Speaker Mark Eves on LD 1230: “No one should have to get their dental care in an emergency room”
- “No one should have to get their dental care in an emergency room.”
~Speaker of the House Mark Eves, at 4/10/13 Dental Access for Maine Coalition press conference, held in the Hall of Flags, 4/10/13.
Chairman Patrick, Chairwoman Herbig, Members of the Joint Standing Committee on Labor, Commerce, Research and Development, good afternoon.
I am here today to introduce LD 1230, “An Act to Improve Access to Oral Health Care.”
As we all know dental care is a critical aspect of a person’s overall health. While I have spent my professional life providing care for those with mental health needs, I have become intimately aware of the connection between oral health, mental health, and a person’s overall health.
I have heard many personal stories in my clinical practice and reviewed the data as a member on the Health and Human Services Committee and the picture is clear- Maine has a significant challenge in accessing dental services-particularly in rural parts of our State.
Over the past couple of years Senator Chris Rector and I worked with the HHS and your committee to get the dental facts.
Both our committees had been facing confusion of dueling statistics from advocates from different perspectives and interests. Together we worked to pass LD 1105. The study was directed by stakeholders including dentists, dental hygienists, clinics and advocates for low-income Mainers. Together that group identified and hired the Center for Health Workforce Studies to perform an objective analysis. While the American Dental Association and Maine Dental Association were the major funders of the effort, Maine foundations, Dental Hygienists and others all financially supported the effort. For those of you who have followed this issue, that alone was a major accomplishment.
Thanks are due to all those who left their turf aside, and agreed that good public policy demands good facts.
And, the dental facts they found paint a clear picture of enormous challenges for low income and rural Mainers to have access to dental care.So now the easy part, the facts:
· Now that we know that more than 55% of kids on MaineCare don’t see a dentist; it is obvious that we have barriers to care.
· Now that we know that Maine has the 6th highest percentage of Medicaid children without access to care in the United States; we know we have barriers to care.
· Now that we know that 15 of 16 Maine counties (73 separate dental health shortage areas) have designated dentist shortage areas; we know we have barriers to care.
· Now that we know one in 5 Mainers live in a dentist shortage area; we know we have barriers to care.
· Now that we know that nearly 40% of Maine dentists are planning to retire in the next five years or substantially reduce their hours; we know we have barriers to care.
· Now that we know that there were 11,960 separate MaineCare ER visits for dental care wasting over $6.6 million in 2009; we know we have barriers to dental care.
Believe it or not, I am being restrained here. The facts are astounding. This extremely thorough report included data distilled from millions of claims files, hundreds of interviews, and dozens of reports. The executive summary alone is 28 pages.
It paints a bleak picture for enormous challenges to care that demand legislative action. Here’s the good news, there are strategies used in other states and other countries that can help alleviate this crisis.
Dental Hygiene Therapy has provided excellent care in over 54 countries and Alaska and Minnesota. Started in New Zealand nearly a century ago, it has been extensively researched and found to provide safe, quality care. There are over 1,100 peer reviewed studies confirming this fact.
We believe this is a proven model that could help address the dental shortage crisis in Maine. Here is what the legislation does:
1. Establishes Dental Hygiene Therapy in Maine
2. Practiced only under the supervision of a dentist as part of a dental home
3. Authorized to perform a very limited number of procedures like drilling and filling surface cavities, removing loose teeth, gluing back a crown that has fallen off, and providing all the cleaning and educational services provided by a hygienist.
Here are the big concerns I have heard:
1. They only get 500 hours of education. That is not true.
All Dental Hygiene Therapist’s would have a hygiene degree. That is 3-4 years in the two Maine programs, and a minimum of two nationally. In addition, they would receive 1 ½ to 2 years of additional education using a curriculum developed by the American Association of Public Health Dentistry. After successful completion of what is typically 4-6 years of education, Dental; Hygiene Therapist’s would receive an additional 500 hours of clinical training under the direct supervision of a dentist. After completion of that, the supervising dentist could issue standing orders to further limit the procedures performed by a Dental Hygiene Therapist. In all, Dental Hygiene Therapist’s would be trained to the exact same standard of care for a very limited number of procedures as a dentist would receive for hundreds, and would have more clinical and class room time than a dentist on those same procedures.
2. Dental Hygiene Therapists will not reduce barriers to care. That is not true.
This legislation specifically limits the care settings for Dental Hygiene Therapist’s to dental clinics, hospitals and private practices serving 25% or more MaineCare patients. The study also finds that Maine’s diverse dental workforce (Independent practice dental hygienists and public health supervision dental hygienists) increases access to care for low-income people and those living in rural Maine. This legislation will increase access to care.
3. 95% of Maine dentists are open to seeing new patients. That is misleading and only partially true.
The question is: are 95% of Maine dentists accepting new MaineCare patients and the answer is no. Only 22% of Maine dentists saw a “significant number of MaineCare patients in 2010” (defined as billing over $100,000 or more annually) and only a quarter of practicing dentists are accepting new MaineCare patients.
4. If dentists received higher MaineCare reimbursement this problem would go away. This is not true.
Between 2008 and 2011 the reimbursement rate went up 26% for routine dental services, but the percentage of MaineCare kids who received care remained basically the same. While I support increased reimbursement, the claim that it will increase access has not proven to be true in Maine, or in most states.
Of course there are many more claims and counter-claims about what is going on, but let me bring you back to the essential problem: too many Maine kids are not getting dental care. These kids have a higher rate of dental disease, which leads to poorer overall health. Dental disease is the most prevalent unmet health need in Maine and in our country, 5x higher than childhood asthma. This leads to a lifetime of tremendous challenges including impacts to cognitive development, self-esteem, missed school days, and economic performance.
There is no one answer to this significant problem. Often we struggle to implement multiple strategies to make a difference. The legislation before you today is a critical strategy to meet a pressing need. I hope that you will join me, Representative Sirocki, Senator Burns and over 45 of your colleagues in supporting this step to improve access to dental care for Maine.