THE PUBLIC HEALTH DENTAL HYGIENE PRACTITIONER ROLE IN MANAGED CARE ORGANIZATIONS. A Fact Sheet Prepared by the PA Dental Hygienists Association

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1 THE PUBLIC HEALTH DENTAL HYGIENE PRACTITIONER ROLE IN MANAGED CARE ORGANIZATIONS A Fact Sheet Prepared by the PA Dental Hygienists Association

2 Background Bill establishing PHDHPs passed and signed into law in 2007 to help alleviate access to dental care issues in PA Final regulations published in 2010 There are currently more than 500 Public Health Dental Hygiene Practitioners (PHDHPs) in PA ready to provide preventive, cost-efficient services to low income and underserved populations

3 What can a PHDHP DO? Dental Screenings and Assessments Oral Hygiene Instruction and Education Oral Prophylaxis (Regular Dental Cleaning) Periodontal Services Radiographs (X-rays) Fluoride Applications Dental Sealants Refer to Dentist for Restorative Work Increase Value of Dental Health; Encourage Use of Preventive Services to Lower Expenses --All services are performed without supervision of a dentist--

4 The Issue Tooth decay is the most common chronic disease in children and has become increasingly prevalent in last few years. Early Childhood Cavities (ages 1-5) are rising faster than all other age groups as parent education and preventive dental health services for preschoolers are often not accessible to communities in need. Preventable dental conditions, including abscessed teeth, are a primary reason for 830,590 ER visits in US in 2009; a 16 percent increase since Medicare, Medicaid and private insurance do pay for hospitalizations required for infectious dental abscesses. Poor oral health is an inappropriate use of hospital emergency rooms. PA reduced MA dental coverage for adults in July 2012 to basic dental coverage excluding root canals and periodontal work. It does still cover cleanings and extractions. MA does cover all medically necessary dental services for enrolled children. The need for PHDHP services is strongest among low-income individuals. Without being recognized as providers, PHDHPs have few chances to see those who need it most. 80% of the decay in children exists in 20% of the population (low-income). This highlights the need of a recognized provider to reduce the incidence of dental disease. Educating patients and parents as well as providing preventive services is the best way to reduce expensive Medicaid dental work.

5 PHDHP distribution in PA PHDHPs are marked in green Red and blue pins indicate community health centers

6 PHDHPs are a workforce that can provide services which are necessary, improve quality of life and help to alleviate the need for more costly medical and dental care

7 Current Problems Under-utilized insurance Only 44% of PA children with Medicaid had a dental visit in 2009 Value of dental care is often overlooked; many providers cannot participate with MCOs because of no-shows Midlevel providers are willing to fill this gap but have no means for payment of services; PHDHPs are not recognized providers by Medical Assistance Traditional dental offices are not readily available for patients with transportation and childcare issues Lack of participating providers Many dentists cannot afford to participate because of high overhead costs Many offices rush Medicaid patients because of perceived low reimbursement rates

8 The Objective: Recognize the Public Health Dental Hygiene Practitioner (PHDHP) as a Medicaid Provider PHDHPs can offer low-cost treatment for all preventive services Preventive services will save money over the long term versus costly restorative work and hospital emergency room/operating room visits PHDHPs are trained to educate patients and encourage regular dental visits PHDHPs can triage patients to appropriate providers in the health care system (dentists, specialists, physicians) PHDHPs can partner with Managed Care Organizations to provide more patients with quality health care

9 Agency for Healthcare Research and Quality Study, March 2011 Medicare beneficiaries who used preventive dental care (one visit a year that included dental cleaning) had more dental visits but fewer visits for expensive procedures and lower dental expenses than beneficiaries who only had oral problems treated at the dentist. Users of preventive dental care were more likely to have dental insurance coverage, and they visited the dentist more often during the year (2.83 vs visits) than those who didn't use preventive care. They also visited the dentist less often for more expensive procedures (0.83 vs visits). As a result, they paid less ($560 vs. $822, on average) for their total dental care. Research Activities, March 2011, No March Agency for Healthcare Research and Quality, Rockville, MD

10 Washington Dental Service Foundation White Paper, 2012 Over a recent 18 month period, there were 54,000 dentalrelated visits to Washington ERs, costing more than $36 million, with $7.6 million in King County alone. Research shows dental care for diabetics could create substantial savings for the state. For example: When diabetics receive regular dental care overall medical costs are cut, on average, by $3,200 a year/patient. Hospitalization costs can be cut by 61% in the first year. In one year, more than 76,000 diabetics were hospitalized in Washington, costing $1.5 billion Ending dental coverage for low-income adults costs taxpayers, WDS, December 2012

11 15 States provide direct reimbursement to hygienists

12 Current Practice (within FQHC) Cheryl and Carol, PHDHPs, work for Keystone Dental in Chambersburg. In 2011, they wrote an Infant/Toddler Program to combat early childhood caries and educate parents, and began seeing patients under the age of 3. These patients see only the PHDHP at their first visit. At the visit, the child has a cleaning, oral evaluation, fluoride varnish application, and caregiver education. In 2012 they saw 195 infants and toddlers; in 2013, 201 infants and toddlers were seen for first visits. When the patient returns in 6 months, they meet the dentist at their recall exam...it is much less scary since they know what to expect at their dental visit. This program is successful because they are extending care to even the youngest family members and it is causing a greater awareness in the parents of what is necessary to combat dental diseases at the earliest stages. The four PHDHPs in the clinic have gained respect and built a greater rapport with patients/parents due to the quality-focused time we have been enabled to spend educating and caring for these little patients."

13 Current Practice (Fee-for Service) Lane, a PHDHP in Northeast PA, runs a public health preventive dentistry business that travels to the patients it serves. Since starting in 2011, her specialty has become memory loss and non-ambulatory residents at long term care facilities. She has enjoyed and learned a lot about treating this special population. The families are so appreciative. Without PHDHPs, these residents would never have any dental treatment. Many residents at long-term care facilities have run out of money and are PA recipients. If PHDHPs were recognized Medicaid providers, we could treat this very deserving population and avoid costly and sometimes deadly dental emergencies.

14 Thank you for your time!

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