WELCOME to the first issue of the Premier Access Dental Update, a newsletter designed to provide

informational support to dentists like you who participate in the Premier Access Children’s Health

Insurance Program (CHIP) and Medicaid programs in Utah. We would also like to take this opportunity

to thank you for your participation – these programs are a powerful tool to improve oral health in the

community and your involvement speaks to your dedication and understanding.

We see this periodical as part of an open-ended dialogue between you and Premier Access; we want

to address the topics that are most pertinent to you. We will focus on “best practices” - techniques or

methodologies that, through experience and research, have been proven to reliably lead to a desired

result. We will also provide you with the most recent updates in the programs to ensure you have all of

the information you need to provide care to your patients. And we will discuss issues that may come from

other participating dentists or through standard reporting. Ultimately, we want you to be successful and

will provide the information necessary for you to achieve your goals.

EXPERIENCING APPOINTMENT NO-SHOWS? We’re here to help. We all know how impactful it can be on daily scheduling when a patient (or two) doesn’t

show and doesn’t call to cancel beforehand. It’s a waste of time and money and makes a re-schedule for that

patient problematic. It’s unfortunate but it’s not uncommon. However, there are a few things you can do to

decrease your rate of appointment no-shows.

A recent study indicates that the method you use to remind your patients about their appointment has

significant impact on promoting positive responses.

The study found that:

• Email reminders result in lower appointment failure and cancellation rates.

• Appointment reminders delivered in English and Spanish result in fewer failed appointment rather than

those delivered only in English.

• Reminders delivered by both the dental staff and an automated system result in fewer failed appointments.

• If the notification of attendance policy is delivered in person, patients are more likely to attend the

appointment.

• If a patient is informed that they violated attendance policy, practices generally saw fewer failed

appointments.

Ultimately, a bit of effort on the “front-end” may lessen future inconvenience and lost revenue. Experiment

and see which one works the best for you … or use them all and cover all of your bases.

For more information, https://www.denti-cal.ca.gov/provsrvcs/bulletins/Volume_30_Number_3.pdf

http://www.dental-tribune.com/articles/specialities/practice_management/816_curbing_cancellations_and_no-shows_begins_chairside.html

http://www.dentistryiq.com/articles/wdj/print/volume-4/issue-1/you-and-your-practice/column-cancellations-broken-appointments.html

http://www.dentaleconomics.com/articles/print/volume-95/issue-9/departments/viewpoint/challenges-and-solutions-to-broken-appointments.html

Spring/Summer 2015

FOR PROVIDERS PARTICIPATING IN PREMIER ACCESS DENTAL GOVERNMENT-FUNDED PROGRAMS IN UTAH

CENTER FOR MEDICARE AND MEDICAID SERVICES (CMS): ORAL HEALTH INITIATIVE LEARNING COLLABORATIVE

The Division of Medicaid and Health Financing (DMHF) is the agency responsible for administering the

Medicaid program and the Children’s Health Insurance Program (CHIP) in Utah. DMHF’s mission is to “provide

access to quality, cost effective health care for eligible Utahans.” To that end, a Quality Strategy has been

introduced which will help accomplish this mission through specific goals and objectives. As part of the Quality

Strategy, DMHF is participating in CMS’ Oral Health Learning Collaborative.

The objectives related to dental are as follows:

• Increase by 10 percentage points the proportion of children age 1-20* who receive a preventive dental

service.

• Increase by 10 percentage points the proportion of children age 6-9* who receive a dental sealant on a

permanent molar tooth.

• Increase by 2 percentage points the proportion of children birth-to-4* who receive fluoride varnish

applications as part of a well-child visit at a physician’s office.

Implementation of the DMHF’s Quality Strategy will take place over a five year time period, ending in 2019.

A review will occur annually and updates will be made as needed during that review. Premier Access will be

cooperating with the State and will align its quality management activities with the State’s objectives.

*Among children enrolled in Utah Medicaid or CHIP for 90 continuous days.

For further information:

http://www.medicaid.gov/medicaid-chip-program-information/by-topics/benefits/downloads/invitationtoapply.pdf

http://www.chcs.org/project/medicaid-oral-health-learning-collaborative/

CHANGES TO CHIP & MEDICAID

New Plan Year Starts July 1, 2015

Medicaid

The following plan updates/changes will be effective

July 1, 2015

CDT Code Opened:

• D1206 Topical application of fluoride varnish

CDT Code Closed:

• D1208 Topical application of fluoride – excluding varnish

CDT Code Limits Changed:

• Limits on the following codes increased from

2 per calendar year to 4 per calendar year (limited to

EPSDT-eligible members):

º D0120 Periodic oral evaluation, established patient

º D1206 Topical application of fluoride varnish

º D1120 Prophylaxis, child

Open to Provider Type 95 (Oral Surgeon):

• CDT D7241 removal of impacted tooth – completely

bony, with unusual surgical complications

CHIP

There are no plan changes to this program July 1,

2015

PROVIDER MANUALS

We are currently working on revisions to the

Premier Access Utah Government Programs

Provider Manual for the new plan year. You will

receive notice via mail when the updated manual is

available online at www.premierlife.com

THE IMPORTANCE OF STERILIZER SPORE TESTINGSterilizer monitoring is an essential part of any in-office infection control program. Many factors can cause

sterilization to fail - from procedural errors like overloading which are easily remedied, to mechanical problems

that indicate your sterilizer needs repairs. Because of this, the ADA, CDC and Premier Access encourage dentists to

regularly assess the efficiency of their in-office sterilizers. Premier Access strongly suggests that you test on a

weekly basis.

Biological indicators (BIs) are the most accepted means of monitoring the sterilization process as they directly

determine whether the most resistant microorganisms (e.g., Geobacillus or Bacillus species) are present rather than

merely determine whether the physical and chemical conditions necessary for sterilization are met. Spores used in

BIs are more resistant and present in greater numbers than are the common microbial contaminants found on patient

care equipment so an inactivated BI indicates that other potential pathogens in the load have also been killed.

Getting Started. Correct functioning of sterilization cycles should be verified for each sterilizer by the periodic (at

least weekly) use of BIs. Users should follow the manufacturer’s directions concerning the appropriate placement

of the BI in the sterilizer. A control BI (not processed through the sterilizer) from the same lot as the test indicator

should be incubated with the test BI. The control BI should yield positive results for bacterial growth. In addition to

conducting routine biological monitoring, equipment users should perform biological monitoring:

• Whenever a new type of packaging material or tray is used.

• After training new sterilization personnel.

• After a sterilizer has been repaired.

• After any change in the sterilizer loading procedures.

If the mechanical (e.g., time, temperature, pressure) and chemical (internal or external) indicators suggest that

the sterilizer is functioning properly, a single positive spore test result probably does not indicate sterilizer

malfunction. Items other than implantable items do not necessarily need to be recalled; however, sterilizer

operators should repeat the spore test immediately using the same cycle that produced the positive BI. The

sterilizer should be removed from service and sterilization operating procedures reviewed to determine

whether operator error could be responsible.

If the result of the repeat spore test is negative and operating procedures were correct, then the sterilizer can

be returned to service. If the repeat spore test result is positive, do not use the sterilizer until it has been

inspected or repaired and retested with BI tests in three consecutive empty-chamber sterilization cycles.

When possible, items from suspect loads dating back to the last negative BI should be recalled, rewrapped, and

resterilized. Results of biological monitoring and sterilization monitoring reports should be recorded and the

results should be retained for at least one year.

For further information, please consult the ADA and CDC web pages as noted below:

http://www.cdc.gov/oralhealth/infectioncontrol/faq/sterilization_monitoring.htm

http://www.ada.org/en/member-center/oral-health-topics/monitoring-sterilizers

QUICK FACTS • There will soon be a NEW PROVIDER SURVEY. We encourage you to respond and let us know your thoughts;

your feedback is very important to us.

• We apologize for any delay you may have experienced in claims payment recently; our vendor has assured

us that it is under control and wants us to let you know that they appreciate your patience.

• We were happy to see our participating dentists who attended the Utah Dental Assn Convention; it was a

pleasure to speak with all of you who stopped by our booth.

HOW TO USE MOTIVATIONAL INTERVIEWING (MI) IN YOUR PRACTICEMI is a well-accepted strategy for behavior change and has been shown to positively affect health behavior

change related to oral health. MI is a person-centered, goal-directed method of communication for eliciting

and strengthening intrinsic motivation for positive change. It has been found that the likelihood for positive

change occurred more readily when the clinician connected the change with what was valued by the patient

and that confrontational styles or direct persuasion are likely to increase resistance and should be avoided.

MI acknowledges that the patient is the one person who most fully understands his or her life. The clinician

must abandon the impulse to solve the patient’s problems (often referred to as the “righting reflex”) and allow

the patient to articulate his or her own solutions.

Using the guiding principles of MI, the clinician follows the patient’s cues and moves between listening, asking,

listening and informing. This collaborative exploration is accomplished through four key principles. Use of

these principles enables the patient to express his or her view of benefits and drawbacks associated with a

particular behavior pattern and determine what action, if any, to take. Ultimately the decision resides within

the patient, not the clinician. In this sense, the clinician allows the patient to have complete autonomy in the

decision making process.

Four General Principles of MI

1.Resisting the righting reflex. Avoid a prescriptive provider-centered style of solving patient’s problems for

them. Guide them in eliciting their own solutions.

2.Understanding your patient’s motivation between current behavior and important goals or values.

3.Listening to your patient through acceptance, affirmation, open-ended questions and reflective listening.

4. Empower your patient by support, self-efficacy and optimism.

Evocative questions to elicit change talk

• Why would you want to make this change?

• If you did decide to make this change, how might you go about it in order to succeed?

• What are the three best reasons for you to do it?

• How important would you say it is for you to make this change, on a scale from 0 to 10, where 0 is not at all

important and 10 is extremely important?

[Follow-up question: And why are you at ____ rather than a lower number of 0?]

• Summarize, and then ask one final question: So what do you think you’ll do?

The forgoing is excerpted from the online article: Motivational Interviewing: A Patient-Centered Approach to Elicit Positive Behavior Change by Karen B.

Williams, RDH, MS, PhD; Kimberly Bray, RDH, MS. The entire article can be read at http://www.dentalcare.com/en-US/dental-education/continuing-education/

ce381/ce381.aspx?ModuleName=coursecontent&PartID=3&SectionID=-1

CONTACT INFORMATION:Your Provider Representative is Amanda Morgan. She can be reached through Provider Services at

866.650.3660The Premier Access website is your dedicated source for patient information, forms and news.

WWW.PREMIERLIFE.COM