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‘Turf battle’ continues over dental practitioner bill

Dentists oppose new classification, while supporters cite need for dental care providers

By Dave Ranney, Mike Shields | January 30, 2012

Opposition from Kansas dentists to a bill that would allow a new type of oral health care provider in Kansas remains firm, despite a four-hour roundtable meeting called by a key legislator with hopes of brokering a compromise.

“I don’t like to see turf battles, and that’s what this is,” said Rep. Brenda Landwehr, a Wichita Republican who heads the House Health and Human Services Committee.

Landwehr sat down Friday with nine opponents of the measure and 10 supporters of House Bill 2280, which was introduced in the 2011 Legislature but stalled after the Kansas Dental Association weighed in heavily against it. The organization speaks for most of the state’s dentists.

Backers of the bill include the state’s safety net clinics, major health foundations, several dentists who disagree with the association’s stand and officials at Fort Hays State University, which wants to launch a program to train the registered dental practitioners if lawmakers will authorize them to practice in the state. Supporters of the bill include the Kansas Health Foundation, which is a major funder of the Kansas Health Institute.

The practitioners would be able to provide a prescribed list of routine dental services under the supervision of a dentist, but the dentist would not necessarily be present during the procedures.

Dentists opposed to the bill have said, with considerable vehemence, that they think it would be unsafe to have the practitioners doing things such as pulling teeth without a dentist present. They say routine dentistry can escalate into something more grave in the course of its delivery and that the practitioners would lack the training to deal with the more serious problems.

“These are not simple procedures,” said Paul Kittle, a Leavenworth dentist, during Friday’s meeting.

Kittle also delivered impassioned testimony against the proposal during last year’s legislative session.

But the bill’s supporters say the midlevel practitioners already have been licensed in two other states and no significant problems developed as a result. The practitioners are needed, they say, to help improve access to dental care, particularly in the state’s rural and other underserved areas.

Both sides in the dispute acknowledge that Kansas has a shortage of dentists, and there are relatively few dentists who are willing to see children on Medicaid, the state-federal health plan for the poor.

“We’re not here to talk about the folks who are already getting dental care. We’re here to talk about the hundreds of thousands of people in our state who can’t access that care,” said Brenda Sharpe, chief executive of the REACH Healthcare Foundation.

Sharpe once served on the Kansas Board of Healing Arts, the panel that oversees doctors and other medical providers. She said she remembered a similar political fight when doctors opposed the licensing of advanced nurse practitioners.

KHI News file photo

Kevin Robertson, executive director of the Kansas Dental Association.

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Kevin Robertson, executive director of the dental association, said the best way to increase the number of dentists willing to see Medicaid patients would be to pay them more for the services.

“We’ve gone 10 years without an increase” in reimbursement rates, he said.

Many dentists who take Medicaid patients lose money on them, according to the association, and those patients tend to be difficult to treat because they miss appointments and are lax when it comes to taking care of their teeth.

“It’s a mystery to me why we have people with no money begging for services and then they don’t keep an appointment,” said Dodge City dentist Richard McFadden.

But the arguments from the dental association have not swayed the bill’s proponents, many of whom believe the dentists’ opposition stems from unfounded concerns about competition and potential loss of income.

“This is a serious problem that needs a serious solution,” said Fort Hays State University President Ed Hammond, noting that many small towns now depend on nurse practitioners for their medical care. The same, he said, would be true for midlevel dental practitioners.

Hammond said he recently had to scramble to find a new dentist in Hays after his dentist decided to no longer accept state-employee health insurance.

The difficulties for the uninsured trying to find a dentist are far worse, he said.

Fort Hays State has developed an 18-month training curriculum for midlevel dental practitioners and intends to launch its program if the bill becomes law.

Neither side seemed willing to budge at Friday’s meeting.

“We wish we had a partnership with dental providers — dentists in particular — but we can’t really wait for them to pull that together,” Sharpe said. “I appreciate and respect all of the concerns that they’ve raised here, but hundreds of thousands of Kansans are going without dental care. There are just too many people who cannot afford the care that’s available to them now.

“It’s the right thing to do and it’s the right time to do it,” she said. “We are tired of being in a state that waits until last. Fifteen other states are moving toward some kind of dental midlevel. The train is moving, and we want to be one of the leaders in this.”

Rep. Brenda Landwehr, R-Wichita.

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Landwehr urged the sides to work together on a proposal each could live with.

“One of two things can happen,” she said. “You can either go back to the drawing board and come up with something you agree on, or you can let the Legislature decide this for you. It’s been my experience — and I’ve been up here 18 years now — that when the Legislature decides things, it doesn’t make people happy,” she said. “It’ll be a lot better for everybody if you can work this out among yourselves.”

Rep. Bob Bethell, an Alden Republican who serves on the Health and Human Services Committee, said a deal likely would be difficult to reach.

“The chairman (Landwehr) is right, this is a turf issue,” he said. “The other thing I noticed is that neither side trusts the other. That makes it hard to compromise.”

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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