Putting the Mouth Back into the Body: Q&A
After a great discussion by our panelists, webinar guests had many questions. While we did not have time to answer all of them, our panelists were able to answer some additional questions after the webinar had ended. If you haven't yet watched the webinar, check out the recording and the slides.
Q: Does your office bill patients for Fluoride Varnish if their insurance does not cover it?
A: Fluoride Varnish (FV) is required to be covered by commercial carriers as part of the Patient Protection and Affordable Care Act. This is the minimum required by ACA; we find many plans also cover the oral health evaluation and family oral health education. We appeal if the FV fee is denied or made patient responsibility, but we do not bill families for services not covered by their insurance. The American Academy of Pediatrics Section on Oral Health has a great sample letter to send to carriers regarding the ACA requirement that FV be a covered service. They also have a map of what is covered by each state, including the periodicity.
Q: Do you have many non-English speaking families? Do you need interpreters to accomplish the oral health education?
A: We have about 15% Spanish speaking families and perhaps 1% Russian. We use in-person interpreters at our well exams. The education flip book is very visual, with lots of pictures, and the interpreter translates what my staff person is saying during the education piece.
Q: Is there an age limit for this service by PCP?
A: FV is covered through age 18 for our commercial patients.
Q: How many dental providers are in your referral pool?
A: We have about 7 between both sites that will take our Medicaid patients. We only refer our commercial patients to dentists that take our Medicaid patients, and most of our staff voluntarily choose to use our dentists that partner to care for Medicaid families.
Q: Regarding buy-in from medical staff, can you share a bit more on how do you maintain buy-in and motivation over time? Some have found there can be more buy-in in the beginning, but over time providers are questioning the effectiveness of a warm handoff.
A: We do a warm handoff for our behavioral health. Dental services are pre-ordered as part of patient prep for the well exam and the MD performs the oral evaluation as part of the physical assessment. No warm hand off occurs with our dental health program.
To maintain motivation and buy-in over time we continued to monitor and share with the teams the results of rates of compliance by PCP. For the first several months we looked at it weekly, publishing a gently spirited competition via email. This helped as staff worked to incorporate the new process into their work flow. After the program was off to a steady start, we published the rates quarterly.
Referring to when we have to connect a family with a dental home, that is not a warm handoff for our practice. The pediatrician puts a referral in our EMR and gives the family our referral teams’ business cards with instructions to call if they haven’t heard from us in 5 days. Our referral team contacts one of our local dentists, gives them the families demographic information and either makes the appointment for the family, or the dental practice contacts the family directly. Different dental practices prefer their own contact methods. After that contact we call the family and give them their dental appointment information or give them the contact information for the dental practice and ask them to call if they don’t hear in a few days. Once we have a ‘referral’ in our EMR we will keep the referral “open” until the dentist sends us back a report that the family has engaged in care. If we don’t hear within 3 months we follow up with the dentist and/or family to help get care established.
