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Americans for Prosperity joins effort to license mid-level dental providers

By Phil Cauthon | January 08, 2014

Jeff Glendening, state director for the Kansas Chapter of Americans for Prosperity.

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The Kansas Chapter of Americans For Prosperity is joining the Kansas Dental Project coalition in a long-simmering dispute with the Kansas Dental Association over whether to allow mid-level dental practitioners to be licensed in Kansas.

"Really, it's about the free market in the realm of professional licensure," said Jeff Glendening, state director for the Kansas Chapter of Americans for Prosperity. "For us, this issue is really about 'Is government the best at telling consumers who should be providing their services?' This allows the market to dictate that. The benefit of that is greater access in underserved areas around the state.

"This is something that we'll be talking about with our members," Glendening said. "I would think — especially for Kansans in rural areas and Kansans in urban areas, maybe not so much in suburban areas — that this would be a big issue. It should be a big issue.

"I've never had to drive an hour and a half to a dentist before. But that's not uncommon, especially out in more rural areas of the state," he said. "I think it's something that will resonate with people once they realize that it is an issue and that there is a solution."


Distribution of primary care dentists by county.

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Mapping the Dental Workforce

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Mid-level dental practitioners

Coalition members are advocating the licensing of so called "mid-level practitioners" to do temporary fillings and tooth extractions in addition to the cleanings, fluoride varnishes and other procedures hygienists do now.

They say allowing dental technicians with proper training to provide more services is a way to expand access to oral health care, particularly in rural areas where dentists are often few and far between.

At least 57,000 Kansans live in so-called 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 2012 report by the Kansas Department of Health and Environment and the University of Kansas Medical Center. KDHE officials project that number will increase as more dentists retire.

This will be the fourth legislative session that advocates plan to lobby for licensing mid-level practitioners as the best available solution. They say their proposal for the 2014 session will closely resemble last year's proposed legislation: House Bill 2157 and Senate Bill 197.

Resistance from dentists

About 15 states with large rural areas have considered licensing mid-levels, but currently only Minnesota and Alaska have done so, in large part due to strong resistance from dentists.

The Kansas Dental Association, which represents most of the state’s dentists, opposes the coalition's plan, arguing it would jeopardize patient care.

Kevin Robertson, executive director of the 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. However, some Kansas dentists have been vocal in supporting mid-levels.

Robertson said the proposal favored by the coalition goes too far because it would allow mid-level providers to perform procedures that are, by definition, considered surgery — that is, anything that includes cutting the hard surfaces of teeth.


Mid-level dental provider bill (HB 2157 and SB 197)

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"A maximum 18-month training is simply not adequate for a dental hygienist to learn restorative dental surgical procedures, science, anatomy and emergency treatments should complications arise during treatment while these (mid-level providers) are treating patients without dentist backup anywhere in the state – perhaps in clinics with limited or no medical support," Robertson said.

He said that extending Medicaid dental coverage to adults is among the things that could yield greater access to dental care.

"Patients who cannot afford dental care from a dentist will not be able to afford treatment from a (mid-level provider) either without adult Medicaid," Robertson said.

Legislative impasse

As recently as this fall, dentists and advocates entered formal mediation to try to find middle ground, but the talks failed.

Rep. David Crum, an Augusta Republican and chair of the House Health and Human Services Committee, said he was disappointed with the failed mediation, but didn't think licensing mid-levels was the only way to address dental deserts.

"I think there's other ways of making dental care more accessible than just that particular option. However, I'm certainly willing to look at any options," Crum said.

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Rep. David Crum, R-Augusta

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But when asked about two options long proposed by the dental association and advocates alike — raising Medicaid reimbursement rates and/or starting a dental school in Kansas — Crum expressed skepticism.

"A dental school would be a pretty tall hurdle," he said.

And he also questioned whether raising Medicaid reimbursement rates for dental procedures would be possible.

"That would have a pretty significant price tag," Crum said. "I do recognize that reimbursement leaves something to be desired, but I don't think it's an unreasonable thing to do, to participate in the Medicaid program, realizing that that portion of their practice isn't going to be real profitable."

Crum is a retired optometrist who used to accept Medicaid patients.

Dentists have said they often lose money treating patients covered by Medicaid in Kansas.


Kansas Dental Project coalition members

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Momentum building

Christie Appelhanz, director for the Kansas Dental Project coalition, said she welcomed AFP-Kansas' involvement in the coalition.

"Momentum for this effort is building here in Kansas and across the country," Appelhanz said. “More than 50 organizations across the state support Registered Dental Practitioners, representing a wide variety of Kansans. We welcome support from any group that recognizes that mid-level dental providers will help us grow the state’s economy and meet the increasing demand for dental care."

AFP is an anti-tax group that champions limited government and often is at odds with the other dental coalition members when it comes to issues such as state spending on social services and tax policy.

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Related coverage: Kansas' Oral Health Care Provider Shortage

Bill considered that would allow dentists to have more practice locations (2/18/14)
Statehouse push made for mid-level dental practitioners (2/12/14)
Americans for Prosperity joins effort to license mid-level dental providers (1/8/14)
Kansas Medicaid program still lags nation in oral health care for kids (11/12/13)
Kansas dental program for children on hold because of KanCare MCO (11/11/13)
Dental mediation effort ends without compromise (11/4/13)
Disputing parties enter formal mediation over mid-level dental providers (10/3/13)
Pew report cites need for mid-level dental providers (6/25/13)
Dentist groups announce scholarships for dentists going to rural areas (2/7/13)
Advocates for mid-level dental providers meet with legislators (2/6/13)
Bill to license mid-level dental providers introduced (1/29/13)
Regents will hear proposal to train mid-level dental practitioners (10/17/12)
Dentist shortage proposal not funded in Regents' recommended budget (9/20/12)
Report questions economic viability of mid-level dental providers (7/26/12)
Task force recommends building state's first dental school (6/21/12)
Dentists shouldn't fear mid-level dental care, expert says (4/20/12)
No consensus on how to end ‘dental deserts’ (4/9/12)
Worldwide review says mid-level dental providers give good care (4/10/12)
Bill to increase dental care access given initial approval in Senate (3/15/12)
New caucus told of oral health success in southeast Kansas (3/8/12)
More Kansans head to ER for dental care (2/29/12)
Dental association says new program will increase access in rural areas (2/2/12)
‘Turf battle’ continues over dental practitioner bill (1/30/12)
Summit to focus on training plan for mid-level dental practitioners (11/29/11)
Between a hygienist and a dentist, a hard sell (10/26/11)
Political fight continues over mid-level dental practitioners (10/11/11)
Better prevention would help solve dentist shortage, advocate says (7/22/11)
Dentists: Practitioner bill flawed (3/9/11)
Videos detail shortage of Kansas dental providers (12/8/10)
Slow going in efforts to solve state’s dentist shortage (8/30/10)
Safety-net clinics filling gap in dental services to low-income Kansans (8/30/10)
Replacing town’s only dentist ‘hardest’ project ever (8/30/10)
Progress made on oral health, but problems remain (1/14/09)
Funding bill contains seed money for 'dental hubs' (5/4/07)
Increasing access aim of oral health coalition (12/21/06)

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