1. TOWN HALL MEETING Northeastern Ohio Dental Hygienists’ Association January 26, 2011 DENTAL ACCESS TO CARE Cathy Patterson, RDH, MS Ed. Maryanne Zavarella, RDH, RD, LD, MS 1

2. HISTORICAL PERSPECTIVE DENTAL ACCESS TO CARE Recommendations of the Ohio Task Force on Auxiliary Utilization and Access to Care Background Report 2010. 2

3. 1998 - Ohio Department of Health convened a Task Force on Access to Dental Care –Stakeholders –Legislators –Ohio Department of Health –Ohio Department of Jobs and Family Services –Hospitals –County Health Departments –Dental Schools –Labor unions and others 3

4. 2000 - Ohio Department of Health recommended incentives for dentists who agree to relocate in designated underserved areas and treat Medicaid and other low income areas 4

5. 2005 forward - –Grants have been accessed so dental residents can provide dental care in hospital settings. –Programs such as Give Kids a Smile and the two dental schools outreach programs also work toward addressing dental needs. –CD ROMs distributed to assisted living and senior centers to educate care givers on maintaining daily oral hygiene. –Dentist’s annual pro bono services. 5

6. Why the ODA resolution for EFDA’s and CDA’s to do supragingival scaling? 6

7. NEW ORAL HEALTHCARE PROFESSIONALS 101 7

8. Alaskan Dental Health Aide Therapist 2 years post high school training to perform preventive services, restorations, simple extractions. ADA does not support this concept. 8

9. What has ADA done to address the Access to Care issue? 9

10. CDHC – Community Dental Health Coordinator 12 months, (1,900 hours) of online and clinical training and 6 months internship –Screenings –Fluoride treatments –Sealant placement –Temporary fillings –Scaling-gingivitis –Using anterior and posterior sickles *Direct supervision by DDS 10

11. CDHC’s –Trained to help patients navigate the health system and to connect patients with dentists by helping them overcome barriers to care such as lack of transportation and child care. –CDHC’s are recruited from the same communities in which they are trained. 11

12. CDHC pilot programs are at: –Temple University in Pennsylvania – urban –University of Oklahoma – rural –University of California in Los Angeles – Native American October 23, 2010 five CDHC’s completed the Oklahoma program. 12

13. ORAL PREVENTIVE ASSISTANT Three months training and assumes enrollees are dental assistants –Graduating from a program accredited by the Commission of Accreditation of the ADA –Certified Dental Assistant (certified by the Dental Assisting National Board - DANB) –On-the-job trained dental assistant who is DANB certified JADA – Vol 139, Nov. 2008 13

14. OPA services would be: –Collection of diagnostic date –Vital signs –Charting –Radiographs –Oral hygiene instruction –Application of fluoride and sealants –Coronal polishing –Scaling of gingivitis patients *Direct supervision by DDS 14

15. OPA potential places of employment –Private dentist office –Schools –Community health centers –Other venues to raise oral health literacy Must stay within the specific state’s regulations. 15

16. WHAT IS THE ADHA RESPONSE TO THE ACCESS TO CARE PROBLEM? MID-LEVEL PROVIDER –Optimizing the dental hygiene workforce –2004, ADHA’s House of Delegates approved the ADHP (Advanced Dental Hygiene Practitioner) workforce model. ADHA.org 16

17. ADHP –Masters Level Dental Hygiene Professional –Building on existing dental hygiene education –Provide diagnostic, preventive, therapeutic, and minimally invasive restorative services. –Collaborative Partnerships with general dentists, specialists and other healthcare providers to ensure comprehensive care. ADHA.org 17

18. ADHP con’t –March, 2008 – competencies and curriculum adopted for the ADHP. –The Nurse Practitioner and the New Zealand Dental Nurse serve as the foundation for the ADHP model. ADHA.org 18

19. STATE TO STATE MID-LEVEL PROVIDER?? PENNSYLVANIA –July, 2007 – The Public Health Dental Hygiene Practitioner –Unsupervised dental hygiene practice in public health settings – focusing on children and nursing home residents. Access, August 2009 19

20. PENNSYLVANIA Con’t –Provide full scope of dental hygiene therapeutic services in public health settings –RDH’s with 3 years supervised clinical experience –5 CE hours in public health + $20.00 fee www.PDHA online.org 20

21. STATE TO STATE MID-LEVEL PROVIDERS MINNESOTA May, 2009 – Dental Therapist (DT) responsibilities: –Basic preventive services –Extractions of primary teeth –Limited prescriptive authority –Graduate of a Bachelor or Master’s program –DDS to be present on site Access, August 2009 21

22. MINNESOTA Con’t Advanced Dental Therapist (ADT)responsibilities: –Allowed by a DT, Plus –Evaluate, assess, Tx Plan –Nonsurgical extractions of permanent teeth –Master’s level educated provider –DDS not required to be present Access, August 2009 22

23. STATE TO STATE MID-LEVEL PROVIDER?? OHIO May, 2010 –House Bill 190  Oral Health Access Supervision Program –DH can provide dental hygiene services outside the traditional office setting –DDS is not required to examine the patient before hygiene care 23

24. OHIO Con’t –Collaborative agreement with DDS in Tx Planning and approved Dental Hygiene services. Refer to Adjunct Information 24

25. The ADHP… Follows the Rapid Practice Changes in the DH Profession: – Affiliated Practice (AZ) – Registered Dental Hygienist in Alternative Practice (CA) – Extended Care Permit RDH (KS) – Public Health Permit (ME) – Collaborative Practice RDH (MN) – Limited Access Permit with Public Health Supervision (MT) – Public Health Supervision (NH) – Collaborative Practice RDH (NM) – Public Health Endorsement (NV) – Public Health Supervision (IA) – Limited Access Permit (OR) – School Sealant Programs (WA) 25

26. OTHER INITIATIVES KELLOGG Foundation PEW Charitable Trust 26

27. KELLOGG FOUNDATION MISSION The W.K. Kellogg Foundation supports children, families, and communities as they strengthen and create conditions that propel vulnerable children to achieve success as individuals and as contributors to the larger community and foundation. Established in 1930 27

28. PEW Charitable Trust –Pew Center on States division identifies and advances effective solutions to critical issues facing states. A non-profit organization that applies a rigorous analytical approach to improve public policy, inform the public and stimulate civic life. Established between 1948-1979 by sons and daughters of J. Howard Pew 28

29. PEW REPORT FINDS ECONOMIC UPSIDE TO MIDLEVEL PROVIDER December 7, 2010 In solo dental practices devoted to serving the privately insured, adding any allied provider increased productivity and pretax profits. In every scenario tested, solo dental practices increased their earnings by a range of 17% to 45% when hiring a new provider In a state with an average Medicaid reimbursement rate (60% of dentists’ standard fees), solo practice dentists serving only the privately insured could hire a dental therapist, shift their patient mix to 80% privately insured and 20% Medicaid patients, and still see their pretax profits increase between 6% and 7%. In states with Medicaid reimbursement rates that are 30%, dental practices see reduced profits when they serve Medicaid enrollees. Yet even in these instances, Pew’s study found that dentists fared better financially serving low-income patients with an allied provider rather than without one. 29

30. UHCAN Universal Healthcare Action Network The Kellogg Foundation will invest $16 million by 2014 in its Dental Therapist projet focusing efforts in Kansas, New Mexico, Ohio, Vermont and Washington. 30

31. UHCAN DENTAL THERAPISTS Duties – It’s envisioned that a dental therapist (DT) will perform routine drilling and filling, extractions (mainly primary teeth), reparative services and supragingival scaling. Education: 3100 hours of training – 400 hours of preceptorship. 31

32. ADA – ADHA do not support this. UHCAN needs a law change and will begin engaging lawmakers about their plan. 32

33. May 18, 2010 – A new group of dentists from at least 15 U. S. States aim to put a stop to the spread of Alaska – style dental health aide therapists (DHAT’s) and similarly empowered midlevel providers. Initial members: AlabamaKansasS. Carolina DelawareLouisianaTexas FloridaMississippiUtah GeorgiaNew Jersey IllinoisN. Carolina IndianaPennsylvania www.drbicuspid.com 33

34. KEY ORAL HEALTH PROVISIONS CONTAINED in OBAMA’S FINAL HEALTH REFORM BILL 34

35. Mandatory pediatric dental coverage for children under 21. The bill expands Medicaid eligibility to all individuals at 133% of the Federal Poverty Level (FPL). This means that 16 million additional people will be eligible for coverage under Medicaid. SEE ADJUNCT INFORMATION 35

36. 36 WHAT IS THE GREATEST NEED? Reform of the Medicaid Program is essential. In Ohio Medicaid reimbursement is 30% of dentists’ standard fee

37. 37 BACK TO THE BEGINNING – Do any other states have Dental Assistants doing supragingival scaling? Access to Care and the Allied Oral Health Care workforce in Kansas: Perceptions of Kansas Dental Hygienists and Scaling Dental Assistants. Mitchell, Peters, Gadbury-Amyot, Overman and Stover. Jrl. Of Dent. Ed – March 2006

38. 38 HOW CAN HYGIENISTS’ BE INVOLVED? –Belong to your professional organization – numbers have an impact. –Stay informed –Educate your patients, dental team and policy -makers. –Be willing to expand your skills