2025 Catalog: All Courses

A Closer Look at the IHS Dental Government Performance and Results Act [GPRA] Measures

What is GPRA?
•   The Government Performance and Results Act [GPRA] and GPRA Modernization Act [GPRAMA] requires Federal agencies to demonstrate that they are using their funds effectively toward meeting their missions. The law requires agencies to have both a 5-year Strategic Plan in place and to submit Annual Performance Plans describing specifically what the agency intends to accomplish toward those goals with their annual budget request. GPRA also requires agencies to have performance measures with specific annual targets. Every year, the IHS reports results for GPRA/GPRAMA performance measures.
o   https://www.ihs.gov/quality/government-performance-and-results-act-gpra/
o   https://www.ihs.gov/sites/quality/themes/responsive2017/display_objects/documents/FY_2023_GPRA_Summary_Report.pdf
o   https://ncuih.org/2024/06/17/driving-success-best-practices-for-gpra-compliance-and-performance/
What are the three dental GPRA Measures?
•   Access to dental services, dental sealants [2–15 year-olds], and topical fluoride [1-15 year-olds].
•   Access to dental services is a prerequisite for the control of oral disease in susceptible or high-risk populations.
•   Topical fluorides and dental sealants have been extensively researched and documented in the dental literature as safe and effective preventive interventions to reduce tooth decay.
o   https://www.aapd.org/globalassets/assets/1/7/g_fluoridetherapy1.pdf
o   https://www.aapd.org/globalassets/media/policies_guidelines/g_sealants-re.pdf
o   https://www.cdc.gov/oral-health/data-research/facts-stats/fast-facts-dental-sealants.html
How is access to dental care measured?
•   Numerator:   Number of patients with a documented dental visit during the fiscal year [0000, 0190, 0191, exam code 30, ICD-10 codes Z01.20, Z01.21, any PRC visit with a dental code]
•   Denominator:   User population
Has IHS achieved the access to care goal?
•   Yes, most recently, IHS achieved the access to care goal in FY 2023 and FY 2024.

How can our clinic improve access to dental care?
•   Develop checks/audits to make sure that staff are adding 0000 or 0190 to each dental visit where any service is provided.
•   Include dental services [screenings, fluoride varnish, sealants] provided outside of the dental clinic in schools, daycares, Head Start centers, medical clinics, etc.
•   Prioritize access to dental services, at least for screenings, for certain populations with an increased risk of disease, such as pregnant mothers, infants and new mothers, preschool children, patients with autoimmune disorders, patients with diabetes, and elders.
•   Think outside the box in utilizing dental workforce models to improve access, such as dental health aides/therapists, expanded function dental assistants, and collaborative/independent practice hygienists.
How are dental sealants measured?
•   Numerator: Patients aged 2-15 years with at least one or more intact sealants [1351, 1352, 1353, or 0007]
•   Denominator:   User population, age 2 to 15
Has IHS achieved the dental sealants goal?
•   Yes, most recently, IHS achieved the dental sealant goal in FY 2023 and FY 2024.


What is the purpose of code 0007?
•   Anytime a patient presents with at least one intact sealant [as judged by the provider] and with no further sealants indicated/treatment planned, the provider should use code 0007.
•   Can be added at any dental visit, not exclusively at the exam [0007 can be coded multiple times, but will only count once]
•   Coding 0007 [non-billable code] gives a three-year credit towards the GPRA sealant metric. Sites can report this code more often; there isn’t a limitation on how often you can report the code.
What are improvement strategies for dental sealants?
•   When indicated, seal primary molars of 0-5 year-olds.
o   In 2016 the ADA and AAPD made the following statement: “Sealants are effective in preventing and arresting pit-and-fissure occlusal carious lesions of primary and permanent molars in children and adolescents compared with the nonuse of sealants or use of fluoride varnishes.”
?   https://www.aapd.org/globalassets/media/policies_guidelines/g_sealants-re.pdf
o   Utilize dental assistants to apply dental sealants
o   Recall patients [risk-based recall], and if needed, re-seal posterior teeth where the sealant has not been retained.
o   If you have availability and equipment, implement a school-based sealant program.
o   Use glass ionomer sealants when moisture control cannot easily be attained.
How are topical fluoride applications measured?
•   Numerator: Patients aged 1 to 15 years who have received one or more topical fluoride applications during the year [1201, 1203, 1204, 1205] [1206, 1208, 5986, 99188,   V07.31, Z29.3]
•   Denominator:   User population, age 1 to 15

Has IHS achieved the topical fluoride application goal?
•   Yes, most recently, IHS achieved the dental sealant goal in FY 2023 and FY 2024.

What are improvement strategies for topical fluoride applications?
•   Apply fluoride varnish to all children and adolescents at high risk of developing caries [should be most of the children and adolescents you examine]
•   Have dental assistants apply fluoride varnish; doesn’t even require chair time.
•   Teach non-dental professionals – such as nurses, mid-level providers, physicians, and community health representatives – to apply fluoride varnish; training is available at www.ihs.gov/doh/ecc. Be sure to collect the data or make sure it is entered correctly in the EHR.
Resources
•   IHS Government Performance and Results Act [GPRA]
o   https://www.ihs.gov/quality/government-performance-and-results-act-gpra/
o   https://www.ihs.gov/crs/gpragprama-reporting/
o   https://ncuih.org/2024/06/17/driving-success-best-practices-for-gpra-compliance-and-performance/
•   American Academy of Pediatric Dentistry - Evidence-based Clinical Practice Guideline for the Use of Pit-and-Fissure Sealants
o   https://www.aapd.org/globalassets/media/policies_guidelines/g_sealants-re.pdf
•   American Academy of Pediatric Dentistry – Guideline on Fluoride Therapy
o   https://www.aapd.org/globalassets/assets/1/7/g_fluoridetherapy1.pdf
•   CDC Dental Sealant Facts
o   https://www.cdc.gov/oral-health/data-research/facts-stats/fast-facts-dental-sealants.html

1]   Define what GPRA is
2]   Identify how sealants are measured.
3]   Know the what the three GPRA measures are.

The speaker has no conflicts of interest to report.

It is the policy of the Indian Health Service, Division of Oral Health, that faculty/planners disclose any financial or other relationships with commercial companies whose products may be discussed in the educational activity. The Indian Health Service, Division of Oral Health, also requires that faculty disclose any unlabeled or investigative use of pharmaceutical products and medical devices. Images that have been falsified or manipulated to misrepresent treatment outcomes are prohibited.

None of the faculty/planners for this activity has a conflict of interest, and there is no use of unlabeled or investigative pharmaceutical products or medical devices. No images have been falsified or manipulated to misrepresent treatment outcomes.The educational objectives, content, and selection of educational methods and instructors are conducted independent of any commercial entity.

The IHS Division of Oral Health is an accredited sponsor of continuing education under the American Dental Association Continuing Education Recognition Program (CERP). ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry. Concerns or complaints about a CE provider may be directed to the IHS at IHS CDE Coordinator or to the Commission for Continuing Education Provider Recognition at CCEPR.ada.org

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