Saturday, July 16, 2011

Institute of Medicine Recommends Increased Dental Care for Underserved Populations - So What?

A new report was released on July 13th.                 

A report was released on July 13 by the Institute of Medicine (IOM) and the National Research Council of the National Academies that focuses on how to improve access to oral healthcare for vulnerable underserved populations. The 243-page document provides a guide for significantly bolstering care to these individuals through changes in the education, financing, and regulation of oral healthcare.

"The current system leaves about a third of the population out. And if we keep on 'keeping on,' we're not going to fix it," said Shelly Gehshan, MPP, in a news conference about the report. Gehshan is director of the Pew Children's Dental Campaign, Pew Center on the States, Washington, DC, and a member of the IOM Committee on Oral Health Access to Services.

The 10 recommendations laid out in the report include the development of a set of oral health competencies for non-dental-healthcare professionals in an effort to better integrate oral healthcare into overall healthcare. They also call for all dental students to participate in community-based education rotations and for the Centers for Medicare and Medicaid Services to fund and evaluate state-based demonstration projects that cover essential oral health benefits for Medicaid beneficiaries.

It is a difficult task to propose all the solutions to fixing the dental care crisis in the United States, and the committee's charge was made even more challenging by the dearth of cost-effectiveness studies on improving dental care access.

"The [IOM] focuses on what the evidence is behind recommendations. We looked for cost-benefit and cost-effectiveness evidence behind these recommendations [in our report]. Unfortunately, the data...are pretty limited," admitted committee chair Frederick P. Rivara, MD, MPH, Seattle Children's Guild endowed chair in pediatrics and professor of pediatrics, School of Medicine, University of Washington.

The committee members were also aware of the need to make their recommendations easy to implement, particularly given the current climate of limited healthcare resources. This charge is reflected in several ways. For example, they recommended that the Centers for Medicare and Medicaid Services fund and evaluate state-based demonstration projects that cover essential oral health benefits for Medicaid beneficiaries, with the goal being to provide evidence for having dental benefits for all Medicaid beneficiaries, noted the committee members.

Read it all.

Here is the report: Improving Access to Oral Health Care for Vulnerable and Underserved Populations

The problem with making recommendations in the era of ObamaCare is that nobody knows from where the funding will come. The federal government and many of the states are bankrupt and they cannot fund new pilot projects to train new dental hygienists to assume duties presently reserved to licensed dentists = mid-level dental providers. Plus, there is no guarantee the mid-level provider model which is being heralded by Pew and other mega foundations will save any costs on the delivery of care.

The states cannot increase Medicaid funding for serving the poor and underserved because their budgets will not allow it. The federal government which is facing massive debt and perhaps default cannot increase matching funds.

So, this report sounds good but unless a funding mechanism is suddenly discovered, it is HOT AIR.

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