-rays Patients are then seen for all restorative care at the main dental clinic Any existing patients are allowed to schedule their cleaning appointments at the New building, or at the Main clinic

Big Successes Increased our number of Adult patients seen We have shifted to 50% Medicaid and 30-40% SFS Much of the equipment at the new clinic was donated due to people believing in our cause More teeth are being saved More Smiles restored More happy patients-rated 95-99% good or excellent by our patient in the yearly survey