The state’s largest dentistry association is disputing the concept of a dental care provider shortage in Wisconsin, instead pointing to low Medicaid reimbursement rates.
During an Assembly hearing yesterday on a bill that would allow dental therapists to practice in the state, Wisconsin Dental Association Director of Government Affairs Matt Rossetto challenged several claims made by proponents of the legislation.
Rep. Mary Felzkowski, R-Irma, says the state would need 211 more dentists to fill existing gaps in dental care access, and dental therapists could help fix that issue. But Rossetto says “we do not have a shortage of bodies in Wisconsin in terms of actual licensed dentists.”
“The dentist-to-population ratio is fine,” he said. “What we do have is an issue where most providers are clustered in urban and suburban areas where the vast majority of patients either have a dental benefit or have the ability to pay cash.”
A bipartisan group of lawmakers have signed onto the legislation, which is being spearheaded by Felzkowski. The only groups opposed are WDA and Marquette University, which houses the state’s only dentistry school.
Sen. David Craig, R-Big Bend, spoke in support of the bill. He said allowing dental therapists to join dental practice teams “will allow for increased access, lower patient cost, and savings for the state, all without compromising the quality of care.”
Rossetto acknowledged the state’s rural residents don’t have access to enough dentists, but he said the bill wouldn’t require dental therapists to practice in those areas. He said the reason for those gaps in dental care access is the same reason rural areas have fewer physicians, attorneys and other professions — “It is simply more difficult for those professions to make a go of it.”
“This is one of the reasons why we believe that without addressing the underlying issues — addressing the necessary increase in reimbursement rates — you’re simply not going to solve the problem,” he said. “You’re going to continue to nibble around the edges.”
But Craig noted that dental therapists receive the same training as dentists for the procedures they’re allowed to perform, and must meet “rigorous standards” approved by the Commission on Dental Accreditation. That entity also oversees the training of dentists.
He cited a research review by the American Dental Association Council on Scientific Affairs showing dental care teams that employ mid-level providers such as dental therapists can reduce the rate of untreated tooth decay more than teams with only dentists.
Plus, he said dental therapists can be tasked with routine procedures, freeing up dentists to perform more complex, costly procedures. Craig said that would lower costs for providers and help them serve Medicaid patients more effectively.
Dental therapy proponents compared the legislation with similar laws passed in other states, pointing to positive outcomes in Minnesota, which has had dental therapists for nearly 10 years. Felzkowski said Minnesota state officials “found that the quality is the same” for basic procedures performed by dental therapists and other providers.
But Rossetto argued the Wisconsin bill and the Minnesota law differ in significant ways.
“The dental therapy proposal in front of you today… contains a dental therapy program that does not resemble anything that has been passed elsewhere,” he said.
As an example, he noted the bill’s requirement for supervision by a dentist doesn’t meet the standard set by other dental therapy programs. He said the requirement for “general supervision” in the bill refers only to the contract between the dentist and dental therapist, and has nothing to do with the dentist being physically present in the facility.
By contrast, “direct supervision” requires that the supervising dentist is located in or near the practice. This requirement is in place for other positions that are often compared to dental therapists, such as physician assistants.
Rossetto also said the bill lacks “some basic patient protections,” as it allows therapists to begin work on a patient before a dentist has performed an examination. And he said it contains no protections for certain situations beyond the scope of dental therapists’ training.
“Serious discussions about the education and the training of therapists need to happen, not because this is a turf war, but because we’re talking about how to deliver quality, uniform patient care,” he said.
Still, Craig noted the dental therapy legislation is nonpartisan and has been “embraced by liberals and conservatives alike.” He said national polling from 2016 by Americans for Tax Reform found 79 percent of responding voters were in support of the idea. That included 77 percent of Republicans, 79 percent of Independents and 80 percent of Democrats.
Felzkowski connected the importance of dental care to overall health and education for children in the state, noting dental therapists could help to indirectly break the cycle of poverty.
“If I have a young child with a mouthful of cavities that are not being treated, they’re not processing. They’re not developing,” she said. “They’re not learning.”
“The dental access problem in Wisconsin directly affects the health of children, those living in rural areas, the disabled and the elderly,” Craig added. “The indirect effects are felt by employers, school districts, taxpayers and the health care system.”
See an earlier story on the bill: http://www.wisbusiness.com/2019/dental-therapy-bill-touted-as-fix-to-states-dental-shortage/
See the bill text: http://docs.legis.wisconsin.gov/2019/related/proposals/ab81