Health Resources and Services Administration urged to improve methods for determining shortage areas

Washington — The ADA is asking the Health Resources and Services Administration to update and improve its methodology for determining health professional shortage areas in response to the agency’s request for information regarding scoring criteria.

“The current model of defining where the greatest needs lie in respect to number and distribution of providers is sorely outdated and inflexible. With an updated, technology-driven approach, we can better allocate resources to enact responsive policy that meets the unique needs of each community,” the ADA wrote in a Sept. 16 letter to HRSA.

“The ADA is hoping to clarify the widespread misconception in the oral health care community that health professional shortage areas are used solely to determine an adequate number of health care providers in a specific geographic area. This perception has led policymakers and stakeholders to focus on solutions that are misaligned with the unique needs of a particular area or county just because it’s designated as a dental health professional shortage areas.”

The ADA asked HRSA to:

Reiterate to stakeholders that the scoring criteria is not based solely on the population-to-provider ratio. “According to HRSA’s scoring criteria for dental health professional shortage areas, the population-to-provider ratio represents only one of the four metrics used to evaluate a county’s designation, and that ratio represents less than half of the aggregate score, accounting for only ten points out of 26 total points. In some scenarios, an area may be designated as a dental health professional shortage area without any points from the population-to-provider ratio but having either full points or nearly full points in the other three metrics.”

Fix misleading scoring considerations. For example, the use of community water fluoridation as a scoring consideration for HPSA designation is significantly misleading. "While community water fluoridation has been shown to be effective in prevention of tooth decay, its presence or absence does not reflect on the number or type of dental providers within a community." The ADA also noted that health centers serving medically underserved patients within a health professional shortage area may serve as an outreach site for a dental school or residency program and “that influx of professionals providing care is not typically reflected in the health professional shortage area designation.” Dentists who practice full-time within a community health center as part of the National Health Service Corps loan repayment programs are also usually not “counted” within the provider population. “Despite several dental professionals expanding access to care within a geographic region, the area would still be classified as a HPSA using the population to provider ratio factor, which is a double weighted consideration,” the ADA wrote. Finally, using the Nearest Source of Care “may result in a county with enough providers still being designated as a dental health professional shortage area.”

Utilize ADA Health Policy Institute data. The ADA told HRSA that HPI has created a database that contains geographic information on dentists in every state. The data includes locations of private dental practices, Federally Qualified Health Centers with dental care services, and dental school clinics and the profile of dentists working in these facilities. The data are then merged with detailed population data, which allows for analyzing the geographic proximity of dentists to the population using geo-mapping techniques. HPI also worked with the Centers for Medicare and Medicaid Services to identify dental care locations where dentists participate in Medicaid or the Children's Health Insurance Program. The ADA said that HPI’s analysis provides a more accurate view than the current HRSA methodology. “The main advantage of HPI’s approach to measuring geographic access to dentists is that it takes account of where the population lives, including Medicaid-insured populations, relative to where dentists are located and incorporates travel time data” and HPI’s analysis “could be easily replicated by HRSA.”

“HPI’s analysis has already had important impacts for policymakers at the state level,” ADA concluded. “The HPI team is currently working directly with several state Medicaid agencies to extend the methodology, incorporate additional tailored research, and develop actionable insights in the area of geographic access to dental care providers. The important take-away from these collaborations with policymakers is that the HPI methodology is very actionable in that it is being used to guide decisions on where to invest state resources to improve access to dental care.”

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