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July 26, 2012
CHICAGO So-called mid-level dental providers would not be an economically viable way to extend access to oral health care in Kansas and four other states, according to a report released Wednesday by the American Dental Association, a dentist group.
But the models used in the report are not comparable to the mid-level model being proposed in Kansas, said proponents of licensing Registered Dental Practitioners here.
The report examined the economic viability of three mid-level models: dental health aide therapists, dental therapists and advanced dental hygiene practitioners. The models were analyzed using local data and interviews from Kansas and four other states where licensing mid-levels is being considered: Connecticut, Maine, New Hampshire and Washington.
The report projected that under most scenarios, practices that employed mid-levels would operate at a net loss, once their training costs, operation costs, salaries, academic debt and projected revenue were factored in. The report was commissioned by the dental association and prepared by ECG Management Consultants.
Kevin Robertson, chief executive of the Kansas Dental Association, acknowledged that the report did not address the specific mid-level model being proposed in Kansas. But he said the report showed that mid-levels generally are not a sustainable way to address areas with a lack of dental providers — also known as "dental deserts" — in the state.
"If a dentist can't make it somewhere, it's certainly going to be harder for someone who can't do all the procedures," such as a Registered Dental Practitioner, or RDP, Robertson said.
"Dentists can do more procedures — like braces, for example — to provide more revenue to make it easier for them to break even on the overhead of an office, which is going to be about the same for an RDP. Doing fillings and other things (RDPs) can do is not going to generate the revenue to make ends meet."
Proponents of RDPs said the report's analysis was too limited. Suzanne Wikle of the Kansas Dental Project said it did not consider a number of options available to communities with no dentist.
For example, she said, private practice dentists could expand their reach to underserved communities by hiring an RDP and partnering with the community to purchase equipment. They also could partner with a medical office or a hospital.
Or mobile equipment could be used, she said.
"Some clinics already have mobile dental clinics that extended permit hygienists use. Adding an RDP to those will only increase their cost-effectiveness," Wikle said.
Kansas mid-level proposal
A mid-level dental provider's training places them between a regular dentist and a dental hygienist — able to fill cavities and perform simple extractions of teeth. Under proposed legislation in Kansas, the practitioners would be able to provide a list of routine dental services under the supervision of a dentist, but the dentist would not necessarily have to be present during the procedures.
Oral Health Kansas, the Kansas Health Foundation and other groups have supported the licensing of mid-level dental practitioners in Kansas. The Kansas Health Foundation is a major funder of the Kansas Health Institute.
Proponents of licensing RDPs say doing so would increase access to oral health care. At least 57,000 Kansans live in dental deserts, where there are no dental services and where the closest dental office is at least a half-hour drive from the resident's home, according to a 2011 report. The report projected that number to increase as more dentists retire.
But opposition from dentists in Kansas — much like in other states — has stalled the measure. Robertson of the Kansas Dental Association has said 99.9 percent of the state's dentists do not support licensing mid-level dental providers because doing so would endanger patients.
Robertson said the proposal in Kansas goes too far by allowing mid-level providers to perform procedures that are, by definition, considered surgery — that is, anything that includes the cutting of the hard surfaces of teeth.
He said Kansas should address dental deserts by training and retaining more dentists. He said a proposal to build the state's first dental school is the best long-term solution for Kansas. The proposal is currently before the Kansas Board of Regents.
At least one dentist in Kansas thinks licensing RDPs should also be part of the solution to the state's dental deserts.
Dr. Dan Minnis in Pittsburg said employing RDPs would be a cost-effective way to extend his private practice.
"I have run the numbers for my practice and the clinic, and it's a win-win for everyone. I will be able to serve more patients, decrease waiting times between appointments, provide solid employment to an RDP and use resources at the dental clinic in a much more effective manner, just like the medical clinic does with nurse practitioners and physician assistants."
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