At a Wisconsin Health News (WHN) event January 9, WHN Editor Tim Stumm noted the growing body of evidence of the importance of oral health on good overall health and asked panelist Laura Rose, WHA vice president, policy development, why dental access has become a bigger priority for WHA going forward and what areas WHA plans to focus on. Rose explained hospitals saw almost 32,000 patients in emergency departments in 2016 for preventable dental conditions. Many of these visits could have been avoided by proper dental care. However, many Wisconsin residents lack access to dental care, particularly among the Medicaid population. Casey Himebauch, Wisconsin’s deputy Medicaid director who was also on the panel, added that only 37 percent of dentists are Medicaid certified, and of those, only 47 percent see 26 or more Medicaid patients per year.
In addition to Rose and Himebauch, panelists included Matt Crespin, associate director of the Children’s Health Alliance of Wisconsin; Monica Hebl, DDS, a member of the Wisconsin Dental Association House of Delegates; and Greg Nycz, executive director of the Family Health Center of Marshfield.
Rose also noted that patients with special needs who require dental treatment to be provided under general anesthesia were cared for at 49 Wisconsin hospitals in 2016, with most of the care being concentrated in about 13 of those hospitals. Nycz noted that parents sometimes travel 500 miles round trip to access dental care for their family members with special needs. Rose said a major factor limiting access is the astronomical cost of hospital-based dental care. The costs are so high because of the time needed to perform treatments on these patients and the number of providers who must be present in the operating room. When Medicaid is the payer, a significant loss of revenue to the hospital is always the result. Additionally, there is a need for more trained dentists to provide this care. Currently, there isn’t a general practice dentistry residency program in Wisconsin. These programs train dentists in hospital-based dentistry. Rose noted WHA’s Special Needs Dental Patients Work Group is looking at ideas for making care more available for this vulnerable population.
All members of the panel mentioned poor Medicaid reimbursement as an issue for dental access. Hebl mentioned Wisconsin’s Medicaid rates for dental care are the lowest in the country for adults and third lowest for children. Rose agreed that low Medicaid reimbursement rates is an issue, but not just for dentists. In 2016, hospitals incurred $1.1 billion in charges for care provided to Medicaid patients that was not reimbursed by the Medicaid program.
The divide between medical and dental care is another problem that impedes dental access. Nycz pointed out the “historic divide” between medicine and dentistry is reflected in the fact that most medical schools spend very little time training medical students on the importance of the oral cavity and how it affects the health of the rest of the body. Crespin noted the Legislature’s passage of AB 146 (which was strongly supported by WHA) is a sign of the trend toward medical-dental integration. This legislation will permit dental hygienists to practice in expanded settings, including hospitals and medical clinics, without dentist supervision. One goal is to integrate dental screening, preventive education and dental referrals into well-baby visits.
Panelists also addressed the emerging issue of using mid-level dental providers, such as dental therapists (DTs) and expanded function dental auxiliaries (EFDAs), as a way to expand access to dental care. Both Crespin and Rose talked about their visits to the University of Minnesota’s dental school to learn about the impact of dental therapists on access to dental care in Minnesota. Rose said while WHA hasn’t yet taken a formal position on the licensure of DTs in Wisconsin, she was impressed with the ability of DTs in Minnesota to work under general supervision of a dentist, which enables them to reach rural and other underserved areas and treat patients without having the dentist present. Crespin stressed that DTs always work as part of the dental team, and Hebl noted that allowing EFDAs to practice in Wisconsin could make dental practices more efficient and might enable dentists to see more patients, including Medicaid patients.
All agreed that much needs to be done to increase dental access in Wisconsin, and if everyone works together for better dental access we could solve the problem.