Advanced dental hygiene practitioner

[DrJeff]

While not directly ADHP related, this will help give some insite as to how legislators think about dentistry. In my home state of CT, where the medicaid reimbursement rates haven't been changed in over a decade and hover at around 30% over the statewide UCR (Usual Customary and Reasonable) rates that non medicaid insurance carrying receive, a group of childrens advocate initiated a lawsuit on behalf of the medicaid children of CT over the very low fees that dentists get reimbursed, as a way to try and improve access to care. This suit first started over 5 years ago. Literally in the past week a settlement was reached where the state in an effort to avoid a court case, decided to set a new fee schedule which will be in the 50-55% of the UCR rate.

Committee members are literally patting themselves on the back at how they almost doubled the reimbursement rates, and how they now think that the dentists of CT will be signing up in droves to participate with the state medicaid plan and greatly help the access issue in CT. The general response from the dentists of CT undoubtedly will end up being something along the lines of "who cares, I'm at best just barely covering my costs or now loosing less money when treating this population of patients" The real slippery slope that we're treading here is that the legislators are starting to insinuate that unless we as dentists in CT "step up to the plate" that they'll either pass legislation that makes licensure contingent upon medicaid participation or use this as reason to pass ADHP in CT, and considering that one of the CT state reps who sits on the health committee is a former hygenist who makes no bones about wanting ADHP in CT, it could get real interesting in my neck of the woods in the next couple of years.

Bottomline from a political standpoint, if you really want to make a difference and get both your and dentistries voice head by legisaltors, then there's 2 things you need to do. #1 be a member of the ADA - your dues go to among other things various political lobbying agencies on both a State and National level and when that lobbyist can say that they're from the ADA or your state society which represents whatever large % of us belong, that helps present a unified front.

#2 Actually make a donation from time to time to your local politicians election fund. Especially with state reps, you'd be suprised how quickly they come to a fund raiser where you can get 10 to 15 dentists together who each make a $50 donation to his/her campaign fund. Then you'll actually one on one get to talk to your elected official, and this makes a much greater impression than a bunch of e-mail letters that most likely one of their staffers reads.

If by chance in practice someday, one of your patients is actually an elected official, make sure that you tell him/her of your concerns about dental political issues when they're in the chair at your office. You'll definately have their undivided attention when you've got the handpiece spinning away in their mouth!

In this day and age, it just takes a little bit of effort, and often a couple of dollars to keep the voice of dentistry heard. And that's a very key thing.

---

Members don't see this ad.

 

[rambo2006]

Thanks for the links and address!

Should I use this school address even if I'm not a student of U of M?
Wouldn't it be more influential if we used our own address from other states than all of us using the same U of M school address to show that this is calling a national attention?

I believe it would be better to sign it with your real address.

 

[rambo2006]

While not directly ADHP related, this will help give some insite as to how legislators think about dentistry. In my home state of CT, where the medicaid reimbursement rates haven't been changed in over a decade and hover at around 30% over the statewide UCR (Usual Customary and Reasonable) rates that non medicaid insurance carrying receive, a group of childrens advocate initiated a lawsuit on behalf of the medicaid children of CT over the very low fees that dentists get reimbursed, as a way to try and improve access to care. This suit first started over 5 years ago. Literally in the past week a settlement was reached where the state in an effort to avoid a court case, decided to set a new fee schedule which will be in the 50-55% of the UCR rate.

Committee members are literally patting themselves on the back at how they almost doubled the reimbursement rates, and how they now think that the dentists of CT will be signing up in droves to participate with the state medicaid plan and greatly help the access issue in CT. The general response from the dentists of CT undoubtedly will end up being something along the lines of "who cares, I'm at best just barely covering my costs or now loosing less money when treating this population of patients" The real slippery slope that we're treading here is that the legislators are starting to insinuate that unless we as dentists in CT "step up to the plate" that they'll either pass legislation that makes licensure contingent upon medicaid participation or use this as reason to pass ADHP in CT, and considering that one of the CT state reps who sits on the health committee is a former hygenist who makes no bones about wanting ADHP in CT, it could get real interesting in my neck of the woods in the next couple of years.

Bottomline from a political standpoint, if you really want to make a difference and get both your and dentistries voice head by legisaltors, then there's 2 things you need to do. #1 be a member of the ADA - your dues go to among other things various political lobbying agencies on both a State and National level and when that lobbyist can say that they're from the ADA or your state society which represents whatever large % of us belong, that helps present a unified front.

#2 Actually make a donation from time to time to your local politicians election fund. Especially with state reps, you'd be suprised how quickly they come to a fund raiser where you can get 10 to 15 dentists together who each make a $50 donation to his/her campaign fund. Then you'll actually one on one get to talk to your elected official, and this makes a much greater impression than a bunch of e-mail letters that most likely one of their staffers reads.

If by chance in practice someday, one of your patients is actually an elected official, make sure that you tell him/her of your concerns about dental political issues when they're in the chair at your office. You'll definately have their undivided attention when you've got the handpiece spinning away in their mouth!

In this day and age, it just takes a little bit of effort, and often a couple of dollars to keep the voice of dentistry heard. And that's a very key thing.

Dr. Jeff, I'm honesty quite dissappointed in what the ADA has done in Minnesota with the bill. They have been quite lax.

 

[DrJeff]

Dr. Jeff, I'm honesty quite dissappointed in what the ADA has done in Minnesota with the bill. They have been quite lax.

My partner, who is on a national ADA subcommittee, concerning political affairs, has heard a few things coming out the the "big 'ol building in Chicago"(ADA HQ).

When it comes to a "mid level practictioner" be it an ADHP or a DHAT, or whatever other acronym someone can dream up, ultimately we're fighting a loosing battle to completely stop their formation. The cold hard reality is a legislator will take a look at the access issues, and liken this new mid-level provider to something similar to a nurse practitioner which has not proven to be the end of medicine.

What in all likelyhood the ADA stance will be (especially considering how their Alaskan opposition failed not that long ago), is the insistance over regulation of the training programs for the mid level provider and then subsequent workplace locations for them (i.e. only can practice in a public health setting). The other factor card yet to be played is the the presumed pool from which most of these potential mid-level practitioners will be drawn from (i.e. hygienist and to some extent, assistants) is already in a shortage situation in many areas of the country, and they too provide an integral piece of any dental team, from the highest of high end boutique spa offices to the medicaid clinic setting.

If the ADA can maintain some control over the education and regulation of this potential mid level provider, then it's no big deal, and that's the ultimate war that dentistry needs to win. Dentistry as a whole when it comes to political issues plain and simple won't win every battle it has to face, they key is to take a few small lumps along the way, but be the one standing at the end.

 

[jatt007]

Just a thought... The modified bill has restrictions (target area/patients i.e undeserved areas, un-insured patients, and also the supervision of the dentist) for the pilot program. Would these restrictions be valid for OHP's after pilot period as well? If they are valid then this would be somewhat better than original drafted bill which had no such restrictions about the target patients/areas and also direct supervision by a dentist.

 

[rambo2006]

Just a thought... The modified bill has restrictions (target area/patients i.e undeserved areas, un-insured patients, and also the supervision of the dentist) for the pilot program. Would these restrictions be valid for OHP's after pilot period as well? If they are valid then this would be somewhat better than original drafted bill which had no such restrictions about the target patients/areas and also direct supervision by a dentist.

Although the word "pilot" was put there, there isnt anything spelled out yet that outlines, the conditions that would prevent it from continuing or would take off the "pilot" restriction and render it permenant. About the modified bill, I dont remember reading anything about un-insured patients but that is a plus to have it in there. That way there are less turf wars.

 

[jatt007]

There was a post by articulatingpad... it said in subdivision 2 about the Oral Health Practitioner bill for Pilot program..I was referring to that post.. Reading from there I think "un-insured patients" is in the amendments to the bill Rambo.. So i was thinking it might not be that bad if the bill passes with all these amendments.. right?

Subd. 2. Requirements to practice in underserved areas. As a condition of being
granted authority to practice as an oral health practitioner, the practitioner must agree to practice in settings serving low-income, uninsured, and underserved patients or in
communities that located in federal dental professional health shortage areas.

 

[blissdental]

I agree with Dr. Jeff and believe it will be a matter of time before another state proposes something like the ADHP. So ADA and state dental associations must come up with some kind of a system like the GPR to reslove the access problem. If dentists in private practice are not willing to see medicaid patients it will either have to be the GPRs or the ADHP/OHP(not that I really think they will, but theoretically) that will have to take these patients.
I also don't blame ADA for not coming out more strong on this issue. It would just worsen the case if they did by giving an impression to the legislatures that the ADA is just a greedy, selfish group fighting for the benifits of its members.
I think it would be best if we fight off this MN case as this ADHP/OHP group will be managed by the ADHA and not the ADA, and then as Dr. Jeff had mentioned, set up our own midlevel group that will be managed by the ADA. Kind of like how it works out with PAs and not the NPs that are managed by the nursing profession.

 

[blissdental]

I believe it would be better to sign it with your real address.

Letter sent. Thanks!

 

[Taurus]

Don't let dentistry degrade like primary care in medicine. It gets worse and worse for primary care by the day. Now, our own testing organization has sold out the profession and will let the nurses take a smaller version of our test.

http://forums.studentdoctor.net/showthread.php?p=6467023#post6467023

It's another sad day for primary care and the rest of medicine is vulnerable now. Once the genie is out of the bottle, you can't stop it.

 

[quackdentist77]

So is Oral Health Practitoners the new name for ADHs? How fancy!
Doesn't this sound just so much more professional than
Advanced Dental HYGIENISTs ?!!
I bet many patients that lack professional knowledge would even take them as some kind of a physician. Many of you may not believe it but I've seem quite a few people outside of the health profession that think ODs are actually physicians!

So obviously the DH are now aware that patients won't be willing to pay the same fees to DH as they would to dentists. They've obviously realized that having that word 'HYGIENIST' (which is what they exactly are) are going to work as a huge disadvantage to them. But at the end, ADHP or OHP or whatever you call it, this group is eventually going to fall under the DH and not the dental profession.

Just an FYI, smartypants..... The new "title" was a concession made by the hygienists to the dental association, because THEY were the ones opposed to it.
(Haven't looked at the discusison board in some time.... same old b.s. though! Glad nothings changed-)

 

[quackdentist77]

Uh, they are technicians who, while highly trained, are not trained in diagnoses and treatment of medical conditions, neither are they trained in the medical model of evaluation and decision-making.

And, I hope all the dentists caught this: " I'm taking notes from their playbook as we speak ", them being the CRNA's. Fight this guys, fight it hard![/quote]

All that intellect you possess must have taken up the sarcasm filtering section of your brain, huh?

 

[aphistis]

Name-calling and personal insults are not welcome and will not be tolerated. Keep it professional, please.

 

[quackdentist77]

1- It is experimental because, this is not Alaska nor is this bill drafted like the program is Alaska. Hence, it is experimental.

When no board exam is required, no competencies addresses, F*&K yea its unsafe for patients. When they do irreversible procedures, it IS UNSAFE. Stop being ignorant and realize that you do NOT know, what u where never taugth or trained to perform. Thus you are not even competent to speak about what is safe to do or not.


Why do you think that there will be no board exam? It sounds like you're implying one just signs up to be an OHP, completes a bit of theory, and is set free to "practice dentistry" with a reference book.

 

[quackdentist77]

Name-calling and personal insults are not welcome and will not be tolerated. Keep it professional, please.

That's perfect! So, I assume then that that will pertain to EVERYONE and not just me, correct?

 

[quackdentist77]

I agree with Dr. Jeff and believe it will be a matter of time before another state proposes something like the ADHP. So ADA and state dental associations must come up with some kind of a system like the GPR to reslove the access problem. If dentists in private practice are not willing to see medicaid patients it will either have to be the GPRs or the ADHP/OHP(not that I really think they will, but theoretically) that will have to take these patients.
I also don't blame ADA for not coming out more strong on this issue. It would just worsen the case if they did by giving an impression to the legislatures that the ADA is just a greedy, selfish group fighting for the benifits of its members.
I think it would be best if we fight off this MN case as this ADHP/OHP group will be managed by the ADHA and not the ADA, and then as Dr. Jeff had mentioned, set up our own midlevel group that will be managed by the ADA. Kind of like how it works out with PAs and not the NPs that are managed by the nursing profession.

May I ask how your "own" mid-level provider will better suit your goals?

 

[blissdental]

May I ask how your "own" mid-level provider will better suit your goals?

We don't even need to go over what benifits this would bring to the dentists.
You are dental 'hygienists' and you have chose to enter that profession of cleaning teeth. Nevertheless your group is asking to practice dentistry which has nothing to do with your profession. You ask to do our work but don't want to be managed by the ADA but by the ADHA. Read the articles regarding this ADHP/OHP issue, those hygienists make decisions on their own without even consulting with the ADA.
Like Taurus had mentioned the PA are under the physicians and not like the NPs that are under the nursing profession. Yes, PAs are troublesome at times and I've heard they too have tried to lobby for independence, but they are still more easy to manage and fit in better within the medical group as they know that their main role is to assist the physicians, not to become one.
Again, it was their choice to become a PA.
Rather than the dentists, I personally feel people like you are very selfish and greedy. You don't want to spend the time and money to become a dentist, but you still want a similar financial and social status as dentists. And please, don't start again with the access problem. If hygienists were really concerned about this problem then all they needed to do was state in the bill the areas on where they would be previlged to work.

 

[quackdentist77]

We don't even need to go over what benifits this would bring to the dentists.
You are dental 'hygienists' and you have chose to enter that profession of cleaning teeth. Nevertheless your group is asking to practice dentistry which has nothing to do with your profession. You ask to do our work but don't want to be managed by the ADA but by the ADHA. Read the articles regarding this ADHP/OHP issue, those hygienists make decisions on their own without even consulting with the ADA.
Like Taurus had mentioned the PA are under the physicians and not like the NPs that are under the nursing profession. Yes, PAs are troublesome at times and I've heard they too have tried to lobby for independence, but they are still more easy to manage and fit in better within the medical group as they know that their main role is to assist the physicians, not to become one.
Again, it was their choice to become a PA.
Rather than the dentists, I personally feel people like you are very selfish and greedy. You don't want to spend the time and money to become a dentist, but you still want a similar financial and social status as dentists. And please, don't start again with the access problem. If hygienists were really concerned about this problem then all they needed to do was state in the bill the areas on where they would be previlged to work.

If you were to read the bill, you would see that it DOES limit a hygienist to practicing in underserved areas. So, that takes care of that. And Nobody in their right mind would/should think that by going the OHP route they are going to make as much money as a dentist. Why are you so hung up on "social status"- As much as you might like to believe, that hasn't even occurred in my thought process. I understand that there is a certain social status that goes along with the title "doctor", however that doesn't pertain in this situation, so there really isn't even a need to address it. It simply doesn't affect one's social status. What do you mean by PA's can be troublesome, but are easier to manage? That sounds awefully condescending and patronizing. And you still didn't address my original question- What do you propose your "own", and by own, I mean the dental association, which technically ISN'T your own, since you are still a student, mid-level provider can/can't do that will better suit your goals? And I'm not talking about "benefits to the dentist", I'm speaking of benefits to the general public.

 

[rambo2006]

quack, you seem illogical, selfish and very ignorant. You fail to value what you are not aware of or trained to perform. I have put many questions up that you and other quack have quacked away from answering. does logic not appeal to you? Ethics...obviously means little to you. I know too many great hygienist and DH students and you quacks are a disgrace to your profession. When I see how u avoid certain statements and questions that put into question the viability or intentions of the bill I cant help but to remember what Jonathan Swift once said.

"It is useless to attempt to reason a man out of what he was never reasoned into." Jonathan Swift

 

[r_u_cool2]

an update

April 4, 2008
ORAL HEALTH PRACTITIONER LANGUAGE IS AMENDED OUT OF SUPPLEMENTAL
FINANCE BILL
The Language Was Deleted Out Of The Bill To Be Considered Another Day


We Want To Thank All Of You Who Have Been Responding To Our Email
Alerts Encouraging You To Contact Your Legislators, Specifically
Senators This Week, On The Oral Health Practitioner (formerly ADHP)
Bill. Your Emails/calls Have Helped To Communicate A Clear And
Concise Message From The MDA About Our Concerns With This
Legislation.

This Week The Bill Moved To The Senate Floor.

Alternative Language

Legislative Language That Would Be An Alternative To The ADHP/oral
Health Practitioner Language Has Been Developed By Senator Yvonne
Prettner-Solon (DFL-Duluth) And Other Senators Who Have Supported The
MDA Position.

The Alternative Language That Was Developed Is A Study And Process
Language, Similar To, But Not Exactly Like, What The University Of
Minnesota Had Brought Forth Earlier In The Process. The Language
Would Have The Commissioner Of Health Convene A Work Group That
Includes Representatives From The U Of M Academic Health Center,
Minnesota State Colleges And Universities, The MDA, The MN Dental
Hygienist Association, The MN Dental Assistants Association, The
Board Of Dentistry, Community Clinics Serving Low Income And
Uninsured Patients, The Department Of Health Rural Health Advisory
Committee And The Commissioner Of Human Services (or The
Commissioner’s Designee) To Develop Recommendations On The
Necessary Education, Scope Of Practice, Program Accreditation,
Practice Settings That Provide The Greatest Access To Underserved
Populations, Supervision And Regulatory Requirements For A New Oral
Health Practitioner.

Additionally, The Group Would Be Charged With Reviewing Existing
Mid-level Dental Practitioners And Therapists Practicing In Other
Countries As Well As New Dental Practitioner Proposals From The
American Dental Association (i.e. CDHC). The Commissioner Would
Report To The Chairs Of The Appropriate Legislative Committees With
Purview Over Health Care Issues By January 15, 2009. This Amendment
Also Is Supported By The U Of M.

The Entire Senate Was Aware That Senator Prettner-Solon Intended To
Offer This Alternative Language On Thursday. The Existence Of This
Alternative Language Was An Important Backdrop To What Actually
Happened Thursday On The Floor Of The Senate.

Senate Floor Action

The Full Senate Took Up S.F. 3813 Early Thursday Afternoon. Earlier
In The Day, There Were Rumors Swirling That An Amendment Might Be
Offered To Strip Out (delete) All The “policy” Language
In The Bill. Indeed, The First Amendment Offered Was By Senate
Majority Leader Larry Pogemiller (DFL-Minneapolis). He Explained To
The Senate That It Was Customary To Examine And Review Finance Bills
And Determine Whether Or Not Too Much “policy” Was In The
Bill. So, The Senate Took A Voice Vote And Agreed To The Amendment,
Which Stripped Out The Policy Language And, In This Case, Sen.
Lynch’s Oral Health Practitioner Language.

The Motion By Sen. Pogemiller Was That The “policy”
Language That Would Be Deleted Out Would Be Taken Up In The Senate
Rules Committee On Another Day. So, Sen. Lynch’s Language Will
Most Likely End Up On Another Moving Bill. It Looks Like It May Be
The Omnibus Higher Education Bill.

Going Forward

The MDA And The U Of M Academic Health Center Will Continue To Work
With Senators On This Proposed Alternative Language. On Thursday, We
Were Prepared For The Vote, But We’ll Continue To Work The
Senators. In The Meantime, We Need You To Contact Your Senator.

Contacting Your Senator

It Is Imperative That When You Contact Your Senator That Your
Communication With Them Is Not Insulting Or Accusatory. Please Do
Not Be Angry When Talking To Them Directly Or In Email
Correspondence. Stay Professional. Stay Above The Fray On This. We
Know How Strongly Many Of You Feel About This Issue And This Has Not
Been An Easy Session. However, We Have Been Told That Some
Legislators Have Received Mean-spirited Communication From Some
Dentists, Which Has Cost Us A Couple Of Key Swing Votes. Therefore,
Please Be Professional And Courteous.

When You Contact Your Senator, Please Emphasize The Following Key
Point:

*Please Support The Dental Amendment That Will Be Offered By Senator
Yvonne Prettner-Solon To The Dental Language That Has Been Developed
By Senator Lynch. This Amendment Would Replace The Oral Health
Practitioner Pilot Program And Replace It With A Study Conducted By
The Commissioner Of Health. This Study Would Allow For A Much
Broader Discussion And Include All The Dental Stakeholders In This
Process. The Purpose Would Be To Require The Commissioner Of Health
To Study The Development Of An Oral Health Worker To Address The
Dental Care Needs Of Public Care Program Patients And Uninsured And
Underserved Populations. It Would Include The MDA And The University
Of Minnesota In The Discussions. Neither Can Support A Pilot Program
At This Time Without Further Study.

If You Have Questions About The Process Or This Amendment, Please
Feel Free To Contact MDA President Jamie Sledd At 763-494-4443,
Legislative Affairs Committee Chair Scott Lingle At 651-227-6646,
Executive Director Dick Diercks At 612-767-8400, Or Legislative
Affairs Director Laura Fenstermaker At 612-767-4255.

Thank You For Your Attention To This Issue And Your Involvement To
Help Ensure An Acceptable Outcome.

 

[blissdental]

If you were to read the bill, you would see that it DOES limit a hygienist to practicing in underserved areas. So, that takes care of that. And Nobody in their right mind would/should think that by going the OHP route they are going to make as much money as a dentist. Why are you so hung up on "social status"- As much as you might like to believe, that hasn't even occurred in my thought process. I understand that there is a certain social status that goes along with the title "doctor", however that doesn't pertain in this situation, so there really isn't even a need to address it. It simply doesn't affect one's social status. What do you mean by PA's can be troublesome, but are easier to manage? That sounds awefully condescending and patronizing. And you still didn't address my original question- What do you propose your "own", and by own, I mean the dental association, which technically ISN'T your own, since you are still a student, mid-level provider can/can't do that will better suit your goals? And I'm not talking about "benefits to the dentist", I'm speaking of benefits to the general public.

I'm getting really tired dealing with your nonsense questions. Read the prior posts that others and myself had been posting.
By the way, if you think I'm "just" a student I can't see why you're even asking me those questions in the first place.

 

[KOM]

I'll just refrain from hiring hygienists and offer the position to say, hair stylists. They might like to expand their expertise into other areas...pay might be a little better.

Then when people start moving into your area of expertise and lobbying for autonomy, maybe we can bring in some taxidermists too and create another group.

I mean, anyone can clean teeth right Quack?

 

[quackdentist77]

quack, you seem illogical, selfish and very ignorant. You fail to value what you are not aware of or trained to perform. I have put many questions up that you and other quack have quacked away from answering. does logic not appeal to you? Ethics...obviously means little to you. I know too many great hygienist and DH students and you quacks are a disgrace to your profession. When I see how u avoid certain statements and questions that put into question the viability or intentions of the bill I cant help but to remember what Jonathan Swift once said.

"It is useless to attempt to reason a man out of what he was never reasoned into." Jonathan Swift

What are you even talking about? Please, ask me anything you like!

 

[quackdentist77]

I'm getting really tired dealing with your nonsense questions. Read the prior posts that others and myself had been posting.
By the way, if you think I'm "just" a student I can't see why you're even asking me those questions in the first place.

You are hilarious! You're the one spouting all sorts of nonsense with no real logic or point behind it. You basically post someone elses response, say you agree with it, and try to make it sound like you have your own position! Yes, I do think you are just a student, and you keep replying to me without answering the question. What is YOUR stance on a dental association approved midlevel provider, what will their duties be, and how will it benefit the public?

 

[blissdental]

You are hilarious! You're the one spouting all sorts of nonsense with no real logic or point behind it. You basically post someone elses response, say you agree with it, and try to make it sound like you have your own position! Yes, I do think you are just a student, and you keep replying to me without answering the question. What is YOUR stance on a dental association approved midlevel provider, what will their duties be, and how will it benefit the public?

Read my posts in the earlier pages of this discussion and you'll see what my stance is. There is nothing illogical about my posts, you simply don't agree or understand it. And I also don't find anything wrong with agreeing with others opinion. You call that support.
Even if I may be "just" a student now, in 5 months I'll be a dental student and 4 years after I'll be a dentist. So of course I need to get involved as this is an issue on my future profession. With that kind of a logic, your opinion should be disregarded as well since you aren't even a ADHP/OHP.
The answers to all your questions on my opinion are in my prior posts and I won't be replying to any further nonsense questions as I'm already too busy sending out emails to dentists and legislators.

 

[StL_to_Boston]

I'll just refrain from hiring hygienists and offer the position to say, hair stylists. They might like to expand their expertise into other areas...pay might be a little better.

Then when people start moving into your area of expertise and lobbying for autonomy, maybe we can bring in some taxidermists too and create another group.

I mean, anyone can clean teeth right Quack?

Just lobby your state government to expand the functions of dental assistants. I know in my state, the state dental associations are attempting to expand dental assistant functions. This will lower the cost of cleanings and maintenance, since you can pay an assistant less, and then maybe you can afford to take on some more underserved patients.

 

[HenryH]

an update

So essentially, they're trying to initiate a study that would gauge the need/potential "benefit" of the ADHP?

 

[tinman831]

Lets discuss without the insults please.

 

[Daurang]

I received this in my email this update from the ADA today...

"In Minnesota, the misguided hygiene practitioner legislation continues to limp along. While the bill has morphed from one establishing ADHPs with no restrictions on where they'd practice into a pilot program allowing 30 "oral heath practitioners" who would be limited to underserved areas, the scope of practice remains the same as before. The good news is that the provision was one of many stripped from a must-pass appropriations bill yesterday; the bad news is that the proponents are still looking for a way to get it voted on before the session ends in a few weeks. ADA staff continues to bolster the MDA's multi-pronged effort to convince the legislature that there are far better ways to improve access.

In addition, our friends at the Maine Dental Association are steeling themselves for what they believe to be an extremely likely and unfortunate legislative outcome—passage of a bill that will make Maine only the second state (after Colorado) to allow completely unsupervised practice of dental hygiene. As unfortunate as that may be, it's important to understand the context in which this took place. The independent hygiene proposal was one of four that were referred last year to the state's Department of Professional and Financial Regulation for Sunrise Review. The other three were 1) licensure of graduates of foreign (non-CODA approved) dental schools, 2) creation of a separate licensing board for denturists and hygienists and 3) creation of an advanced practice dental hygienist who could do restorative care and extractions. Maine participates in the ADA State Public Affairs program and ADA staff and local lobbying and public affairs consultants have been working with Maine all along. But given the MDA's assessment of the inevitability of losing that fight, and considering the three out of four favorable rulings from the Sunrise Review, the MDA has accepted this outcome as "least worst" and will not actively oppose the independent hygiene measure when it comes to a floor vote, believing that doing so would only make matters worse."

 

[aphistis]

http://www.adha.org/downloads/June_2007_ADHP_Competencies.pdf, page 17.

Note to ADHA: When publishing a proposal attempting to convince people that you should be allowed to prescribe controlled substances, major factual errors like listing cocaine as a schedule I drug aren't a great way to build credibility.

 

[HenryH]

I received this in my email this update from the ADA today...

"In addition, our friends at the Maine Dental Association are steeling themselves for what they believe to be an extremely likely and unfortunate legislative outcome—passage of a bill that will make Maine only the second state (after Colorado) to allow completely unsupervised practice of dental hygiene. As unfortunate as that may be, it's important to understand the context in which this took place. The independent hygiene proposal was one of four that were referred last year to the state's Department of Professional and Financial Regulation for Sunrise Review. The other three were 1) licensure of graduates of foreign (non-CODA approved) dental schools, 2) creation of a separate licensing board for denturists and hygienists and 3) creation of an advanced practice dental hygienist who could do restorative care and extractions. Maine participates in the ADA State Public Affairs program and ADA staff and local lobbying and public affairs consultants have been working with Maine all along. But given the MDA's assessment of the inevitability of losing that fight, and considering the three out of four favorable rulings from the Sunrise Review, the MDA has accepted this outcome as "least worst" and will not actively oppose the independent hygiene measure when it comes to a floor vote, believing that doing so would only make matters worse."

So in other words, the ADHP thing in Maine is likely going to happen? If all these new hygienists-on-steroids flood the markets in that state and are capable of performing the majority of a dentist's work, how will dentists there cope financially? Isn't this like opening the floodgates to a massive oversupply of dentists?

 

[blissdental]

So in other words, the ADHP thing in Maine is likely going to happen? If all these new hygienists-on-steroids flood the markets in that state and are capable of performing the majority of a dentist's work, how will dentists there cope financially? Isn't this like opening the floodgates to a massive oversupply of dentists?

No, I read it as that they will be able to do only hygiene work even if they go independent so that's different from the ADHP/OHP that get to be almost dentists.
Please correct me if I'm wrong.

 

[Taurus]

While dental hygienist autonomy is better than the ADHP, dentistry is not out of the woods if this becomes the national norm. Just teeth cleaning is a huge driver for the rest of the dental practice. Furthermore, once they have autonomy, don't think that dental hygienists will be happy with just that. Over time, they will push for more scope, such as the ADHP scope and teeth whitening. Dentistry still needs to address the problem increasing access to more poor people. If they don't, the states will do it for them.

 

[KOM]

Dentistry still needs to address the problem increasing access to more poor people. If they don't, the states will do it for them.

Forgive me, as I come from a small (very small <1000 people) town, but why do people like practicing in the big city so much? My wife comes from a huge city and loves the small town life.

 

[reapply2007]

In medicine nurse practitioners (NP) and physician assistants (PA) get paid from insurance companies at approx 60% of an MD/DO's salary. The idea is that more comprehensive service and stronger clinical decisionmaking is provided by a MD/DO.

I don't see any mention of this in the proposed expanded hygenist responsibilities. Why not follow the model of medicine? Reimbursement at the same rate as a DDS/DMD would imply that there is no difference in quality of care between an expanded hygenist role and a DDS/DMD role.

The legislation could also put in mandatory medicaid patient base threshholds for licensure of the expanded responsibilities.

Similarly, why not license foreign trained BSDs at a level equal to the expanded dental hygenists with the same service requirements?

 

[dds2016]

This whole thing boils down to the government giving more for less. Politicians constantly support the "little guy" because that is how they get votes. By allowing the average student/worker ie. a DH (generally the type of person who doesn't take school very seriously) an easier way to basically be a dentist without the all day everyday for 4 years straight schooling; is the politicians way of making the "little guy" happy.

What

 

[Taxi Driver]

I think this melds nicely into the corporate dentistry thread. It would be much cheaper for corporate dentals to employ an ADH than a dentist. I would not be surprised if corporations were actually behind this push for adh programs.

Dentistry is a multi-billion dollar business. Big business isn't just sitting back saying " wow, thats neato". They are drooling like Pavlov's dog. If they can wrestle away the power from the GP dentist then they can take over.

There used to be Mom & Pop pharmacies all around 30-40 years ago. Now if you graduate from pharm school you are working at CVS or Walmart.

 

[blissdental]

I think this melds nicely into the corporate dentistry thread. It would be much cheaper for corporate dentals to employ an ADH than a dentist. I would not be surprised if corporations were actually behind this push for adh programs.

Dentistry is a multi-billion dollar business. Big business isn't just sitting back saying " wow, thats neato". They are drooling like Pavlov's dog. If they can wrestle away the power from the GP dentist then they can take over.

There used to be Mom & Pop pharmacies all around 30-40 years ago. Now if you graduate from pharm school you are working at CVS or Walmart.

Corporates try to take over every single thing that they could scrape money out of and it's making me sick. This is exactly why I look around and try to use a private pharmacy instead of cvs or walgreen. It kind of upsets me to see the majority of the pharmacists having no choice but to be salaried and work under somebody when they're the ones that have the professional knowledge and doing all the work. It's no longer a choice but has became a must.
If corporates start hiring ADHP and run private clincs out of business with their super low prices, I'm wondering who would actually go to dental school in the next 20 or 30 years to get that that slightly higer salary than the ADHP. That is definitely undermining the dental profession in the U.S., that is if they even care.

I personally think the only way the dentists could prevent their power from getting stolen away would be to strenghen the ADA and for the pay docs to quickly leave the corporates after they make just enough to pay back loans.

 

[blissdental]

Taurus, would you mind if I asked a question regarding corporation in medicine. I haven't seen that many fields in medicine that have gone corporate. For example, I'm sure plastic surgery has a very lucrative market but haven't gone corporate. So I was wondering what distinguishes medicine from pharmacy or optomtetry from getting it corporate?
Why aren't corporates setting up their clinics using PAs of NPs with a few physicians to supervise them? I see alot of midlevels going into private practice rather than corporate. Isn't it true that the CRNAs mostly go independent than corporate?

 

[makushin]

Taurus, would you mind if I asked a question regarding corporation in medicine. I haven't seen that many fields in medicine that have gone corporate. For example, I'm sure plastic surgery has a very lucrative market but haven't gone corporate. So I was wondering what distinguishes medicine from pharmacy or optomtetry from getting it corporate?
Why aren't corporates setting up their clinics using PAs of NPs with a few physicians to supervise them? I see alot of midlevels going into private practice rather than corporate. Isn't it true that the CRNAs mostly go independent than corporate?

Wouldn't HMO's be considered corporate medicine?

 

[blissdental]

true.. but I meant corporate in the way explained by taxi driver

 

[makushin]

Pharmacy and optometry are largely retail, and that is why they have gone the way of walmart. While they require a high level of education, eye exams, glasses and pills are pretty generic goods. Dentistry is not, just ask anyone that has had a poor experience at the dentist.

The real threat to dentistry is any government involvment, as they are the entity with the great power to twist the free-market dynamics of dentistry.

 

[blissdental]

Pharmacy and optometry are largely retail, and that is why they have gone the way of walmart. While they require a high level of education, eye exams, glasses and pills are pretty generic goods. Dentistry is not, just ask anyone that has had a poor experience at the dentist.

The real threat to dentistry is any government involvment, as they are the entity with the great power to twist the free-market dynamics of dentistry.

It seems that even in most countries with universal health care, only a small portion of dentistry is covered. Tax rates would go way too high if the gov tried to cover most of dentistry. Look at the dentistry in UK. They used to have universal dentistry but the gov is now trying to get their hands off of dentistry, probably because they find it hard to manage everything with their budget.
So as long as we could get the midlevel issue under our belt, I doubt we would have much of a problem looking at most of the other countries even with universal health care.

But my question is why the majority PAs and NPs aren't going corporate. You see Walmart hiring pharmacists and optometrists but you don't see any coprs hiring a bunch of NPs or PAs with a few physicians to supervise them.
I've rather seen more of those midleves going private. So is this simply because they aren't retail? If that is the main or only reason that they aren't controled by corps, then wouldn't it be safe to assume that dentistry would be even the more so?

 

[Taurus]

Taurus, would you mind if I asked a question regarding corporation in medicine. I haven't seen that many fields in medicine that have gone corporate. For example, I'm sure plastic surgery has a very lucrative market but haven't gone corporate. So I was wondering what distinguishes medicine from pharmacy or optomtetry from getting it corporate?
Why aren't corporates setting up their clinics using PAs of NPs with a few physicians to supervise them? I see alot of midlevels going into private practice rather than corporate. Isn't it true that the CRNAs mostly go independent than corporate?

It depends on your definition of "corporation". Medicine is going "corporate" as well. Physicians aren't opening clinics in Wal-Marts, but what's happening instead is that it's getting harder and harder to be in private practice. Because of referral patterns determined by health networks and high malpractice, more and more physicians are forced to work for a hospital where they become employees. For some, it doesn't make economic sense anymore to stay independent.

Think of about how there used to be lots of mom & pop stores, pharmacies, and eye glass places. Then the Wal-Mart's, CVS's, and Lenscrafters came into town and drove most of the mom & pop out of business. It's a business model evolution. Private practice anything is not very efficient. These big chains have economy of scale.

 

[makushin]

Private practice anything is not very efficient. These big chains have economy of scale.

I have to say, this is just not true. There are many trades and professions where the owner/operator model is more efficient. Economies of scale are not always evident enough to overcome the efficiency of the owner/operator model.

 

[gryffindor]

But my question is why the majority PAs and NPs aren't going corporate. You see Walmart hiring pharmacists and optometrists but you don't see any coprs hiring a bunch of NPs or PAs with a few physicians to supervise them.
I've rather seen more of those midleves going private. So is this simply because they aren't retail? If that is the main or only reason that they aren't controled by corps, then wouldn't it be safe to assume that dentistry would be even the more so?

Have you seen a CVS Minute Clinic near you? I think that is a PA hired by CVS to see walk-ins for "straightforward" problems - sore throat, cough, fever, etc. I'd bet if the model works for CVS, Wal-mart won't be too far behind in implementing it.

 

[blissdental]

Have you seen a CVS Minute Clinic near you? I think that is a PA hired by CVS to see walk-ins for "straightforward" problems - sore throat, cough, fever, etc. I'd bet if the model works for CVS, Wal-mart won't be too far behind in implementing it.

I've seen one but thought it was a physician. It's really hard to tell who's what in those white coats.

 

[blissdental]

I have to say, this is just not true. There are many trades and professions where the owner/operator model is more efficient. Economies of scale are not always evident enough to overcome the efficiency of the owner/operator model.

I agree with makushin on this. Threre are actually many countries out there where the majority of pharmacies and optical office are private. Most of them work for corporate or as a pay pharmacists for a few years to save up some money but then they go private because they know they could do alot more better than getting salaried.

My derm who is also the doc that a premed friend of mine had been shadowing is also a private practitioner and his office is always busy and I'm sure he's doing a lot better than the average pay docs. Some of his patients are medicaid but he also does alot of cosmetic procedures like laser resurfacing or laser skin lift. All the medical device and machines seemed state-of-the-art, prices were pretty reasonable and he would give discounts for cash and check payments and he also had some kind of a discount payment plan for people without insurance. He is a great physician but it seemed to me that he also knows how to run a business.
Also, a relative of mine that runs a group orthopedic clinic is doing great financially. I've heard there are 4 co-investor owner docs and 6 pay docs that run the clinc and they too had invested enough into their clinc to do to most of the surgical procedures within their clinc without much referring.
So I agree that it would definitely be more efficient to work in a larger hospital setting if you're in a field like Cardiothoracic surgery, but for most of the other fields in medicine, I really can't see how getting into corporation would necassrily be more efficient.

If CVS and Walmart are running those pharmacies even though they have to pay for those high salaries, they're doing it because it's profitable. So if most of the pharmacies in this country were private, that profit going to CVS or Walmart would be going to the individual pharmacists. You could tell this easily because the cost of products in corporate pharmacies and the private pharmacies are rarely different.

 

[Taurus]

What's the advantage of economy of scale? Because of its size, Wal-Mart can negotiate on its behalf better prices for many things than any independent practitioner. If Wal-Mart has 10,000 dentists working for it, it can get better prices for equipment, malpractice, etc. It can keep those savings to increase its profit margins or pass them onto the consumer. It's hard to argue that Wal-Mart is not one very efficient monster. Why do you suppose that you don't see many mom & pop stores, pharmacies, etc? They went out of business. It's not like if they didn't try to compete with the Wal-Mart's. They just couldn't compete with a massive company with a nationwide distribution network and huge negotiating power.

 

[blissdental]

What's the advantage of economy of scale? Because of its size, Wal-Mart can negotiate on its behalf better prices for many things than any independent practitioner. If Wal-Mart has 10,000 dentists working for it, it can get better prices for equipment, malpractice, etc. It can keep those savings to increase its profit margins or pass them onto the consumer. It's hard to argue that Wal-Mart is not one very efficient monster. Why do you suppose that you don't see many mom & pop stores, pharmacies, etc? They went out of business. It's not like if they didn't try to compete with the Wal-Mart's. They just couldn't compete with a massive company with a nationwide distribution network and huge negotiating power.

You are absolutely right in that private clinics are no match to corporates. And that's exactly why I make an effort to use private pharmacies..because I know Walmart and CVS are doing just great..great enough to run most of the private clinics out of business. I know this is no big deal and wouldn't make much of a difference, but it's my way of showing support to small business.
I agree with all your comments but this just takes me back to my original question. What is it about medicine or dentistry that is stopping Walmart from totally plunging in?
I'm guessing they may be hessitant as they find it alot more complicated and inefficient to sell service than products.

By the way, different story but I had a chance to speak with an OD that runs an eye clinic in one of the Walmarts and he told me that Walmart doesn't hire him or the other optometrists. They just pay rent to Walmart and they themselves run their office. He told me only the optical section is run by the opticians that are hired by Walmart.