Building a Stronger
(Dental) Health Care Workforce
Lynn Bethel, RDH, MPH
Director, Office of Oral Health
Massachusetts Department of Public Health
October 4, 2011
Oral Health is an essential part
of everyday life
• Good oral health enhances
the ability to speak, smile,
smell, taste, touch, chew,
swallow, and convey
feelings and emotions
through facial
expressions.
• Oral diseases, which range
from cavities to oral
cancer, cause pain and
disability for millions of
Americans each year.
Neglected Epidemic ?
• 53 million children & adults have untreated
tooth decay in their permanent teeth
• 50% of children, 96% of adults and 93% of
those over 65 years have experienced tooth
decay
• 25% of adults 65+ are fully edentulous
• 35,000 cases of oral cancer are diagnosed
annually
• Most oral diseases are PREVENTABLE!
Source: CDC Oral Health 2010 (www.cdc.gov) May 2011
Dental Disease
• Infectious – transmissible
• Most common chronic disease in childhood
• Connection with other health conditions –
cardiovascular disease, diabetes, preterm
births, bacterial pneumonia
• Affects learning and work time, selfesteem, employability
• 44 million Americans
do not have health
insurance
• 100 million (33%)
Americans do not
have dental
insurance
• $2.3 trillion spent on
health care (2008)
• 4% of $2.3 trillion
is spent on dental
care
Affordable Care Act
PL 111-148
• Includes new and expanded federal
programs to support dental public
health programs and the development of
an adequate dental workforce.
ACA & Access to Dental Care
• 16 million beneficiaries are scheduled to
join Medicaid in 2014; 5.3 million will be
part of the pediatric dental benefit included
in the essential benefits package.
May 12, 2010
Practitioners Needed to Remove Designation
of Health Professional Shortage Area
1
110
12
42
41
118
52
109
19
7
61
4
85
27
392
30
49
11
109
59
105
92
55
512
Ratio of Underserved to Total Population
222
270
179
420 48
244
38
232
25
7
97
31
279
28
132
67
22
27
61
213
193
179 288 224
236
751
5
7 (NH)
5 (DC)
= <10%
= between 10% - 20%
= >20%
Numbers = Practitioners Needed to Remove Designation
Source: Pew Charitable Trusts- Pew’s Children’s Dental Campaign
May 2011
ACA Dental Workforce
Initiatives
Expanded Dental Training and
Residency Programs
Alternative Dental Workforce
• Mid-Level Provider
– Dental Health Aide Therapist – Alaska
(2005)
– Dental Therapist – Minnesota (2009)
– Dental Therapist – Kansas, New Mexico,
Ohio, Vermont and Washington ***
*** $16 million – W K Kellogg Foundation
ACA Dental Workforce
Initiatives
Demonstration/Evaluation of
Alternative Dental Workforce
Not
Not everyone sees this
as a step forward.
Dear Dr. Dentist
Urgent action is needed. Please click here to write your Senator today. This week the Senate appropriations committee will consider
the FY 2012 Labor, Health and Human Services and Education bill. The American Dental Association (ADA) is aware that various
groups have lobbied the committee in support of funding for the “Alternative Dental Health Care Provider Demonstration Projects,”
which were created as part of the new health care reform law and would likely permit non-dentists to perform irreversible/surgical
dental procedures. The ADA strongly opposes federal funding for these demonstration projects.
Please write your Senator who is a member of the Appropriations committee today and let him/her know that:
·
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·
·
·
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The existing dental workforce model is a proven delivery system.
The dentist workforce is growing, as five dental schools have opened since 2000 and over a dozen schools are at varying stages
of development.
Dental practices have become more efficient. Today it takes only 88 practices to serve the same number of dental patients as
100 practices during the 1980s.
There is no evidence to support the economic feasibility of mid-level providers, such as dental therapists who
are trained to perform irreversible, surgical procedures.
A few states – using either state funds or private funds – are already testing new dental delivery models. We should not use
scarce federal dollars to duplicate these efforts.
Federal funding for oral health programs should focus on fully implementing the prevention and public health infrastructure
programs, as education and prevention are the most cost effective ways of minimizing untreated dental disease.
A recent article published in JAMA concluded that increasing Medicaid reimbursements levels to dentists boosted the number
of Medicaid-eligible children treated.
The Institute of Medicine (IOM) released two reports on oral health this summer. Neither endorsed the mid-level provider.
Click here to write your Senator on this important issue.
Thank you for all you do for the profession, and please forward this email to other dentists in your state so they too can take action.
Ray Gist, DDS
President
http://www.adha.org/governmental_affairs/downloads/Direct_Access_Map.pdf
Chapter 530 of the Acts of 2008
“A registered dental hygienist practicing as a public
health dental hygienist may perform in a public health
setting, without the supervision or direction of a
dentist, any procedure or provide any service that is
within the scope of his practice and that has been
authorized and adopted by the board as a delegable
procedure for dental hygienists in private practice
under general supervision.”
“Public health dental hygienists shall be directly
reimbursed for services administered in a public
health setting by MassHealth or commonwealth care
health insurance…”
Rules and Regulations
• 234 CMR 5.00…a Public Health Dental Hygienist
must:
– Be a registered dental hygienist with a valid
license to practice in the Commonwealth;
– Have three years of full-time or an equivalent
4500 hours of clinical experience;
– Have the appropriate training pursuant; and
– Hold a written collaborative agreement with a
licensed dentist who holds a valid license to
practice in the Commonwealth.
What is a Public Health Setting?
1.
2.
3.
4.
5.
6.
7.
8.
Residences of the homebound,
Schools and Head Start programs
Licensed nursing homes and long-term care
facilities
Clinics, health centers, hospitals, and medical
facilities
Prisons, residential treatment facilities,
Federal, state or local public health programs,
Mobile dental facilities and portable dental
programs; and
Other facilities or programs deemed appropriate by
the Board and the Department.
Geographic Distribution of Sites Served
(FY2011)
MassHealth (Medicaid) FY2011
• Total Paid Claims: 15,255
• Unduplicated Members: 7,935
• Total Reimbursement $568K; $71.68
per member
• 61% of services were provided to school
age children (6-9 yrs)
• >1% of services provided
to anyone 21+ yrs.
www.mass.gov/dph/oralhealth
Office of Oral Health
www.mass.gov/dph/oralhealth
Oral.Health@state.ma.us
www.mass.gov/dph/hcworkforcecenter