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Access strategies discussed at Capitol Hill forum

ADA urges public-private collaboration

August 17, 2012

By Craig Palmer, ADA News staff

Washington—A Capitol Hill forum Aug. 17 advanced varied strategies for “Oral Health: Putting Teeth into the Health Care System.”

“Addressing the complex problem of oral health access requires a comprehensive approach and the application of multiple solutions,” Dr. Monica Hebl told the forum audience convened by the Alliance for Health Reform with support from the Robert Wood Johnson Foundation.

“The ADA believes that collaboration among the private and public sectors is the correct approach to address the needs of the underserved,” said Dr. Hebl, chair nominee of the Association’s Council on Access, Prevention and Interprofessional Relations and one of four invited panelists. Also addressing the forum were Dr. Lynn Mouden, chief dental officer for the Centers for Medicare & Medicaid Services; Julie Stitzel, a manager for the Pew Children’s Dental Campaign, and Christy Jo Fogarty, a licensed dental therapist in Minnesota.

The Association’s presentation addressed access determinants, solutions and program areas, fluoridation (see 10 reasons to fluoridate story), dental Medicaid, Give Kids A Smile, Chapter Advocacy Training on Oral Health (an ADA Foundation and American Academy of Pediatrics collaboration), emergency room utilization and dental safety net capacity, oral health literacy and the ADA Community Dental Health Coordinator (CDHC).

The forum examined strategies to address “impaired access to dental care” and “gaps and disparities in access and care,” including “alternative models [that] aim to improve access.” Forum registrants included congressional and government agency staff, dental, medical and other health professional and media representatives.

“What we have demonstrated today is that this is a multi-faceted area of inquiry,” co-moderator Ed Howard said in concluding the forum.

Materials packaged for forum participants and posted at the Alliance website include the ADA PowerPoint presentation and related documents. Other issue papers offered to forum participants include:

• the 2011 Centers for Medicare & Medicaid Services oral health strategy, which says that states may want to “consider reimbursing new mid-level dental providers and other non-dentists (e.g. hygienists, medical providers) who provide specific, limited oral health services. National dental organizations have recommended inclusion of several new types of mid-level dental providers. Some states have begun training and licensing these new mid-level providers. In addition, many states already reimburse non-dentists, such as pediatricians, for services like fluoride varnish. A few states currently reimburse dental hygienists for direct care. These new providers may help improve access to dental services by increasing the points of entry into a dental office.”

• a color-coded map offered by the Pew Center on the States, which highlights a swath of green “states that are exploring new ways to expand the dental workforce” sweeping from Northwest south and across the nation’s midsection through the Northeast.

• dental therapist Christy Jo Fogarty’s “demographics of those I have served” since Dec. 2011, which says that 11 percent of nearly 900 patients needed emergency care, 72 percent traveled more than 10 and up to 500 miles to receive care, 2 percent required hospital based care, 80 percent had public insurance and 13 percent were uninsured and 30 percent were African American, 9 percent East African, 37 percent Hispanic, 18 percent Asian and 6 percent Caucasian.

The ADA and American Academy of Pediatric Dentistry joined in a response to the CMS oral health strategy that said in part, “We disagree with CMS lumping mid-level providers and non-dentist preventive services together as a strategy, as we believe those are two distinct options. As noted, many states currently allow pediatricians to bill Medicaid directly for preventive services such as fluoride varnish. This required no change in state medical practice acts. However, many of the proposed services for mid-level/non-dentist/non-physician providers would require a significant modification in the state dental practice act.” The ADA-AAPD Feb. 9, 2011 letter to CMS was not among the materials offered by the Alliance for Health Reform.

“Further, given historically low Medicaid reimbursement levels in many states, it is unclear how new providers with presumably the same equipment costs would be able to participate in Medicaid or CHIP [children’s health insurance] programs in higher numbers than dentists,” the letter said. “We are also concerned that these new providers may simply focus on preventive services and hinder the establishment of a true dental home. The assertion that 'these new providers may help improve access to dental services by increasing the points of entry into a dental office’ is simply an assertion without any empirical verifying data.”

The forum was broadcast live on C-SPAN channel one and by Twitter feeds @ hashtag #OralHealth. The Alliance will post a transcript within a week of the proceedings.