Federal Funding for Oral Health: The Financial Model for Federally Qualified Health Centers (FQHCs)

1. “Federal Funding for Oral Health: The Financial Model for Federally Qualified Health Centers (FQHCs).” Successful Models of Partnership Between Schools and Health Centers 54th Annual ADEA Dean’s Conference November 12, 2012 Rick Mumford, DMD, MPH Clinical Associate Professor Director of DISC Program UNC-School of Dentistry Department of Dental Ecology

2. Extramural Clinical Rotation’s Role in Community – Based Clinical Dental Education UNC - SOD and Community Health Centers Our primary partners – NC AHECs & NCCHCA

3. Dentistry In Service to Community – (DISC) ProgramExtramural Clinical Rotation’s Role in Community – Based Clinical Dental Education UNC - SOD and Community Health Centers How we make the program work - How the parts work together to achieve our respective missions

4. UNC – SOD DISC – Community-based Extramural Clinical Programs:An Educational Mission • Dentistry In Service To Communities • DDS Students Summer 3rd Year clinical rotations – required (8 weeks) • DDS Students All other clinical additional rotations • Student Health Action Coalition (SHAC) - Volunteer student clinic entering its fourth decade. • DH Student practicums – required (3 weeks) many NC communities • International Projects – Students learn a global perspective of service • ENNEAD Student Volunteers – NC Public Schools, NCDS-MOM clinics and community health fairs • Student Organizations – such as “Sealant Saturdays” Greene County • Notes:A full-time faculty or adjunct is required onsite as attending and preceptor for clinical activities. These are volunteer, non-paid adjuncts. • UNC-CH partners with NC AHEC to provide AHEC housing during required clinical rotations

5. UNC - SOD Extramural rotations - 4th Year Students Dentistry in Service to Communities – DISC Program • DISC PROGRAM GOALS • The DISC IV extramural program has two primary goals: • To give students an opportunity to observe and participate in a variety of oral health care delivery systems – public dental practices while providing clinical care • To expose students to a diverse patient population, including those with special needs – which students would be unlikely to encounter in the dental school clinic - but which are represented in communities where dentistry is practiced (two 4-week rotations required; one - a public dental practice and one – a hospital rotation) • Note: With course director permission, two general practice rotations are permitted

6. UNC-SOD DISC Students – Clinical Credit Received • Currently four departments allow clinical credit for some procedures completed on extramural rotations: • OMFS allows up to 20 extractions • Prosthodontics allows 2 full sets of dentures • Pediatric Dentistry allows credit for child patients seen in pre-approved sites with boarded pedodontists • Diagnostic Sciences & General Dentistry • Allows credit for biopsy submission

7. Extramural Clinical Rotation’s Role in: Community – Based Clinical Dental Education - UNC - SOD and NC AHEC: A training mission Our primary partners – NC AHECs & NCCHCA http://www.ncahec.net/

9. NC AHEC Regions

10. DISC Sites by AHEC Region

11. Extramural Clinical Rotation’s Role in: Community – Based Clinical Dental Education UNC - SOD and NC CHC: A healthcare access mission Our primary partners – NC AHECs & NCCHCA http://www.ncchca.org/

13. Dentistry In Service to Community – (DISC) Program

14. NC Counties served Summer 2011 Total students 78Alamance Chatham Cumberland Durham Forsyth BurkeGaston Buncombe Greene Catawba Granville Robeson Guilford Wayne Orange Wilkes New Hanover JonesMecklenburg EdgecombeOrange MoorePerson HaywoodPitt LincolnSampson StanleyRowan WakeWayne (Represents 66 active sites) DISC Rotations 2011 – Total (156) 115 Student Rotations in NC - 74% 41 Student Rotations U.S. other or international – 26%

15. 15 8 1 9 11 10 12 14 2 4 13 17 16 5 7 6 3 DISC Rotation Sites in North Carolina by County Alleghany Camden Ashe Gates Northampton Surry Currituck Stokes Person Vance Caswell Warren Rockingham Hertford Granville Pasquotank Halifax Watauga Wilkes Yadkin Forsyth Guilford Bertie Avery Franklin Mitchell Orange Alamance Durham Nash Caldwell Davie Alexander Edgecombe Yancey Madison Martin Tyrrell Washington Wake Davidson Dare Iredell Burke Randolph Chatham Wilson McDowell Catawba Rowan Buncombe Pitt Beaufort Haywood Hyde Lincoln Johnston Greene Swain Lee Cabarrus Wayne Rutherford Harnett Henderson Graham Gaston Stanly Moore Cleveland Montgomery Jackson Polk Lenoir Transylvania Mecklenburg Craven Macon Cherokee Pamlico Jones Clay Cumberland Richmond Hoke Sampson Union Anson Duplin Scotland Carteret Onslow Robeson Bladen Pender New Hanover Columbus 42 Blue Counties indicate presence of DISC Sites 66 Active NC DISC Sites Brunswick 10/19/12

16. Dentistry In Service to Community – (DISC) Program Community Health Centers - 2012 Outside NC: Colorado - Peak Vista CHC Georgia - Good Samaritan - Atlanta Maine - Penobscot CHS (some others less often)

17. Key Program Costs $: • Staffing – 2 FTEs (1-Faculty, 1- Staff) • Student Stipend (Inside NC ↑ 35 miles) • Housing (Inside NC ↑ 35 miles) • Preceptor Annual C.E. Event • Travel (New sites, Troubleshooting) • Misc.

18. Cost Estimates $: • Staffing = ~ $250,000 • Student Stipend = ~ $18,000 • Housing = ~ $6,000 ($5.00/night) • Preceptor Annual C.E. Event = ~ $5,000 • Travel = ~ $3,000 • Misc. = ~ $5,000 Approx. $287,000 to $290,000/yr

19. Funding Sources $: • Staffing – 2 FTEs – AHEC (state funds) • Student Stipend - AHEC (state funds) • Housing - SoD (state funds/Dean’s Acct.) • Preceptor Annual C.E. Event – (Dean’s Acct.) • Travel - AHEC (state funds) or Dent Foundation • Misc. - Dent Foundation + “In-Kind Cost of Preceptors & Clinics”

20. Find Partners with state funding and solid network of advocates & an inter-professional missionMaximize use of “in-kind” resources (Existing clinics and dental staffs)Incentives to partners: Community service reports to AHEC Waive fee to post job openings Reduced rate or free C.E. to preceptors Adjunct faculty appointments (CV help) Electronic use of health sciences libraries Student stores discount Grant letters of supportReciprocate Funding Sources $ Free Advice:

21. UNC – SOD DISC Program Highlight AHEC Annual Report—School of Dentistry 2010-2011 1 October 2011 Using the UNC School of Dentistry's Dental Faculty Practice fee schedule, as it more closely reflects the cost assumed by patients at private practices, the students provided $1,302,938 in dental services to underserved populations in North Carolina.

22. UNC – SOD: Dentistry In Service to Communities Program DISC + CHCs & AHECs = a successful partnership Serving North Carolina “safety net” dental clinics and helping to expand access to oral health care across the the state for over 20 years! Rick Mumford, DMD, MPH Director, DISC Program UNC at Chapel Hill - School of Dentistry Campus Box # 7450 Chapel Hill, NC 27599-7450 rick_mumford@dentistry.unc.edu T - 919.966.2787 F - 919.843.1170

23. Thank you – Questions? Спасибо Sukriya Xièxiè nǐ! Merci