Building a Stronger (Dental) Health Care Workforce Lynn Bethel, RDH, MPH Director, Office of Oral Health Massachusetts Department of Public 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 ( May 2011www.cdc.gov

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, self- esteem, employability

44 million Americans do not have health insurance $2.3 trillion spent on health care (2008) 100 million (33%) Americans do not have dental insurance 4% of $2.3 trillion is spent on dental care

Affordable Care Act PL 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

= between 10% - 20% Practitioners Needed to Remove Designation of Health Professional Shortage Area = <10% = >20% 7 (NH) 5 (DC) Ratio of Underserved to Total Population Numbers = Practitioners Needed to Remove Designation Source: Pew Charitable Trusts- Pew’s Children’s Dental Campaign May 2011

Expanded Dental Training and Residency Programs ACA Dental Workforce Initiatives

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.click here Please write your Senator who is a member of the Appropriations committee today and let him/her know that: · 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 hereClick here to write your Senator on this important issue. Thank you for all you do for the profession, and please forward this to other dentists in your state so they too can take action. Ray Gist, DDS President

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.Residences of the homebound, 2.Schools and Head Start programs 3.Licensed nursing homes and long-term care facilities 4.Clinics, health centers, hospitals, and medical facilities 5.Prisons, residential treatment facilities, 6.Federal, state or local public health programs, 7.Mobile dental facilities and portable dental programs; and 8.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.

Office of Oral Health