Ann Marie Marciarille: The Pediatric Dentistry Market Is About to Get a Big Shock
Ann Marie Marciarille:
PrawfsBlawg: Just Open Your Mouth Wide and Say: "Dental Therapist": Pediatric dental services are included in the essential health benefits standard of the Affordable Care Act… individual and small-group plans sold in the exchanges and outside the exchanges [must] offer pediatric dental services, as of January of 2014…. And dental services already are part of the benefit package for children who are enrolled in Medicaid.
Demand for pediatric dental services is about to increase. But no one knows by how much….
Centers for Disease Control estimate over two thirds of Americans age 16 to 19 have decay in their permanent teeth…. How many… will step forward for dental care is unclear…. California estimates a further 900,000 pediatric Medicaid enrollees will soon join Medi-Cal, California's version of Medicaid…. [A]bout half of all currently Medicaid eligible children have not seen a dentist within the past year. Whether bringing their parents into Medicaid eligibility as part of what is sometimes called a "culture of coverage" will increase pediatric dental demand in the population of Medicaid enrollees is also unclear….
One final thing we do know is that some subset of Medicaid enrollees who have tried to access pediatric dental services but failed, did so because of an inability to find a dental provider who would accept Medicaid reimbursement…. HHS estimates that twenty percent of the nation's 179,000 practicing dentists accept Medicaid…. Medicaid dental reimbursements… vary from state to state… can be as low as 25% of market rates…. Some… have begun to talk about using dental therapists… [who] typically have two to three years of training beyond high school. Minnesota is the first state to have established a licensing system for dental therapists… charting, cleaning, even some work on cavities…. Minnesota's Board of Dentistry appears to have made at least a temporary peace with what I call dentistry's scope-of-practice wars….
[W]e do have substantial experience in using dental therapists with under-served rural populations in Alaska. Alaska's Dental Therapist Health Aides ("DHAT") experiment has been moving forward since 2005 under the auspices of the Alaskan Native Tribal Health Consortium. The first DHAT trainee cohort was trained in New Zealand…. The results for consumers are good, even very good…. Quality measures have been quite high.
Now remote Alaskan locations are one thing and rural underserved populations in Wisconsin another, but I am pretty certain the dental therapist scope-of-practice wars have only just begun. Organized dentistry is concerned about quality standards, educational standards, and the liability concerns of dental therapist supervisors. Organized dentistry is also worried about oral health care provider competition.
I will watch….
I tell my students that, in health care, innovation often starts in the arena of government-funded health insurance and spreads to the world of commercial insurance only later. If Medicaid leads the way in championing the use of dental therapists as lower-cost providers to fulfill its promise of pediatric dental services, I assure you commercial insurance providers both inside and outside of the exchanges will take note.
So, whoever you are, just open your mouth wide and say "dental therapist."
