Critical Importance of HHS to Dental Education and Training IOM Workshop IOM Oral Health Initiative Committee Jack E. Bresch Associate Executive Director and Director of the ADEA Center er for Public Policy and Advocacy Washington, DC June 28, 2010
Summary of Presentation Health Resources and Services Administration (HRSA) Centers for Medicare and Medicaid Services (CMS) National Institutes of Health (NIH) and National Institute of Dental and Craniofacial Research (NIDCR) 2
Academic dental institutions rely on HHS programs to provide support to dental residents, to enable new innovative education and research, and to increase the diversity of the student body. 3
HRSA Title VII Health Professions Programs Health professions education programs, administered by HRSA and authorized under Title VII of the Public Health Service Act, support the training and education of health care providers, including oral health professionals. Programs provide loans, loan guarantees, scholarships to students, and grants/contracts to academic dental institutions and non-profit organizations. They are the only federal programs designed to educate health professionals in interdisciplinary settings to meet needs of at-risk and underserved populations. 4
HRSA Title VII Primary Care Medicine and Dentistry Title VII Primary Care Medicine and Dentistry Prior to 2010 supported only graduate-level training in dentistry for primary care (general) and pediatric dentists; and Grants to plan, develop, and operate residency programs in GD/PD through innovative non-traditional methods of education Federal support for GD/PD training programs helped create: 59 new general dentistry residencies and 560 new positions between 1977 and 1995 (72% of net growth in program) 120 pediatric dentistry positions between 1998 and 2006 5
HRSA Title VII Changes in Health Care Reform (P.L. 111-148) Creates a separate dental section for Training in general, pediatric and public health dentistry (Sec. 748) Makes dental public health and dental hygiene programs eligible to apply for training grants Makes dental schools eligible for grants previously available only to medical schools Pre-doctoral training programs in primary care Faculty development programs in primary care Use of funds for academic administrative units (for oversight, evaluation, and other administrative department/division activities) Creates new faculty loan repayment program for general, pediatric and public health dentists who agree to serve as full-time faculty 6
HRSA Title VII Grants Title VII grants to dental schools to: Plan, develop, participate in training programs in general, pediatric, or public health dentistry for dental students, residents, practicing dentists, dental hygienists Provide financial assistance to those who plan to work in the practice of general, pediatric, public health dentistry or dental hygiene Plan, develop, operate a program for those who plan to teach in general, pediatric, public health dentistry or dental hygiene 7
HRSA Title VII Grants Provide financial assistance (trainees/fellowships) to dentists who plan to teach or are teaching in general, pediatric, or public health dentistry Provide technical assistance to pediatric training programs in developing and implementing instruction regarding the oral health status, dental care needs, and risk-based clinical disease management of pediatric populations, especially underserved children 8
HRSA Title VII Diversity Programs Programs increase minority representation in the health professions. All were reauthorized in the Affordable Care Act (P.L. 111-148) Centers of Excellence (COE) -Provide financial aid to health professions schools with significantly higher enrollment of URM students to encourage pursuit of careers in health professions. Health Careers Opportunity Program (HCOP) -Funds pipeline programs that identify and recruit individuals from disadvantaged backgrounds and support their education and training in the health professions. HCOP and COE have encouraged more than 459,036 URM and disadvantaged students to consider careers in health 83% of these programs say they couldn t survive without HRSA s federal support 9
HRSA Scholarship and Loan Repayment Programs Scholarships for Disadvantaged Students (SDS) - Financial aid to schools that train primary care practitioners, enroll URM students, and yield students who work in MUSAs Faculty Loan Repayment Program (FLRP) Funds to recruit and assist individuals from disadvantaged backgrounds who are willing to serve as faculty for at least two years in a dental or other health professions school or training program Public Health, Preventive, Medicine, and Dental Health Programs - Funds to build states/local programs with support for public health, preventive medicine and public health dentists in underserved areas National Health Service Corps Funds for scholarships to cover tuition, fees, educational costs and living stipends of students; loan repayment provides up to $50,000 to pay off student loans (for students/primary care professionals who commit to 2-4 yrs in HPSA) 10
CMS Dental Graduate Medical Education Medicare 1965 - provided Graduate Medical Education (GME) funding to hospitals for both physicians and dentists, as both included in the definition of physician in the Medicare statute Hospital could receive only Direct GME (D-GME) funding for dental residents training in non-hospital locations (dental schools) D-GME payment -defray direct training costs, i.e., salaries and fringe benefits for residents and faculty, and hospital overhead expenses IME payment - operating costs for patient care, i.e., broader range of services, more intensive treatments, sicker patients, etc 11
CMS Dental Graduate Medical Education Balanced Budget Act of 1997 (BBA) - allowed IME payments for residents in non-hospital locations, i.e., dental schools May 2003 CMS Proposed Rule seriously jeopardized residency training in dental schools by changing eligibility requirements Impact on dental school residency programs: 32 dental schools had GME agreements 6 schools with GME agreements not impacted by CMS rule 26 schools lost GME funding for most or all of their residency programs 12
CMS GME in Health Care Reform P.L. 111-148 Health Care Reform Time spent by medical and dental residents in scholarly (didactic) activities now eligible for GME funding In hospitals - Direct (D-GME) and Indirect (IME) funding In dental schools (non-hospital settings) only D-GME Previously, hospitals and dental schools did not receive IME nor D-GME funding for time residents spent in scholarly activities 13
NIH/NIDCR NIH/NIDCR provides loan repayment, fellowships and scholarships, and institutional grants to support individuals and academic dental institutions to: Encourage innovative research training programs and build capacity of academic dental institutions to address the nation s health needs through dental, oral, and craniofacial research. Promote research careers by supporting promising students and independent scientists seeking to address basic, behavioral, and clinical research questions that can improve oral, dental and craniofacial health. Facilitate translational research projects in which clinical research complements basic science lab research. Support underrepresented racial and ethnic groups, individuals with disabilities or from disadvantaged backgrounds in pursuit of careers in research. 14
NIH/NIDCR Loan Repayment: NIH LRP for Pediatric Researchers Supports health professionals in the conduct of research directly related to diseases, disorders, and conditions in children. NIH Clinical Research LRP for Individuals from Disadvantaged Backgrounds Supports health professionals from disadvantaged backgrounds who pursue clinical research careers. NIH LRP for Health Disparities Supports health professionals in pursuit of research careers focused on minority health/health disparities. Since 2002, 82 individuals have received support. 70 percent of recipients had dental degrees 15
NIH/NIDCR Fellowships & Scholarships: Diversity in health research Supplements research training and career development for individuals from under-represented minority groups, w/disabilities or from disadvantaged backgrounds. Ruth L. Kirshstein awards Stipends and partial tuition to students: 1) in dual degree programs at dental schools; 2) PhD candidates pursuing NIDCR-aligned research; 3) from underrepresented minority groups or w/disabilities. Patient-oriented research -Supports PhD students with clinical training to pursue patient-oriented research careers. 16
NIH/NIDCR Independent scientist awards Provides salary and fringe benefits for new scientists to pursue research careers in professorships at dental schools or in conjunction with dental specialty training. Junior faculty development - Trains academic health professionals in the latest clinical research methodologies. Summer dental programs -Provides dental students with stipends for training and direct exposure to research procedures at the NIH campus or at another NIH location. 17
NIH/NIDCR Institutional Grants: Dental and craniofacial research workforce -Grants to eligible institutions committed to supporting pre-doctoral and postdoctoral trainees in full-time research careers Dual degree programs (DDS-DMD/PhD) -Fund institutional training for dental students to pursue careers in oral health or biomedical research and in clinical training programs Clinical electives - Provide rotations for 3 rd and 4 th year dental students to get first-hand experience in the design, conduct and management of clinical trials at NIH s Clinical Research Center 18
For More Information Contact Jack Bresch 1400 K Street, NW, Suite 1100 Washington, DC 20005 Phone: 202-289 289-7201 Breschj@adea.org