1. MIDLEVEL PROVIDERS THE PUBLIC HEALTH & PRIVATE PRACTICE DEBATE
ALLISON M. DIMATTEO, BA, MPS

2. Defining Midlevel Providers
Midlevel providers (MLP) in dentistry have always been in around and are considered to be dental assistant, dental hygienists, dental therapists. Minnesota has a new dental provider-dental therapist. Someone focused more so on prevention and other contributing factors that can lead to dental disease. Policy has been inconsistent at defining their scope of duties and the type of care they deliver.

3. Defining Midlevel Providers
The procedures that MLP provide may be licensed to perform, vary considerably from state to state.
We cannot just create new MLPs without defining what that role entails.
POLICY ISSUE…Which organized group or legislative body can determine how educated and trained “non-dentist” oral care providers deliver the care they are licensed to do?

4. Things to consider… Financing Access Dental Model Lack of consistency
Independent or within the dental team
Access
Are we creating a tier of second class patients who receive different care? Prevalent in underserved communities.
Dental Model
Enhanced care or Better access to care?
Lack of consistency
Scope of services differ within the 50 states. Dental Practice Act (governing legislation).
Training
Only two years of training beyond high school.

5. What is the ADA saying? Pros/Cons
The ADA recognizes the growing need of access to care.
This is essential to improving the industries reach.
The ADA believes that the risk of permitting non-doctors to do surgery outweighs the benefits.
Are MLP practicing within their boundaries? Are they clear?
Concern for new MLP in varying states (Minnesota) vs. expanding existing MLP duties.

6. What are the Dentist Saying? Pros/Cons
Training MLPs for certain procedures would be an advantage if used properly.
Can allow for dentists to spend more time treating and diagnosing.
MLP can improve the industry’s reach.
“Territorial fighting”
Leave the MLP to do the highly skilled surgeries.
Not in favor of independent MLP.
Are MLP puling people
out of the private
practice system?

7. The Validity of Comparing Dental MLP to Other Healthcare Models
The medical model for MLP is similar to the dental model in that they work alongside the physician/dentist. There is supervision involved.
The dental/medical MLP can provide access to care and an efficient level of care to pockets of populations that do not receive care.
The main difference in the dental MLP model revolves around the invasiveness of the procedures performed.

8. Future Consideration for the Ideal World
Surgical: Preventive:
Dentists Dental Hygienists, Assistants

9. Healthcare Reform Movement
Input has been absent from practitioners who actually provide services to those underserved.
Policy is written by those who most likely do not practice within this population.
Money is earmarked for initiatives that call for MLP and to assess the efficacy of this model.
Can dentist embrace the relationship with the MLP?

10. What is the Economic Impact?
Healthcare reform movement will impact the acceptance of MLP because it has the potential to provide an increase in funding.
The expansion of the number of people who will qualify for dental benefits.
There is nothing to assess the economic impact of MLP in the industry.
False assumption that an increase in MLP will reduce the cost of care by doing procedures at a reduced fee.