Integrating Fluoride Varnish Delivery in Primary Care: Insights from a Workflow and Cost Analysis.

Objective: Fluoride varnish (FV) application for young children is a recommended procedure in primary care settings, but many medical practices struggle to integrate it due to time constraints and other barriers. Our objective was to gather evidence for streamlining the delivery of FV and estimate the costs of implementing a FV program in primary care.

Methods: Six practices in Georgia currently applying FV during well-child visits were recruited in a purposive sample of a representative mix of urbanicity, geographic dispersion, patient demographics and level of implementation. Time study analysis was conducted to collect data on FV application time. FV workflow was documented using key insights from FV delivery field notes. Cost estimates were calculated, using data on average hourly wages for providers and FV reimbursement rates.

Results: FV application and related activities require approximately 2.5 minutes during the well-child visit. Insurance reimbursements exceeded total FV delivery costs, ranging from almost $3,000 to $3,600 annually (2024 USD) for a new to established practice applying FV only once per day and with national Medicaid reimbursement rates. Practice managers and providers currently applying FV find value in the process, are supportive, and have identified strategies to effectively integrate FV in their routine practices.

Conclusions: FV application Medicaid reimbursement rates are favorable to cover FV delivery costs and can yield profit for practices. Existing literature and results from this study suggest barriers to FV application during pediatric well-child visits are surmountable, enabling implementation of guidelines.