ADHA responds to ADA reports on economic viability of mid-level providers

July 31, 2012
ADHA says methodology used to conduct study impacts the validity of the conclusions drawn by the research.

CHICAGO, Illinois—The American Dental Hygienists’ Association reviewed the six studies released July 25, 2012, by the American Dental Association examining the economic viability of mid-level providers in dentistry and finds that the methodology used to conduct the study impacts the validity of the conclusions drawn by the research.

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The research, conducted by ECG Management Consultants views the access to care crisis through the lens of economic viability and makes assumptions about mid-level providers that may not be accurate.

ADHA advocates for evidence-based strategies that support improved oral health and wellness. The organization’s main concerns with the ADA reports are that: 1) they excluded information about—and from—mid-levels that are currently in practice in favor of projected data about proposed workforce models, and 2) the provider models they included do not accurately describe those proposed in the five states addressed in the study.

The reports considered the financial sustainability of three alternative provider models: the Dental Health Aide Therapist, the Dental Therapist, and the Advanced Dental Hygiene Practitioner. Research was not conducted in Minnesota and Alaska, the only two states where mid-level dental providers currently practice.

One practicing mid-level provider is Christy Jo Fogarty, RDH, MSOHP, a Minnesota licensed dental therapist. Fogarty works for Children’s Dental Services in Minneapolis, a private nonprofit serving nearly 30,000 low-income children and pregnant women across the state.

According to CDS, Fogarty ranks fourth in productivity among the 17 providers CDS employs, including dentists, and costs $45 an hour as opposed to the $75 an hour a dentist earns. As a dually licensed dental therapist and dental hygienist, Fogarty may provide preventive care combined with restorative services within the dental therapy scope of practice.

Fogarty is on track to become an Advanced Dental Therapist, pending development of Minnesota Board of Dentistry certification. The ADT will facilitate collaboration with the dentist in the absence of on-site supervision, similar to how a nurse practitioner works with the physician. A report on the efficacy of DTs and ADTs is expected in early 2014 from the Minnesota Department of Health and the Minnesota Board of Dentistry.

Mid-level providers have been proposed in the states included in ADA’s research (Connecticut, Washington, Vermont, New Hampshire, and Kansas), but the reports do not accurately reflect the models being proposed.

Kansas and Vermont are each considering a licensed dental hygienist with one additional year of education. Washington state has considered legislation, HB 2226, to establish two providers: “a two-year educated dental practitioner and a dental hygiene practitioner who is a licensed dental hygienist that has completed a post-baccalaureate advanced dental hygiene therapy education program.”

The access to care crisis is bigger than a funding problem and will require the entire dental team working to the extent of their education and skills. ADHA encourages ADA and all stakeholders to engage collaboratively across disciplines to define solutions.

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References available from association upon request.