Dental Therapy: A Workforce Option to Improve Access to Oral Health Care in Wisconsin Jane Koppelman, Research Director, Pew Dental Campaign Wisconsin Oral Health Conference September 26, 2018
Our Mission: The Pew Dental Campaign strives for cost-effective policies that will mean millions more people get the basic dental care they need to lead healthy lives.
Overview Problem Definition: Access to Care Gap A Solution: Why Dental Therapy? New evidence: access, cost efficiency, health outcomes Update on State/Tribal Activity Variation in DT model across states/legislative proposals 3
The Problem: Access to Care Mission of Mercy clinic in Cape Girardeau, Missouri on May 3, 2013. People camped out in line for two days to receive free dental care. @ 75 million lack dental insurance Public Clinics at Capacity Maldistribution/shortage of dentists Few Medicaid Providers 4
1.5 million Wisconsinites live in dentist shortage areas 5
Wisconsin Medicaid Access to Dental Care 37% of dentists Enrolled in Medicaid in 2014 33% of Medicaid children Received dental care in 2016** * **2016 EPSDT data reported by CMS 6
Dental Therapists: Part of the Access Solution Similar to nurse practitioner or physician assistant role in medicine Provide preventive and routine restorative care (e.g. cavities, extractions) Work under supervision of a dentist 7
Why Employ Dental Therapists? Make it economically viable for practices to treat more Medicaid patients Extend reach of dental practices to underserved areas Improve efficiency and economic bottom line 8
Dental Therapy: A Growing Evidence Base 9
Evidence on safety of dental therapists Review of 1,100 documents show dental therapists deliver safe, effective care 10 10
MN: Increasing Access to Care Higher proportion of DTs in rural areas than other health professions DTs provide services at 370 mobile dental sites throughout the state Reduced travel times and wait times for patients, especially in rural areas On average 84% of patients seen by DTs are on public insurance 11
Making the Business Case in MN Main Street Dental (rural private practice) Additional $24,000 profit/ served 200 more Medicaid patients in DT s 1 st year Increased overall patient visits by 27% Midwest Dental (private practice) Average monthly revenue increased by $10,042 71% of DT s patients were on public insurance HealthPartners (nonprofit provider/insurer system) Productivity (billable procedures) differential between DTs/ dentists = 9% Compensation package for dentists almost triple that for DTs 12
Increasing Access & Revenues in MN People s Center Health Services (FQHC) DT conducted 1,756 patient visits in 1 year Estimated Medicaid revenue generated exceeded her employment cost by $30,000 Apple Tree Dental (non-profit) Uses DT On-Site at Nursing Home 71%- 85% of fees are for procedures that a DT can provide Advanced dental therapist provided 8-10 visits/day savings $52,000 annually in lower labor costs Apple Tree Deploys DT to Rural Hospital-Based Dental Clinic ADT more than 1,525 dental visits annually, working 4 days a week ADT s daily financial productivity 94% of clinic dentists 13
DHATs Increase Access to Care in Alaska 14
Research on Improving health outcomes DHAT Study: Practicing in Yukon Delta, 2006-2015 Children and adults had better oral health in communities with dental therapists compared to communities without. Children under age 3 had fewer extractions Children received more preventive care Adults: fewer extractions & more preventive care visits. 15
Dental Therapy: State and Tribal Activity 16
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Authorization of Nurse Practitioners 18
U.S DT Workforce Minnesota: 86 DTs and ADTs working @ 14 new students each year (and more applicants than slots) Alaska: 30 DHATs on the ground in AK @ 6 new students each year in ANTHC program 19
U.S DT Workforce (cont.) Washington (Tribal population): 2 DHATs in WA 5 students in training in AK Oregon Pilot 2 DHATs working on approved pilot sites in tribal entities 4 students in training in AK Non-tribal entity applying for pilot approval 20
Dental Therapy Model Across States: Variations on a Theme 21
ALASKA Dental Health Aide Therapist MINNESOTA Dental Therapist/ Advanced Dental Therapist MAINE Dental Hygiene Therapist VERMO NT Dental Therapist ARIZONA Dental Therapist Date Passed Started practice: 2005 2009 (started practice: 2011) 2014 2016 2018 Education Associate degree or prior ANTHC program grad (both programs = 27 months) DT: Bachelor s (min) ADT: Masters Min of Bachelors No degree specified No degree specified Preceptorship 400 hrs. or 3 mos. (whichever is longer) DT: None ADT: 2,000 hours 2,000 hours 1,000 hours 1,000 hours Hygiene License Required No Not in law, but only available training programs are for hygienetherapy Supervision General DT: Indirect for restorative ADT: General Yes Yes Yes, but not required to maintain Direct for restorative care General General Permanent teeth extractions Only uncomplicated, if authorized in advance by dentist DT: No ADT: Only periodontally diseased Only periodontally diseased, if authorized in advance by dentist Only periodontally diseased Only periodontally diseased, under direct supervision Restrictions on Patient Alaska Native communities 50% underserved and/or publicly insured 50% underserved and/or publicly None Only practice in 22 FQHCs, CHCs, non-
Thank you! Questions? Contact: jkoppelman@pewtrusts.org 23