Friday, July 27, 2012

The Morning Drill: July 27, 2012

Jay W. Friedman, D.D.S., M.P.H.

Good Friday morning!

On to today's dentistry and health headlines:

Is the ADA's midlevel provider economic analysis fair? By Jay W. Friedman, DDS, MPH

The ADA studies on the economic viability of alternative dental providers released this week have more holes in them than a slice of Swiss cheese.

The studies actually documented the financial feasibility of a dental therapist "within a larger dental practice." Yet, the overall summary conclusion is that "the introduction of additional providers does nothing to address this issue [of providing care to underserved populations]."

If dental therapists can't address this issue, applying the same criteria to dentists logically leads to the same conclusion. Dentists earn three or four times as much -- or more -- than dental therapists, and therefore do not represent an economically viable model to address the issue. If dentists were included in the study as one of the alternative providers -- which they actually are -- the study would have concluded that dentists are least able to provide care for the underserved. But this is so well-known, it hardly warrants annotation.

Apart from not including dentists as alternative providers, the studies have a number of structural flaws. For example, they distinguish between DHATs (dental health aide therapists in Alaska) and DTs (dental therapists), asserting that the preventive and restorative functions of DHATs are limited or less extensive than for DTs, when they are in fact the same.

Cotswold dentist quits Olympics over rota demands

A COTSWOLD dentist has blamed "unreasonable" working hours and "poor organisation" for her decision to pull out of volunteering at the Olympic Games.

Kathryn Smith, who practices at Chipping Manor Dental Practice in Cirencester, was eager to sign up as a volunteer dentist for the Athletes’ Village at London 2012.

But when she was given her rota, she was shocked to learn she was expected to work for up to 60 hours a week for free with less than seven hours sleep in between some shifts.

She said that after around two months of pleading with the organising committee for a more reasonable rota, she felt so stressed by the situation that she decided to pull out.

Satcher advocates midlevel dental providers to improve access to care

In 2000, then-Surgeon General David Satcher called national attention to “a silent epidemic” of oral diseases, afflicting America’s most vulnerable citizens - poor children, the elderly and racial and ethnic minorities.

The crisis continues, Satcher said last week at a conference hosted by the Morehouse School of Medicine in Atlanta.

Under the Patient Protection and Affordable Care Act, more than 5 million additional children will become eligible for dental benefits. But who will care for them? As it stands, the nation’s 30 million Medicaid children are already entitled to care, but the majority don’t get in to see dentists.

“We now have an opportunity to dramatically increase coverage,” said Satcher, now director of The Satcher Health Leadership Institute at Morehouse School of Medicine. “But adding dental benefits will not translate into access to care if we do not have providers in place to offer treatment.”

Satcher went on to a major hot-button issue in the world of oral health care: the question of midlevel providers.

The problem is this: More than 49 million Americans are living in areas with a shortage of oral health care providers. It would take nearly 10,000 additional dental practitioners to meet the current needs, according to the U.S. Department of Health and Human Services Health Resources and Services Administration. The shortage of dental providers disproportionately affects people living in poor and rural areas.

With the Affordable Care Act, “We now have an opportunity to improve access to dental health services,” noted Satcher. “But how do we put in place a health care system that meets the needs of all?”

Satcher spoke out for pilot programs such as those now being sponsored by the federal government and the W.K. Kellogg Foundation targeted at exploring alternative provider models such as dental therapists, who, with two or more years of intensive technical training, provide a range of services including preventive and restorative procedures and simple extractions.

The therapists work under the general, not direct, supervision of dentists and have been serving in other countries for decades. In 2005, dental health aide therapists, also known as DHATs, started working on tribal lands in Alaska as part of a longstanding federally authorized program that trains residents of Alaska Native tribal villages to provide basic care to their neighbors. In 2009, Minnesota became the first U.S. state to approve a law allowing such midlevel dental workers to practice.

“I think we need more dentists and I think we need more professionals who are not dentists but who can contribute to oral health services,” Satcher said.

Shreveport dentist charged with defrauding Medicaid

A Shreveport dentist is behind bars, facing charges accusing him of medicaid fraud.

Charles S. Williams, Jr., 48, of 815 Ontario Street is charged with fraudulently billing the state’s Medicaid program for services that were never rendered, according to the Louisiana Attorney General's office.

Williams, who has been a provider of dental services through the Louisiana Medicaid Program since 1991 is charged with 16 counts of Medicaid Fraud for intentionally presenting fraudulent claims.

According to the Attorney General's office, the charges stem from a joint investigation by the Attorney General’s Medicaid Fraud Control Unit and the Louisiana Department of Health and Hospitals.

Investigators reportedly found that Williams repeatedly billed the Medicaid Program from August of 2008 to July of 2009 for services he did not perform, including impressions, bone and gum grafts, excision of gum flaps and other oral surgeries.

They said Williams surrendered to the Attorney General’s Medicaid Fraud Control Unit for arrest on Tuesday, and has since been booked into the East Baton Rouge Parish Prison.

Enjoy your morning and weekend!

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