# **TO: Area Dental Officers, Headquarters Dental Staff** 

# **FROM: Director, Division of Oral Health**

**SUBJECT: Dental Conf. Call Minutes of 3 April 2007**

**DATE: 5 April, 2007**

Aberdeen: Dr. Bernstein

Alaska: No representation on call.

Albuquerque: Dr. Good

Bemidji: Dr. Jackson

Billings: Drs. Troyer, Vesbach

California: Dr. Riggio

Nashville: Dr. Ricks

Navajo: Dr. Cadieux

Oklahoma: Dr. Smith, Dr. Chiarchiaro

Phoenix: Dr. Huber

Portland: Dr. Crow

Tucson: Dr. Temlock

Headquarters: Drs. Halliday, Van Pelt, Blahut, Lozon, Schaeffer

CDE: Dr. Kinney

NOHC: Dr. Holmes

# 

# **[Budget Update (Dr. Halliday)]{.underline}**

FY2007: The DOH still has not received our operating budget for the
fiscal year. Only Direct Ops budgets have been distributed at HQ. .
While it is hoped that DOH will receive an operating budget very soon,
Dr. Halliday will most likely start sending some funding out to the
Areas and National programs. There is also no news to report on the
appeal of DOH planned obligations that the HQ management has designated
as being disapproved.

FY2008: There has been no budget news on the FY2008 budget, since our
last conference call. As you will recall, on February 5^th^, the
President submitted his proposed FY2008 President's Budget to Congress.
While the President's Budget is not the final budget for FY2008, the
proposed budget for DOH would be \$135,755,000. This would be an
additional \$18 million, or approximately 15 percent, increase over the
FY2007 estimated budget of \$117,731,000. The overall proposed budget
for IHS in FY2008 is \$3.3 billion, which is a \$212 million
(approximately 7%) increase over the FY2007 CR/JFR level. The proposed
budget includes new funds to help provide for the estimated additional
patient load over FY2007 levels, cover increased pay costs for the
federal and tribal employees who provide services, and to meet the
rising costs of providing these services. The proposed budget includes
an additional \$41 million toward covering increased federal employee
pay costs and to allow tribally run health programs to provide
comparable pay raises to thief staffs. There is also a total of \$13
million included for the continuation of the construction of the Barrow
Hospital. There is also an additional \$19 million included to staff and
operate one joint venture project at Muskogee, Oklahoma and a Youth
Regional Treatment Center located at Pyramid Lake, Nevada.

The American Dental Association is drafting their annual testimony to
the Senate and it has been reported that the ADA will advocate on the
following items for the IHS DOH:

-   Continued funding for volunteers/externs

-   Continued funding for MDUs

-   Funding for the procurement of equipment and software, related to
    the EDR

-   Expansion of funding for the CPSCs

-   Funding for LTT in clinical and public health training/residencies

FY2009: There is no update on the FY2009 budget narrative.

**[Recruiting Update (Dr. Lozon)]{.underline}**

-   Drs. Jim Schaeffer and Lynn Van Pelt will assume responsibilities
    for the maintenance of the MORE Candidates and MORE TDY Candidates
    system. Dr. Schaeffer will manage candidates with last name starting
    with A-L and Dr. Van Pelt will assist candidates with last name
    starting with M-Z.

-   Accession Bonus policy is being drafted by OCCFM. The details of the
    mechanics of dispersement of the \$60,000 bonus are not complete.
    Our recommendation to OCCFM included dispersment in increments. Drs.
    Halliday and Lozon discussed the progress of this and other Dental
    Compensation policy issues this morning with OCCFM. OCCFM let them
    know that they do not anticipate any reason why the AB policy should
    not go through. After today's conference call, Drs. Halliday and
    Lozon contacted OCCFM to provide them with further justification, as
    recommended by the ADOs, to prioritize the Dental Compensation
    Policies.

-   Extern Program Progress Report

    -   171 applicants

    -   14 withdrew

    -   84 placed

    -   73 not selected yet

    -   34 of the 56 US Schools represented and 1 Canadian Dental School
        represented in the 171 applicant pool.

**[Loan Repayment Program (Dr. Lozon)]{.underline}**

-   Carla Billingsley was unavailable the past week while working on
    Scholarship applications. She states there is still money available
    in the April Round and she will provide Dr. Lozon with the March
    report as well as the anticipated April projection. Dr. Lozon will
    provide a report via e-mail as soon as the data is received from
    Carla. The April deadline is April 13, 2007.

-   A Question from the field has been asked on 2 occassions/2 separate
    cases in the last 10 days. "Can an individual that has not served
    their complete IHSLRP obligation that wants to go to LTT on their
    own return after training and serve the remaining time. In the past
    the IHSLRP has considered this and has granted when the majority of
    the time has already been served. On some occasions they have been
    burned which led to placing the IHSLRP Recipient in default. IHSLRP
    has sought a legal opinion on whether the practice of delaying
    payback due to LTT on their own is allowed\-\--or if they are
    required to place candidate in default immediately upon candidate
    going to LTT on their own? For this reason, they will not commit to
    approving LTT (on their own) deferrals, with a promise to return to
    serve obligated IHSLRP service, until they receive legal direction.

# **[National Oral Health Council (Dr. Holmes)]{.underline}**

The NOHC met in San Diego during the last week of February. The Council
sponsored two excellent speakers that were well attended in the breakout
sessions:

Dr. Dee Robertson talked about the ongoing caries research projects
being conducted at various IHS sites.

Dr. Mike Winkler spoke on Bisphosphonates and Osteonecrosis of the jaw.

Our main emphasis this year will be the development of the DOH website
([www.doh.ihs.gov](http://www.doh.ihs.gov/)) along with Mary Beth Kenny.
To assist in that task, the Council has divided up into various work
groups. I have listed these below. We believe that the website has the
potential to be a great resource for the dissemination of information to
those in the field. Since most of the information that was covered by
the old IHS Dental Newsletter can now be found on the website, it will
probably be discontinued---this topic is still under discussion. If you
have any suggestions, please forward them through your NOHC Area
representative.

> **Web Site Development**
>
> ([www.doh.ihs.gov](http://www.doh.ihs.gov/))
>
> Heshmat Mortazavi
>
> Kim Sturm
>
> Phil Driscoll
>
> Joe Hosek
>
> Rich Schoen
>
> Clinical Alerts: i.e.: Bisphosphonates
>
> Clinical Essentials: i.e.: Extractions in pts. on anticoagulation tx.
>
> Make manuals such as "Clinical Specialties in Dentistry" more user
> friendly

**Recruitment and Retention**

Bill Morningstar

Joyce Biberica

Tony Likes

Rick Troyer

GPR/AGPR conversion

Commissioned Corps fact sheets

Exit survey

Cost analysis retention vs. new hire.

**Oral Health Issues**

Tammie Gibson

Richard Schoen

Heshmat Mortazavi

Kim Sturm

Phil Driscoll

Joe Hosek

**CDE**

Continue development of **links** to other sites...working with Mary
Beth Kenny

**Awards**

Tammie Gibson

Jan Colton

(Lynn Van Pelt to serve in an advisory position)

To devise methods to increase nominations, streamline scoring
procedurures.

**Dental Disparities**

Jan Colton

Stuart Holmes

Rick Troyer

Richard Schoen

Develop Data base to increase awareness of the incidence/consequences of
dental disease, correlation between oral health and chronic disease,
coordination of dental concerns

**HP/DP**

Travis Fisher

Rick Troyer

Richard Schoen

Jan Colton

Joyce Biberica

Review possibility of funding small research projects as well as those
which supplement supply budgets, investigate the possibility of having
presentations/table clinics result from funded projects, publish grant
awards on website.

**Research**

Joyce Biberica

Stuart Holmes

# **[CDE (Dr. Kinney)]{.underline}** 

**Update 2007**

Organizing Update 2007 is moving along. The meeting has a good mix of
speakers including IHS specialists, University of Colorado Dental
School, NIH, Navy, Army specialists, as well as nationally known
specialists like David Resnick and Dr. Young.

**Oral Health Program Guide (OHPG)**

The draft of the OHPG is available to ADOs through a link on the dental
portal. The first two chapters are tagged so a person can search OHPG by
words or string or words. The search can be displayed in PDF, Word, and
web formats. The OHPG can also be printed in PDF.

**Expanded Functions**

Work on the train the trainer EF course with Michael Kincaid, Terry
Haney, and Steve Florer is continuing. Should have a draft for ADO
comment at the ADO meeting.

# 

# **[GPRA (Dr. Blahut)]{.underline}** 

A lengthy and spirited discussion of potential GPRA revisions took place
on the March conference call. No consensus recommendation was reached.

Two basic problems we must address:

1.  Ever-increasing annual goals. This represents an OMB operating
    strategy. It cannot be overcome by revisions to objectives. As long
    as there is potential to exceed annual goals, regardless of how the
    objective is worded, there is potential for increased expectations
    from OMB. Even if annual goals are not exceeded or met, there is
    potential for OMB to postulate an elevated goal for the following
    year if they consider it to be "realistic and ambitious,"
    independent of our collective assessment. Ever-increasing annual
    goals can be postulated whether objectives are in terms of procedure
    counts or ratios. Revision to a ratio will not effectively address
    this problem.

2.  Vacancies and population growth, both of which affect our ability to
    continue to meet annual goals.

    a.  Access to care: cannot be revised significantly, as access is a
        basic measure widely used throughout DPH, including the HP2010
        national assessment project.

    b.  Sealants: can be revised to a ratio. "Of all children ages x
        through y who were seen in our dental program this year, z%
        received one or more sealants."

    c.  Individuals who receive one or more topical F treatments: can be
        revised to a ratio similar to the sealant example, item b.
        However, as discussed on the conference call, revision to this
        objective will be a more difficult "sell" to OMB, as we have
        only one year of evaluative data, plus baseline data, and have
        exceeded the annual objective by a wide margin.

Drs. Blahut and Chiarchiaro attended the national GPRA planning
sessions, 28 -- 29 March 07. Many new potential objectives were
discussed. Two proposed revisions to dental objectives received positive
attention:

-   Changing the sealant count to a ratio of sealants placed over
    patients seen. The issue of what to do with a patient who is seen
    (and therefore counted in the denominator) but without appropriate
    teeth needing sealants was discussed. If we do nothing to code this
    patient, it becomes somewhat analogous to the current situation of
    "sealed communities," in which no backlog of unmet need remains. If
    we choose to code this individual in order to count him in the
    numerator, an additional, non-procedural, non-ADA code, without
    associated relative value units, will be necessary.

-   The periodontal measure first suggested by our periodontists and
    discussed positively at the fall 06 GPRA planning meeting was
    discussed briefly in hallway or "sidebar" conversations.

Mid-term progress report, documenting productivity with respect to
dental objectives for July 06 through December 07, was received the
morning of this conference call. In keeping with the agreed-upon plan
for data sharing, this report and future progress and year-end reports
for all Areas for this current year will be shared collectively with all
ADOs, so that the entire team can address issues of productivity and
documentation together. Prior to our next ADO meeting 05/06 data along
with the latest 06/07 progress reports will be shared collectively in
preparation for our 07 annual meeting in order to present a sequential
pattern over time of productivity and documentation.

# 

# 

# **[HP / DP (Dr. Blahut)]{.underline}**

Because of the continuing resolution and uncertainties surrounding our
current annual operating budget, no hp / dp awards have yet been made
from the group of proposals received 1 November 06.

The ADO group recommended that if distribution cannot be accomplished
prior to 1 June, no distribution during fy07 be made. If no distribution
is made in fy07, the current proposals will be "carried over" into fy08
and awarded utilizing fy08 funding, when available. No new announcement
or round of competition would be held during the fall of 07 in this
scenario.

# **[EDR Update (Dr. Chiarchiaro)]{.underline}** 

The RFI for the Dentrix software expired on March 23.  There were no
responses.  We are currently awaiting approval from GSA for a limited
source procurement of the Dentrix software.  We have also submitted a
statement of work to GSA for the EDR Implementation Support contract.

A request for a sole source procurement and statement of work for the
EDR Interface contract has also been submitted to GSA for review.

# **[ADO Annual Meeting Update (Dr. Blahut)]{.underline}**

**ACTION ITEM:** The quality of our ADO / HQ meeting is dependent on the
quantity and quality of our agenda items. Please submit suggestions for
agenda items to both Drs. Halliday and Blahut. An early formulation of
an agenda will allow us to determine whether continuation of the meeting
into Friday will be necessary (at present it appears we will conclude
our meeting on Thursday at or before 5pm). This determination will need
to be made in advance, so the hotel accommodations can be arranged.

**ACTION ITEM:** Sleeping rooms within one block of HQ are now available
for reservation. Call the Ramada Rockville Inn at 301-881-2300, and ask
for the IHS dental meeting rate of \$162, reservation code #7279. If you
have any difficulty reserving a room at this rate, you should feel free
to ask to speak to Ms. Sandi Urso, Sales Manager.

Rooms are reserved for check-in no earlier than 4pm on Monday, 18 June,
and are available at this rate through Thursday evening, 21 June, for
Friday morning departure. All rooms are smoke-free. Each individual is
responsible for reserving and paying for their own accommodations.

These sleeping rooms will be held until 19 May for our group, and then
released for general sale. The only other hotel within walking distance
of HQ is significantly more expensive, and sold out for the week of 18
June, so you are encouraged to make your reservation at your earliest
convenience.

**[CPO Update / Deployments (Dr. Halliday)]{.underline}**

[Commissioned Corps Transformation]{.underline}

> It is anticipated that there will be a formal announcement regarding
> the transformation of the Commissioned Corps this month, along with
> the implementation of several new Commissioned Corps initiatives
> (e.g., OCCO phone answering service, new CC website, new online
> application process, new recruitment materials).
>
> [Deployments related to the President's Latin America
> Initiative]{.underline}
>
> It is anticipated that two (2) dental officers and four (4) dental
> hygiene officers will be asked to deploy per 3-4 week deployment
> missions, commencing mid-June through mid-October. The deployments
> will be done in conjunction with a mission with the U.S. Navy on the
> USNS Comfort.
>
> Dr. Halliday traveled to Central America last week with Secretary
> Leavitt as to initiate discussions with the governments of Costa Rica,
> Nicaragua, Honduras, El Salvador and Guatemala to establish a health
> educator/provider training program in Panama City, Panama. More
> information will be released as the program develops, but Dr. Halliday
> was told that there will definitely be a dental component as part of
> the modular training programs offered at the training center.

Answers to some questions raised during the 04/03/2007 ADO-HQ conference
call (Compiled by Dr. Schaeffer):

1.  **QUESTION**: Who will take care of the credentialing of healthcare
    providers involved in this mission?

> **ANSWER**: CAPT Rutstein alluded to these questions with the
> following comment excerpted from his email 29 March on the mission,
> see pasted below:

"From: Rutstein, David (HHS/OPHS)

Sent: Thursday, March 29, 2007 8:11 PM

Subject: USNS COMFORT Mission to Latin America and the Caribbean

> The countries involved require visiting health care providers to
> submit credentials for in-country review prior to an intended visit.
> Some of the countries require this to be done 60 days in advance.
> Other countries are less stringent."
>
> Additional information was offered by CDR Dan Beck, Deputy Director of
> OFRD by phone. He said that the credentialing will be coordinated by
> OFRD with documentation provided through the HHS Office of Global
> Health Affairs (OGHA) to the Navy. At this time it appears that the
> only thing required with be documentation of current licensure and
> OFRD's "certification" of clinical currency. He also believes that any
> credentialing accomplished through the Navy for those who served on
> deployments to Lejeune, Pendelton, or Quantico may still be valid. He
> will confirm both of these items and get back to us with more detail.

2.  **QUESTION**: Was the supply request list submitted from IHS

> dentists turned in to the supply chief onboard the USNS Comfort?
>
> **ANSWER**: No. Dr. Rosaly Correa-de-Araujo, MD, MSc, PhD, Director,
> Office of the Americas (for HHS Office of Global Health Affairs), is
> the lead HHS contact person and liaison with the Navy for this
> mission. The requested supplies/materials list was provided to her as
> well as RADM Halliday, and the two dental officers making the
> preliminary site visits to Latin America. Jim Schaeffer sent a follow
> up message to the USNS Comfort supply chief to see if he's received
> any of this information. If not, He will follow up with our HHS/USPHS
> leads to confirm that this information is shared with the Comfort
> supply chief.

**[MCRP Update (Dr. Blahut)]{.underline}**

Peer and expert reviews have recently been received for six IHS dental
cases. In all six, it was determined that the Standard of Care was met.
This trend reflects well upon our providers.

It also underscores the need for, and value of, good documentation. Good
documentation is necessary in order to ascertain the standard of care
has been met. Furthermore, claims in which the standard of care was
likely met, but documentation was poor, are sometimes settled in the
claimants' favor, depending on specific details and allegations.

**[Other Topics]{.underline}**

Dr. Halliday has received preliminary interest from the U.S. Army in the
opening of one, one-year AEGD residency position. This has not been
finalized, but if it occurs would be a one-time offer and the residency
would commence in mid-August 2007. If you are interested in sending one
of your dental officers to this training, please contact Dr. Halliday.

Update on the American Dental Association has proposed hosting an
"American Indian/Alaska Native Oral Health Access Summit". The date(s)
have not been finalized and the ADA may postpone the summit until
sometime in FY2008.

Dr. Halliday has sent, via email, his report from the last Combined
Surgeon General's Policy Advisory Council Meeting and Chief Professional
Officers/PAC Chair Meeting, March 23, 2007. This is what he had intended
on covering under the conference call agenda item listed as "CPO
Update".

**[Area Reports]{.underline}**

Area Dental Officers and Area Dental Directors are reminded that they
are responsible for submitting written reports reflecting their comments
for these minutes. No one is taking notes during these calls. Each
individual participating on the call is asked to contribute a written
report reflecting his or her presentations, if any, on the call.

**Aberdeen**: No report.

**Alaska**: No representation on call.

**Albuquerque:** No report.

**Bemidji:** No report.

**Billings:** No report.

**California:** No report.

**Nashville:** No report.

**Navajo:** No report.

**Oklahoma:** No report.

**Phoenix:** No report.

**Portland**: No report.

**Tucson:** No report.

**[NEXT CALL]{.underline}**

The next scheduled conference call is Tuesday **8 May.**

Future calls: 5 June. 3, 10, or 17 July, at the convenience of the
group.

> File: ADOconfcall / 2007 / confcallmin0407