The Washington State Dental Association has put together a short economic analysis of a proposed dental hygiene practitioner found in HB 2226 and SB 6126. This analysis lays out the revenue and expenses a dental hygiene practitioner would have if he or she treated Medicaid patients in a signle chair clinc. WSDA believes that practitioners created in HB 2226 and SB 6126 are not economically viable without extensive government subsidy. This is one of many reasons why we are asking legislators to vote NO on HB 2226 and SB 6126.
Two New Studies Raise Patient Safety and Economic Feasibility Concerns about Midlevel Providers in HB 2226/SB 6126
The Journal of the California Dental Association published two studies this month which raise concerns about patient safety and economic feasibility of dental practitioners envisioned in HB 2226 and SB 6126. Proponents of HB 2226 and SB 6126 have claimed dental practitioners provide results as safely as dentists and will make dental care more affordable.
In the first study, Researchers from NYU and Columbia University conducted a systematic review of existing safety studies on dental auxiliaries from around the world and concluded that there is insufficient evidence to conclude dental auxiliaries can perform irreversible (surgical) procedures safely. The systematic review makes the following conclusion:
"Available evidence is sufficient to a larger extent to conclude that the auxiliary providers are capable of providing safe and high quality reversible procedures....However, the evidence in relation to the irreversible procedures related outcomes is insufficient" (CDA Journal, Vol 40, °1, page 78, bold and underline added by WSDA).
The most recent safety study on Dental Health Aide Therapists (DHATs) in Alaska was completed in 2010 by RTI International and the Kellogg Foundation. The RTI study only evaluated 5 DHATs who performed 37 extractions (seven done on children) and 54 restorations (25 done in children). The systematic review made the following statement on this study:
"The cross-sectional nature, smaller number of DHATs (five), lack of direct comparison of DHAT procedures to that of dentists, and convenience samples and records, prevented this study from drawing robust conclusions regarding the true safety and other aspects of the DHAT program. [RTI International] authors also cautioned that the findings are not generalizable" (CDA Journal, Vol 40, °1, page 71).
In the second study, researchers from ECG Management Consultants assessed the economic viability of three alternative practitioner types for provision of dental care to the underserved. Two of the three models correlate with the dental practitioner and dental hygiene practitioner in HB 2226 and SB 6126. This study estimates that total tuition and cost-of-living associated with training midlevel practitioners will exceed $130,000 and none of the models “are sustainable without tuition subsidies, grants, or other approaches to decreasing the debt burden” (CDA Journal, Vol 40, °1, page 56).
A series of revenue projections for dental practitioners working in public health clinics with different combinations of Medicaid and private insurance patients were also included in the economic analysis. This analysis found the model most similar to dental hygiene practitioners to be “not sustainable in any scenario.” The model most similar to dental practitioners was able to break even (revenues exceeding expenses by $5) with a payer mix consisting of 50 percent reimbursement from private dental plans and the other 50 percent from Medicaid, which is drastically different from payer mixes found in community health centers in Washington State (CDA Journal, Vol 40, °1, page 58).
Both studies in their entirety can be found here: http://www.cda.org/library/cda_member/pubs/journal/journal_0112.pdf
For more information, call or email Bracken Killpack, Director of Government Affairs at firstname.lastname@example.org or 206-973-5227 (direct).
Hearings for House Bill HB 2226 (and its companion, Senate Bill SB 6126 ) on Midlevel providers have been set for Thursday, January 19 at 10:00 a.m. and 1:30 p.m., respectively in Olympia. It is imperative that you voice your concern about this bill at Dental Action Day - See below. The bill is very similar to last year’s with a few differences, including: Disciplinary authority of both midlevels is moved from the Secretary of Health to DQAC; Language from HB 1310 which states “An advanced dental therapist may practice without the supervision or off-site supervision of a dentist” has been removed from HB 2226. However, “Off-site supervision” and all other contractual supervision remains the same as in HB 1310. Additionally, aesthetic changes are as follows: The terms dental therapist and advanced dental therapist have been changed to dental practitioner and dental hygiene practitioner; the term written collaborative agreement has been changed to written practice plan contract; and collaborating dentist has been changed to contracting dentist. Visit here to view the bill in its entirety. Earlier this year Rep. Cody stated that passing dental midlevel legislation is one of her “top three” priorities in the upcoming session. We’d like to welcome all dentists to travel to Olympia for the hearings — together, we can demonstrate what we mean by “One Profession, One Voice.” For more information, call or email Government Affairs Director Bracken Killpack at 206-973-5227 (direct) or email@example.com.
Dental Action Day · Register Today! The 2012 DAD is January 27 in Olympia. Decisions made — like those on HB 2226 and SB6126 — could result in fundamental changes to dental care delivery. Other issues like health care reform, funding for higher education and dental residency programs, and further cuts to dental care for the most in need. Sign up to attend today! For additional information, call Michael Walsh at 800-448-3368 or email at firstname.lastname@example.org.