A recent op-ed (Nov. 25 Tribune) entitled “Expand options for dental care” pointed out some significant facts related to oral health.
In particular, the author’s emphasis on oral health being important for the overall health of the body is a vital message that dentists are constantly trying to convey.
We also appreciate the author’s admission that the reason many Medicaid patients are unable to find dentists willing to treat them is not because of a shortage of dentists, but because in Wisconsin Medicaid reimburses, on average, just 27 cents on the dollar for dental procedures — 48th in the nation.
In the 2015-2017 state budget, Gov. Scott Walker approved a four-county dental Medicaid pilot, raising the Medicaid rates for pediatric and adult emergency dental procedures in Brown, Marathon, Polk and Racine counties.
Initial data from the pilot indicate more patients are being seen in these counties, more care is being delivered and — perhaps most importantly — there is a significant and sustained increase in the number of dentists in these counties who are accepting Medicaid patients.
My Wisconsin Dental Association colleagues and I support the expansion of this pilot to more counties, including La Crosse. We hope Gov.-elect Tony Evers and the Legislature will support an expansion of the dental Medicaid pilot in the upcoming state budget.
While Heather Brekke is correct in her column in identifying many of the issues plaguing access to dental care in Wisconsin, her solution of dental therapists is misguided.
First, she equates dental therapists with physician assistants, a common comparison. However, physician assistants require an education of six years. Minnesota is the only state in the country currently educating dental therapists, and the longest program available is three years.
Second, physician assistants do not work without supervision, as hinted at in the article. Their practice act requires that a physician be physically available within a certain timespan should something go wrong. All proposals for dental therapists in Wisconsin so far do not afford patients this protection.
Third, the idea that therapists are working successfully in four states is misleading at best. Vermont and Maine have dental therapy laws on the books, but have yet to train a single therapist. Colleges in their states have shown little to no interest in such a program.
Alaska’s Dental Health Aide Therapist program was created decades ago to help provide basic dental hygiene services to those in extremely rural areas, and cannot legitimately be compared to a dental therapist as proposed for Wisconsin.
It’s important to note that roughly 70 percent of the dental therapists in Minnesota work in the seven-county Twin Cities metro area, while very few work in underserved rural areas.
Furthermore, despite nearly 10 years of dental therapy in Minnesota, access to dental care for Medicaid patients has continued to decline, so much so that in the spring of 2017 the federal government warned Minnesota that it was at risk of losing federal funds if it did not increase access to dental care for children on Medicaid. The state’s response was, predictably, to propose raising Medicaid rates. Pretending that we can simply throw more providers at the problem without additional funding is folly, and Minnesota’s experiment only provides further proof.
Finally, another common argument in favor of dental therapists — cost savings — fails to hold up, particularly when we use the comparison of doctors and physician assistants.
The Health Care Cost Institute’s 2016 data shows the average office visit to a primary care doctor cost $106 in 2016, compared to $103 for a visit to a physician assistant or nurse practitioner. This comes even after visits to nurses and nurse practitioners rose by 129 percent between 2012 and 2016, and visits to primary care doctors declined, amid a shift toward mid-level providers in primary care.
My fellow dentists and I have been working for years to increase access to dental care by participating in a variety of charitable care programs and continuing to see Medicaid patients despite the very low payments, all the while fighting for proper Medicaid reimbursement for dentists.
The most cost-effective and timely solution is to fix the current underfunded system, so today’s dentists can welcome more Medicaid patients into their practices rather than create another provider category that will take time and money without actually improving access.