Advanced dental hygiene practitioner

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From a dentist on Dentaltown, here are the addresses of more supporters of the bill. The bill will be voted upon tomorrow night (March 13) so write now! Of course the response of the senator to the dentist who posted the address is so senseless, it should give you some good points in opposition.

Here is the reponse I received from my state senator in Minnesota. Although he is not an author of the bill, he supports it.

"While I respect your stance on tihs issue, I must tell you that I do
not agree with it. The point you raise about medical assistance rates
being so low that dentists are not accepting patients highlights one of
the necessities of why I believe we need this legislation. Seeing that
dentists are turning away MA patients because of the rates, it is my
belief and that of many supporters of the bill that ADHP trained
individuals will be more accepting of MA patients, thus expanding access to
care.

Thanks again for contacting me on this important matter. While I
respectfully disagree with your stance on this issue, I do want to assure
you that I appreciate you sharing your views and will take them into
consideration when this bill is discussed. Please do not hesitate to
continue to contact me on further issues and concerns."

Sincerely,
Rick Olseen
State Senator District 17

The MA rates in MN for a cleaning are $27.00, hygeients are paid ~$35.00/hr + benefits. I would assume that an ADHP would command more than regular hygeiensts. So actually how does this improve the access to care issue, if the dentist and/or ADHP loses money on each patient seen?

Senator Olseen can be reached at [email protected]. Other supporters/authors of the bill are:
Ann Lynch [email protected]
John Marty [email protected]
Tony Lourey [email protected]
Linda Berglin www.senate.mn/senatorberglinemail
Julie Rosen [email protected]

Please let them know what you think of this bill for all Minnesota dentists."
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We received this from ASDA today:

Hello,

This just in: ADHP Bill will be heard in the Health and Human Services
Budget Division tomorrow (3/13/08) at 6pm. Room 123. It will be important for all of us to be there. I have also included a sample letter from the MDA for us to personalize. Feel free to include your own person experiences, etc. Please
send out your emails and call your Senators and Reps. ASAP! Phone numbers
and emails of the finance committee members are below.

Main Issues with the bill:

1) No direct supervision of a Dentist.
2) The wide scope of irreversible procedures for the ADHP’s.
3) No specification of having the ADHP’s required to serve underserved
populations.

I have also attached an article regarding Colorado’s Dental Hygienist that
are able to practice privately doing hygiene, which was to help the access
to care problem, but not restricted in the bill to underserved populations.
This article talks about how the dental hygienists practiced in areas
similar to traditional DH’s and fees were similar for supervised and
unsupervised DH’s if not more. So basically, it didn’t help the access to
care problem. Read abstract for a summary.


Thursday, March 13, 2008 - 6:00 PM

***Revision 1: Agenda Addition(s)***
Health and Human Services Budget Division
Chair: Sen. Linda Berglin
6 p.m. Room 123 Capitol

NOTE: Limited testimony (1/2 hour) will be taken at this time only.


Agenda:
S.F. 2895-Lynch: Advanced dental hygiene practitioner level of
practice establishment.

Finance Committee:

Chair: Linda Berglin (Big Proponent)
651.296.4261

Vice Chair: Ann Lynch (Co-Author and Proponent)
651.296.4261 [email protected]

Ranking Minority Member: Michelle L. Fischbach
651.296.2084 [email protected]


Members: Sharon L. Erickson Ropes (Voted as a Proponent... may be persuaded
otherwise)
651-296-5649 [email protected]

Paul E. Koering (Opponent)
651-296-4875 [email protected]

Tony Lourey (Proponent)
651-296-0293 [email protected]

Mary A. Olson
651-296-4113 [email protected]

Yvonne Prettner Solon (Undecided)
651-296-4188 [email protected]

Julie A. Rosen
651-296-5713 [email protected]

Kathy Sheran
651-296-6153 [email protected]
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you guys there in the area need to get in there and raise hell! i would be there in a heartbeat, but i live on the other side of the US. :(

Some of my dental school friends said that they arent worried about this, "because it will be a long time before it affects us."

well to me its like watching a cockroach walk in the door of your house. if you let him walk in and crawl under the couch you are right when you think, "it will be a while before he has the house swarming in cockroaches"....but the infestation definitly will occur. so, instead of letting him walk in. crush him before he gets his foot in the door....then there will never be an infestation....period.

which is easier, crushing him with one step, or spending hundreds of dollars and lots of time on an exterminator, which will never trully have you house rid of these cockroaches ever again?
 
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gryffindor said:
From a dentist on Dentaltown, here are the addresses of more supporters of the bill. The bill will be voted upon tomorrow night (March 13) so write now! Of course the response of the senator to the dentist who posted the address is so senseless, it should give you some good points in opposition.

Also from this post: "The MA rates in MN for a cleaning are $27.00, hygeients are paid ~$35.00/hr + benefits. I would assume that an ADHP would command more than regular hygeiensts. So actually how does this improve the access to care issue, if the dentist and/or ADHP loses money on each patient seen?"
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This more than anything will be the self limiting step for ADHP. Funding! The real cost for a hygenist in many parts of the country, especially in MA where it's being considered, is closer to $50 an hour by the time the benefits are thrown in. Take those medicaid rates, since thats the population that the "all knowing" legislators think that all the ADHP's will be treating:rolleyes:, throw in pay + benefits, throw in the other overhead costs (materials, a presumed assistant for this ADHP too, office space rental, etc, etc, etc, and that ADHP better be producing ATLEAST $100 an hour just to break even. With current medicaid rates in many states, that ADHP better be doing 3 to 4 procedures an hour, and doing them as well as a dentist, to successfully justify their place in an office. Now what would be even more of a disaster waiting to happen, would be if a couple of ADHP's tried to open up their own clinci and work on just medicaid patients. Without SIGNIFICANT government subsidies, there's almost no way a clinic designed to increase access to care could stay in business.

While legislators might not understand dentistry, they DO understand dollars. If they want more dollars for a program they either have to raise our taxes(not very popular with voters - especially in todays economy) or cut from some other gov't funded programs(also not very popular). This IMHO is the real angle of attack that dentistry should be taking, not that an ADHP couldn't do the procedures, but that financially they WON'T be able to do the procedures without SIGNIFICANT gov't funding, not what constitutes a rversible verses irreversible procedure.
 
Just as a side...guess what consituted a major portion of the first hearing's DH argument was?

The boy who died from the abscessed tooth. They used it over and over and over again to support their argument. :thumbdown:

They're playing dirty.
 
DrJeff said:
This more than anything will be the self limiting step for ADHP. Funding! The real cost for a hygenist in many parts of the country, especially in MA where it's being considered, is closer to $50 an hour by the time the benefits are thrown in. Take those medicaid rates, since thats the population that the "all knowing" legislators think that all the ADHP's will be treating:rolleyes:, throw in pay + benefits, throw in the other overhead costs (materials, a presumed assistant for this ADHP too, office space rental, etc, etc, etc, and that ADHP better be producing ATLEAST $100 an hour just to break even. With current medicaid rates in many states, that ADHP better be doing 3 to 4 procedures an hour, and doing them as well as a dentist, to successfully justify their place in an office. Now what would be even more of a disaster waiting to happen, would be if a couple of ADHP's tried to open up their own clinci and work on just medicaid patients. Without SIGNIFICANT government subsidies, there's almost no way a clinic designed to increase access to care could stay in business.
While legislators might not understand dentistry, they DO understand dollars. If they want more dollars for a program they either have to raise our taxes(not very popular with voters - especially in todays economy) or cut from some other gov't funded programs(also not very popular). This IMHO is the real angle of attack that dentistry should be taking, not that an ADHP couldn't do the procedures, but that financially they WON'T be able to do the procedures without SIGNIFICANT gov't funding, not what constitutes a rversible verses irreversible procedure.
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Just an FYI.... I, working as a "regular hygienist", (not a "super-hygienist", phonie, wannabe dentist, etc....) averaged $169.65/hr production over the last year, and that's only with hygiene services. So according to your calculations, it all sounds quite viable.
 
KOM said:
Just as a side...guess what consituted a major portion of the first hearing's DH argument was?

The boy who died from the abscessed tooth. They used it over and over and over again to support their argument. :thumbdown:

They're playing dirty.
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How is that playing dirty or even unapplicable?
 
quackdentist77 said:
How is that playing dirty or even unapplicable?
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Because what nobody is mentioning here is that this boy's life meant little enough to his mother that she wasn't willing to spend $50 of her cigarette money to have it extracted. It'd be nice to have it done at a clinic where her Medicaid applied, but if this kid's life was important enough that a bunch of complete strangers were morally bankrupt, according to you, for not going out of their way to get the problem taken care of, where does that place mom?

Go ahead and lay all the blame on the dentists if it makes you feel better, but if you seriously think that's the entire problem, you're either not paying much attention or you don't know as much about the issue as you think.
 
quackdentist77 said:
How is that playing dirty or even unapplicable?
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The problem is that a boy dies and you use it to support your cause as if you will be the saviors of this problem. I'm from AK, I've heard from a dentist who fly's out once a week to care for villagers and has witnessed the sub-standard care some dental therapists provide. In one case, he was called out to treat an infection from an extracted tooth (from a therapist) that had spread to the patient's neck and was beginning to obstruct their airway.

Maybe the dentist should have let the patient die so it could then garner the national attention the other case did and use it to refute your argument.
 
KOM said:
The problem is that a boy dies and you use it to support your cause as if you will be the saviors of this problem. I'm from AK, I've heard from a dentist who fly's out once a week to care for villagers and has witnessed the sub-standard care some dental therapists provide. In one case, he was called out to treat an infection from an extracted tooth (from a therapist) that had spread to the patient's neck and was beginning to obstruct their airway.

Maybe the dentist should have let the patient die so it could then garner the national attention the other case did and use it to refute your argument.
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That's a great point you've raised! I'm quite certain that there has never been an infection caused from a DENTIST extracting a tooth! Excellent case!
 
aphistis said:
Because what nobody is mentioning here is that this boy's life meant little enough to his mother that she wasn't willing to spend $50 of her cigarette money to have it extracted. It'd be nice to have it done at a clinic where her Medicaid applied, but if this kid's life was important enough that a bunch of complete strangers were morally bankrupt, according to you, for not going out of their way to get the problem taken care of, where does that place mom?

Go ahead and lay all the blame on the dentists if it makes you feel better, but if you seriously think that's the entire problem, you're either not paying much attention or you don't know as much about the issue as you think.
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I'm pleased to see you've been paying such close attention.... FINALLY, someone has realized that all this time I've only been trying to blame the dentists! You guys should win some sort of intellectual award! Fabulous.
 
quackdentist77 said:
Just an FYI.... I, working as a "regular hygienist", (not a "super-hygienist", phonie, wannabe dentist, etc....) averaged $169.65/hr production over the last year, and that's only with hygiene services. So according to your calculations, it all sounds quite viable.
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His calculations were based upon the assumption that the hygienist was treating MA patients. Is your $169.65/hr production coming from those MA patients you are so eager to treat?
 
quackdentist77 said:
Just an FYI.... I, working as a "regular hygienist", (not a "super-hygienist", phonie, wannabe dentist, etc....) averaged $169.65/hr production over the last year, and that's only with hygiene services. So according to your calculations, it all sounds quite viable.
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I'm guessing that you're in a private practice setting billing out private practice rates as opposed to a medicaid based fee schedule, which is what the politicans expect that the ADHP will treat to ease the access problem. At Medicaid rate, your roughly $170 an hour becomes more like $50 to 70 an hour at best in most states.
 
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quackdentist77 said:
That's a great point you've raised! I'm quite certain that there has never been an infection caused from a DENTIST extracting a tooth! Excellent case!
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Little bit of swelling, some inflammation...oh yeah, the patient will be fine. That would be your prognosis eh? Right up until the patient can't breathe and a dentist comes in to bail you out.

At least they taught you what an infection was in hygiene school. I'm impressed. Did they also teach you an infection is caused by animolecules?
 
bodiddely said:
His calculations were based upon the assumption that the hygienist was treating MA patients. Is your $169.65/hr production coming from those MA patients you are so eager to treat?
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+ that's because you were working for a dentist, Quack.
People who could pay for that money for cleaning would might as well just go to a dentist if prices were similar. And even if you think you could ask for cheaper prices, how cheaper do you think you could get? And it's going to be even more so for other procedures.
Even for cleaning, after some time patients are going to realize that there's often going to be cases where they would have to be referred to a dentist since ADH procedures are still limited than a dentist, and they would end up paying extra or double the amount to get another check up.
 
quackdentist77 said:
That's a great point you've raised! I'm quite certain that there has never been an infection caused from a DENTIST extracting a tooth! Excellent case!
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You've made a right point. Even dentists who go through double the amount of professional education can make mistakes. That's why the dental profession is pointing out how more likely and a higher risk it would be for people with half the amount of training asking to do the same dentistry.
 
Hi,
I think I am very late in the discussion and the decision might be made very soon. ... but from what I read in the thread I think three things are really needed to be added in the bill:
1) ADHP should be restricted to the underserved area.
2) ADHP should be "ONLY" or maybe "PRIORITIZE" taking the medicaid patients .
3) The IRReversible procedures should not be in the list of job duties.
The first two points are the real issues faced by non-insured people. and 3rd point is very much required due to lack of knowledge of ADHP and the harm they can do by doing those.
And for the curriculum.. I think they should have an entrance exam and also must have B.S. compulosry .. these might already be there.. but having (6.5) 4+2.5 yrs of study would still filter out the CC grads ....
 
quackdentist77 said:
Just an FYI.... I, working as a "regular hygienist", (not a "super-hygienist", phonie, wannabe dentist, etc....) averaged $169.65/hr production over the last year, and that's only with hygiene services. So according to your calculations, it all sounds quite viable.
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Your reply here reflects your true thoughts.
If you really intended to go serve those in need through this ADHP, your reply would have been more like, "We hygienists are different from you greedy dentists. We know working as a ADH would bring us less $$ than a dentist as we would be seeing MA patients, but at least we could help those poor people that you dentists kicked out."
 
Originally Posted by aphistis
Because what nobody is mentioning here is that this boy's life meant little enough to his mother that she wasn't willing to spend $50 of her cigarette money to have it extracted. It'd be nice to have it done at a clinic where her Medicaid applied, but if this kid's life was important enough that a bunch of complete strangers were morally bankrupt, according to you, for not going out of their way to get the problem taken care of, where does that place mom?

Go ahead and lay all the blame on the dentists if it makes you feel better, but if you seriously think that's the entire problem, you're either not paying much attention or you don't know as much about the issue as you think.
I'm pleased to see you've been paying such close attention.... FINALLY, someone has realized that all this time I've only been trying to blame the dentists! You guys should win some sort of intellectual award! Fabulous.
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So do you have a substantive response to the issues I pointed out, or did you really expect to get away with such a weak attempt at evasion? I personally suspect the latter, but I'm willing to give you a second chance.
 
jatt007 said:
Hi,
I think I am very late in the discussion and the decision might be made very soon. ... but from what I read in the thread I think three things are really needed to be added in the bill:
1) ADHP should be restricted to the underserved area.
2) ADHP should be "ONLY" or maybe "PRIORITIZE" taking the medicaid patients .
3) The IRReversible procedures should not be in the list of job duties.
The first two points are the real issues faced by non-insured people. and 3rd point is very much required due to lack of knowledge of ADHP and the harm they can do by doing those.
And for the curriculum.. I think they should have an entrance exam and also must have B.S. compulosry .. these might already be there.. but having (6.5) 4+2.5 yrs of study would still filter out the CC grads ....
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The damn shame of it all is that you put those clauses in there and you're not going to attract any more people to the field. Why? Because this is a capitalistic society...and the monetary allure just isnt there for these people. There is no hidden altruistic agenda here...it's all money driven. Why swap one group's greed for another who sacrificed less?

Sorry, I'm bitter, tired, 7 tests in the past 10 days that didn't go as well as they should have. Been writing emails all week...and now it's time to go make an appearance at the hearing tonight and support our profession. Wish us luck!

I encourage everybody to get a hold of an article entitled "The Economic Aspects of Unsupervised Private Hygiene Practice and Its Impact on Access to Care" from the ADA. It's a study showing how the increased autonomy of DH in Colorado has essentially done nothing to increase or improve quality or access to care.
 
quackdentist77 said:
I'm pleased to see you've been paying such close attention.... FINALLY, someone has realized that all this time I've only been trying to blame the dentists! You guys should win some sort of intellectual award! Fabulous.
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Isn't about time that this troll is banned? Adds nothing to the discussion.

troll-web.jpg
 
Taurus said:
Isn't about time that this troll is banned? Adds nothing to the discussion.

troll-web.jpg
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There isn't any trolling happening. quackdentist77 is holding a minority view (and I clearly disagree with her as strongly as anyone here), but disagreeing with us and sticking to her guns doesn't make her a troll. As long as everyone plays by the terms of service, everything's fine.
 
quackdentist77 said:
I'm pleased to see you've been paying such close attention.... FINALLY, someone has realized that all this time I've only been trying to blame the dentists! You guys should win some sort of intellectual award! Fabulous.
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Wow.. I gues this is what you call a culture shock.
Back where I'm from, hygienists never dare speak to dentists in this way.
 
Are there going to be dental therapists and ADHP? I was just wondering. I read some of the midlevel providers' (medicine) post. All these CRNA's and NP's brag about how they can go to school for six years and get paid the same as family practice doctors. They all said, "Why waste your time in med school and rack up loans and you can go to NP school? You can diagnose and treat effectively as the physician." My favorite part: "Results show the same number of patients died under our care comparing to the physician." Expect these comments from ADHP. They will say, "These idiots are wasting their precious time in dental school, and they can go to dental hygiene school and then the master program. You would be in less debt."
 
blissdental said:
Wow.. I gues this is what you call a culture shock.
Back where I'm from, hygienists never dare speak to dentists in this way.
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Then go back to Korea where no one is equal and everyone is judged by how much money they make and what schools they went. What the hell are you doing in the U.S.?
 
jlc111 said:
Then go back to Korea where no one is equal and everyone is judged by how much money they make and what schools they went. What the hell are you doing in the U.S.?
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Stay on topic and stay civil, please. Remarks like this have no place in this or any discussion.
 
red88m said:
Which masters programs don't require a bachelors first? I've never heard of any- can you show us these?
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There are many 3 year NP programs that you can attend where you get your bachelors during your studies towards your masters. These programs do not require you to have a bachelors prior to matriculation into the masters program.
 
I just stumbled in this debate and I can see both sides of the argument. Honestly...the dentists should have seen this coming and let it get to far already. You all should have limited the scope of what DH can do a long time ago and kept em in their place lol (jk). At the highschool I work at, the parents only want to come out once they find out the football program is about to be shut down, when it was discussed for several PTO meetings throughout the entire previous year.

I mean honestly...Hygenists make enough where I am jealous and just the term 'hygenists" already sounds autonomous ...throw an 'assistant' in their title :) (jokes!!!).
The way we as human's work is that we equate money with self worth, you pay a teachers aide 9/10 of what you pay a teacher what do you think will happen, they will want to run the show. I am sure plenty of TA's are capable but of being teachers but we implemented this systems and many systems in healthcare as a ceremonial 'rites of passage'. All Healthcare professions can use the 7-8 years of training to justify their incomes but lets be honest, most of us will forget half of the info we learn from school. I have a B.S. in Neuroscience and Behav bio from a top a top 25 Univ(been over 4 years now), but my little sister taking basic cognition classes as a sophomore at UM would own me. This all about all about Turf and you gave the DH's the proverbial 'inch' and they are now requesting the "mile'

I think the one question that has been raised that no DH has answered is what about Dental Assis start creeping in on their already limited scope of practice? Would you like that? Healthcare and higher education is all about turf and protecting it. Otherwise, we'd have paralegals defending cases since they are good 'orators', PA's performing heart transplants because they are good with their hands and pharm tech's checking meds because they know Viagra is the blue pill.
 
Thanks kato for the article. And many thanks to all the dental students showing up to try and oppose the bill (I hope there are dentists showing up too). What is it with these hygienists in MN? Do they not make enough money up there scraping teeth that they feel the need to spend all this energy trying to branch out and play doctor?
 
I really wish they would have had this program 4 years ago before I decided to quit my job as an RN, uproot my family, move them 2500 miles across the country, find another job as an RN so I could work to pay the bills while going to dental school, find new schools for my kids, get them up at 6:30 every day so they can get on the bus, and listen to how unhappy my wife is with her new job and how she misses her family. Boy, if I could have just taken this route and saved myself 2 years instead of becoming a DDS it would have been so much easier. Hopefully everyone can hear the sarcasm in this post. By the way I am 34 years old. I don't have a problem with mid-level practitioners but they need to have their place and that place needs to be written into law. Also, how are these programs going to be funded, by our tax dollars or are Advanced Hygeine programs going to be popping up at every private school across the country charging 45-50k each year for tuition?
 
KOM said:
The damn shame of it all is that you put those clauses in there and you're not going to attract any more people to the field. Why? Because this is a capitalistic society...and the monetary allure just isnt there for these people. There is no hidden altruistic agenda here...it's all money driven. Why swap one group's greed for another who sacrificed less?

Sorry, I'm bitter, tired, 7 tests in the past 10 days that didn't go as well as they should have. Been writing emails all week...and now it's time to go make an appearance at the hearing tonight and support our profession. Wish us luck!

I encourage everybody to get a hold of an article entitled "The Economic Aspects of Unsupervised Private Hygiene Practice and Its Impact on Access to Care" from the ADA. It's a study showing how the increased autonomy of DH in Colorado has essentially done nothing to increase or improve quality or access to care.
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I wish you all very good luck in defending the profession. Also I would like to thank you and all the supporters in this situation. I would have contributed more if I was not in Canada. I think you all are doing your best and we will be thankful to you all if we could stop this bill from being passed without any amendments. I hope that we turn proponents into opponents, and also the undecided votes to be opponents with all our very just and reasonable and practical reasonings. This bill should not be passed as it is, else it would be a disaster as we can see it clearly. At least we should stick to the underserved area and un-insured patients access, and also non-inclusion of surgical processes, as I posted before and also as suggested in the article on ADA posted by Kato (thanks for that)... All the best and keep strong.. we should not let them do this.. :thumbup:
 
Any news? what happened yesterday at the hearing?
 
gryffindor said:
"Seeing that
dentists are turning away MA patients because of the rates, it is my
belief and that of many supporters of the bill that ADHP trained
individuals will be more accepting of MA patients, thus expanding access to
care."

Sincerely,
Rick Olseen
State Senator District 17
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What is his reason for thinking this? Why does he think that an ADHP would be more willing to take MA patients? They can make more money as a hygenist than treating MA. And the ADHP's know this. That is why there is nothing in this bill that mandates them seeing the underserved even though that is their pedestal.

On another note - I have seen a lot of attacks on quackdentist. She is not the one to blame. It does no good to belittle her. She is seeing an opportunity to expand her career and possibly her income. Just like all of us she wants to provide the most she can for her family and herself. Do not blame her for this bill - blame the lawmakers.
 
rrc said:
What is his reason for thinking this? Why does he think that an ADHP would be more willing to take MA patients? They can make more money as a hygenist than treating MA. And the ADHP's know this. That is why there is nothing in this bill that mandates them seeing the underserved even though that is their pedestal.

On another note - I have seen a lot of attacks on quackdentist. She is not the one to blame. It does no good to belittle her. She is seeing an opportunity to expand her career and possibly her income. Just like all of us she wants to provide the most she can for her family and herself. Do not blame her for this bill - blame the lawmakers.
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The reply from the State senator is EXACTLY why dentistry can't get up in arms about an ADHP doing "irreversible" procedures, but they seriously need to focus on the dollars and cents part! This senator seems unaware of what the current hygiene provider(likely the first batch of potential ADHP's) makes an hour and seems to think that they'll just give up their larger hourly rate that they're currently earning in the private practice setting and jump over to both lower pay AND more responsibility that an ADHP in a public setting would incur. Especially in a time when if anything in a decent amount of the country, there's a high demand for MORE of those higher paying, less responsibility hygiene positions. The elected officials grandeose views of the ADHP as the cure for access to care has 1 major problem, FUNDING. Plain and simple, it will need significant subsidies from government sources to effectively operate the number of clinics needed to make anything resembling a dent in the acces to care problem. Whereas if you took those same dollars and committed them to a more reasonable medicaid fee schedule, you'd see a heck of alot more dentists participating to some degree with medicaid programs and likely a much greater quantity of care given over a wider geographic area this way than via the ADHP.

Most elected officials don't understand dentistry, they DO understand our tax dollars though.
 
rrc said:
What is his reason for thinking this? Why does he think that an ADHP would be more willing to take MA patients? They can make more money as a hygenist than treating MA. And the ADHP's know this. That is why there is nothing in this bill that mandates them seeing the underserved even though that is their pedestal.

On another note - I have seen a lot of attacks on quackdentist. She is not the one to blame. It does no good to belittle her. She is seeing an opportunity to expand her career and possibly her income. Just like all of us she wants to provide the most she can for her family and herself. Do not blame her for this bill - blame the lawmakers.
Click to expand...
I totally agree... The bill should say that ADHP WOULD ONLY/MOSTLY BE serving Medicaid patients... otherwise..if they have the choice for their target patients, why would they choose lower reimbursement for their expensive treatment by taking in MA patients??... Therefore the "mandate" of serving the Medicaid/underserved patients is needed in the bill. I hope we had a positive outcome from the hearing yesterday.. any news yet??
 
It interesting to watch predents and dental students debate a topic that have little understanding of. We as dentists have inadvertently created this problem by not addressing it when it first came up. Ask ourselves, are we boycotting the expansions of auxillaries because we spent 200K on an education and fear we won't make a great living or is it because we are genuinely concerned about the welfare of others? The ADA has been an embarrassment as far as professional representation on this topic and it saddens me sometimes to call myself a member. Instead of coming up with solutions, we decide to take the role of whiners who just say no you can't do that. If we don't act as a profession to provide basic life sustaining access to dental care the gov't will intervene and you are now seeing the effects of this. If you've done private practice you'll know that the majority of patients are seeking a standard of care far different from the low/no income. I don’t philosophically believe that everyone is entitled to dentistry but the politicians do so we need to move forward to accommodate them on some level. Keep in mind too that children can’t pick who their parents are so I have a bigger heart for them than some piece of crap that wants to sit on their porch all day and collect a check. The people and the politicians just want the bare basics such as amalgams and extractions to keep them from dying from dental infections. These aren't the people you want as patients as they can't keep appointments and are best served as emergency/walk-in basis. Once these super-hygienists are trained it's impossible to tell them they can only work in certain areas. Do we have PA's that only work in certain areas?

You need to learn about market segmentation before you can have an educated discussion on providing access to care. In every other market outside of healthcare from restaurants to department stores, there are different levels of delivery. In cars, you can buy a Mercedes(aka-high end cosmetic dentistry) or a Hondai(dental HMO's). These people asking for care just want the lowest level, piece of crap car that's going to get them from point A to point B without dying along the car ride. We as dentists are so afraid that we're not going to be able to sell our average car (Honda for example) that we get all protective and just say no to the politicians. This just creates more hatred towards our profession and increases the likelihood of an outcome that is even more restrictive on our livelihoods. The ironic thing is that unless there's some kind of protection of the super-hygienists the malpractice lawyers will have a field day with them. As GPs are held to the same standard of care as specialists, so to will the auxillaries be held to that of the GPs in the court of law. Also, the gov't will realize very quickly that costly it is to operate a practice run by auxillaries.

My point is don't just write to your politicians and say no that's not fair. Brainstorm and kick the ADA people in the butt to bring about change. This is just an idea but how bout setting up bare bones gov’t satelite dental offices or increase the capacity of GPRs then encourage politicians to offer tax incentives to dentists donating time. Or make GPRs mandatory. Here in pennsylvania we have EFTAs which can greatly increase the workload a dentist is capable of as they place the fillings... so maybe expand this nationally. Personally, I just don't think that super-hygs are a great threat they're made out to be. It's just brain-dead politicians overreacting to the situation at hand to the lack of perceived access to care. The biggest thing we should be voicing about is lack of pt education not lack of care. Dentistry is 95% preventable and yet we should not be held liable for these individuals that refuse to take care of themselves. Socialized medicine fails because it perpetuates the mentality that one is not responsible for ones own health. Once the gov't tries running these shops without a dentist, they're soon realize why dentists are saying their med assistance fees are too low. It’s very expensive to treat these people especially when the can’t make their appointments half the time.

'Never expect a man to take a stance to that which he believes adversely affects that which goes into his own pocket at the end of the day.'
-Ben Franklin
 
pietrodds said:
My point is don't just write to your politicians and say no that's not fair. Brainstorm and kick the ADA people in the butt to bring about change. This is just an idea but how bout setting up bare bones gov’t satelite dental offices or increase the capacity of GPRs then encourage politicians to offer tax incentives to dentists donating time. Or make GPRs mandatory. ]
Click to expand...

How about 5 years dental training at all state supported dental schools ? In their 5th year, all dental students who receiving in-state tuition are required to work at the clinic in federal designated underserved areas. Problem solved :):)
 
jatt007 said:
Hi,
I think I am very late in the discussion and the decision might be made very soon. ... but from what I read in the thread I think three things are really needed to be added in the bill:
1) ADHP should be restricted to the underserved area.
2) ADHP should be "ONLY" or maybe "PRIORITIZE" taking the medicaid patients .
3) The IRReversible procedures should not be in the list of job duties.
The first two points are the real issues faced by non-insured people. and 3rd point is very much required due to lack of knowledge of ADHP and the harm they can do by doing those.
And for the curriculum.. I think they should have an entrance exam and also must have B.S. compulosry .. these might already be there.. but having (6.5) 4+2.5 yrs of study would still filter out the CC grads ....
Click to expand...

I have a huge problem with that one - please explain you rationale
 
jatt007 said:
Any news? what happened yesterday at the hearing?
Click to expand...

March 14, 2008
Legislative Committee Update
UPDATE ON THE ADHP BILL

LAST NIGHT SF 2895 WAS PASSED BY THE SENATE HEALTH FINANCE COMMITTEE
5-3. SENATOR LINDA BERGLIN, COMMITTEE CHAIR AND A STAUNCH ADVOCATE OF
THE ADVANCED DENTAL HYGIENE PRACTITIONER, SEVERELY LIMITED OUR
OPPOSITION TESTIMONY TO THE POINT THAT OUR CONCERNS WERE NEVER
ADEQUATELY ADDRESSED. THE BILL NOW GOES ON TO THE SENATE FINANCE
COMMITTEE, AS YET UNSCHEDULED.

ONCE AGAIN, THE HEARING ROOM WAS FILLED TO OVERFLOWING WITH NUMEROUS
DENTAL STUDENTS AND DENTISTS. OPPOSITION TESTIMONY WAS GIVEN BY DR.
JAMIE SLEDD, MDA PRESIDENT AND DR. ROCHELLE AVENT-HASSAN, DIRECTOR OF
NORTH POINT HEALTH AND WELLNESS CENTER (A COMMUNITY CLINIC IN
NORTHEAST MINNEAPOLIS).

IN VERY ELOQUENT TESTIMONY, DR. TONY DIANGELIS, DENTAL DIRECTOR OF
HENNEPIN COUNTY MEDICAL CENTER, INDICATED THAT EVEN THOUGH HCMC IS
PART OF THE “SAFETY NET COALITION,” HE DOES NOT SUPPORT
THIS BILL. RECOGNIZING THE SEVERITY OF THE DENTAL ACCESS PROBLEM, HE
GAVE COMPELLING, HEART-FELT STATEMENTS ABOUT THE VERY NEGATIVE EFFECT
THIS BILL IS HAVING ON THE DENTAL TEAM.

SENATOR YVONNE PRETTNER SOLON (DFL-DULUTH) OFFERED AN AMENDMENT TO
DELETE ALL OF THE LANGUAGE IN THE BILL, WHICH WOULD HAVE EFFECTIVELY
HAVE KILLED THE BILL, AND TO SUBSTITUTE FOR THE ADHP SAYING THAT THE
UNIVERSITY OF MINNESOTA ACADEMIC HEALTH CENTER IS REQUESTED TO
PREPARE A COMPREHENSIVE PLAN FOR CREATING A NEW MID-LEVEL DENTAL
PRACTITIONER BASED IN THE SCHOOL OF DENTISTRY. THE UNIVERSITY OF
MINNESOTA WAS NOT ALLOWED TO SPEAK TO THE AMENDMENT. THE AMENDMENT
FAILED TO PASS ON A TIE VOTE OF 4-4.

THE MINNESOTA DENTAL ASSOCIATION AND OUR ALLIES CONTINUE TO
VIGOROUSLY OPPOSE THE ADHP BILL AND WORK HARD TO DEFEAT IT. THE
STEPPED UP GRASSROOTS EFFORTS ON THE PART OF PRACTICING DENTISTS ARE
DEFINITELY HAVING A POSITIVE IMPACT. BUT, THIS LOOKS TO BE A DRAWN
OUT, PAINFUL FIGHT.

DURING THE HEARING LAST NIGHT, THE POSITION OF THE MDA WAS GROSSLY
MISCHARACTERIZED BY THE SPONSORS OF THE LEGISLATION. THEY CLAIMED
THAT THE MDA HAD AGREED TO NUMEROUS CONCESSIONS…WHICH WE HAD
NOT. THE MDA AND ADA WILL CONTINUE TO OPPOSE THIS BILL AS LONG AS IT
INCLUDES UNSUPERVISED SURGICAL PROCEDURES.

WE ASK THAT YOU STAY ACTIVE, AND CONTINUE TO CONTACT LEGISLATORS
ABOUT YOUR CONCERNS.

USE THIS LINK TO CONTACT MEMBERS OF THE SENATE FINANCE COMMITTEE.
HTTP://WWW.SENATE.MN/COMMITTEES/COMMITTEE_BIO.PHP?CMTE_ID=1007&LS=85
LEGISLATIVE AFFAIRS COMMITTEE
 
KinKs said:
I have a huge problem with that one - please explain you rationale
Click to expand...

There is no rationale for it and it unenforceable. You can't have two levels of care for different areas. Spoken like someone that doesn't understand 'standard of care'... a preDent I presume? Whatever bills get passed in whatever state, you can be certain that it will eventually trickle down to a state near you.
 
r_u_cool2 said:
March 14, 2008
Legislative Committee Update
UPDATE ON THE ADHP BILL

LAST NIGHT SF 2895 WAS PASSED BY THE SENATE HEALTH FINANCE COMMITTEE
5-3. SENATOR LINDA BERGLIN, COMMITTEE CHAIR AND A STAUNCH ADVOCATE OF
THE ADVANCED DENTAL HYGIENE PRACTITIONER, SEVERELY LIMITED OUR
OPPOSITION TESTIMONY TO THE POINT THAT OUR CONCERNS WERE NEVER
ADEQUATELY ADDRESSED. THE BILL NOW GOES ON TO THE SENATE FINANCE
COMMITTEE, AS YET UNSCHEDULED.

ONCE AGAIN, THE HEARING ROOM WAS FILLED TO OVERFLOWING WITH NUMEROUS
DENTAL STUDENTS AND DENTISTS. OPPOSITION TESTIMONY WAS GIVEN BY DR.
JAMIE SLEDD, MDA PRESIDENT AND DR. ROCHELLE AVENT-HASSAN, DIRECTOR OF
NORTH POINT HEALTH AND WELLNESS CENTER (A COMMUNITY CLINIC IN
NORTHEAST MINNEAPOLIS).

IN VERY ELOQUENT TESTIMONY, DR. TONY DIANGELIS, DENTAL DIRECTOR OF
HENNEPIN COUNTY MEDICAL CENTER, INDICATED THAT EVEN THOUGH HCMC IS
PART OF THE "SAFETY NET COALITION," HE DOES NOT SUPPORT
THIS BILL. RECOGNIZING THE SEVERITY OF THE DENTAL ACCESS PROBLEM, HE
GAVE COMPELLING, HEART-FELT STATEMENTS ABOUT THE VERY NEGATIVE EFFECT
THIS BILL IS HAVING ON THE DENTAL TEAM.

SENATOR YVONNE PRETTNER SOLON (DFL-DULUTH) OFFERED AN AMENDMENT TO
DELETE ALL OF THE LANGUAGE IN THE BILL, WHICH WOULD HAVE EFFECTIVELY
HAVE KILLED THE BILL, AND TO SUBSTITUTE FOR THE ADHP SAYING THAT THE
UNIVERSITY OF MINNESOTA ACADEMIC HEALTH CENTER IS REQUESTED TO
PREPARE A COMPREHENSIVE PLAN FOR CREATING A NEW MID-LEVEL DENTAL
PRACTITIONER BASED IN THE SCHOOL OF DENTISTRY. THE UNIVERSITY OF
MINNESOTA WAS NOT ALLOWED TO SPEAK TO THE AMENDMENT. THE AMENDMENT
FAILED TO PASS ON A TIE VOTE OF 4-4.

THE MINNESOTA DENTAL ASSOCIATION AND OUR ALLIES CONTINUE TO
VIGOROUSLY OPPOSE THE ADHP BILL AND WORK HARD TO DEFEAT IT. THE
STEPPED UP GRASSROOTS EFFORTS ON THE PART OF PRACTICING DENTISTS ARE
DEFINITELY HAVING A POSITIVE IMPACT. BUT, THIS LOOKS TO BE A DRAWN
OUT, PAINFUL FIGHT.

DURING THE HEARING LAST NIGHT, THE POSITION OF THE MDA WAS GROSSLY
MISCHARACTERIZED BY THE SPONSORS OF THE LEGISLATION. THEY CLAIMED
THAT THE MDA HAD AGREED TO NUMEROUS CONCESSIONS…WHICH WE HAD
NOT. THE MDA AND ADA WILL CONTINUE TO OPPOSE THIS BILL AS LONG AS IT
INCLUDES UNSUPERVISED SURGICAL PROCEDURES.

WE ASK THAT YOU STAY ACTIVE, AND CONTINUE TO CONTACT LEGISLATORS
ABOUT YOUR CONCERNS.

USE THIS LINK TO CONTACT MEMBERS OF THE SENATE FINANCE COMMITTEE.
HTTP://WWW.SENATE.MN/COMMITTEES/COMMITTEE_BIO.PHP?CMTE_ID=1007&LS=85
LEGISLATIVE AFFAIRS COMMITTEE
Click to expand...
Thanks for the update..it passed without any amendments.. not happy.. but we need to keep trying..good luck ..
 
This is claimed by ADHP proponents here that the ADHP's would be a solution to the problems in underserved area ... and they wont do it,, for sure ..
KinKs said:
I have a huge problem with that one - please explain you rationale
Click to expand...
 
They have went too far when they said that ADHP could extract teeth. That's a surgical procedure. They should be supervised. If you want to be an ADVANCED DENTAL HYGIENE PRACTITIONER, at least do some procedures that is kind of related to that. Teeth extraction is not one of them. Periodontal treatment is fine. It's kind of related. If they practice independently without a dentist involved, it would be kind of stupid. Why would you put yourself in a big liability risk by doing the same procedures as the dentists by yourself and you went to school for six years? For example, a general dentist do some complex procedures and he could of refer his patients to a specialist. He screwed up. He charged less for the procedure but he has to pay the same amount in the liability as the specialist. Not literally pay because you have malpractice insurance but you get the picture.The point is you would be in the same liability risk as the dentist even if you went to school in less time. I could be wrong. If I want to be ADHP, I want to be supervised. You can do whatever come to mind with a dentist involved. If you want to be unsupervised, they are going to try their best to limit your practice. I don't know. Maybe it's not the best solution. This is based on what I know so far. The same goes for nurse practitoner. They claimed that they are applying a nursing model to their practice. I don't know how you can apply nursing to diagnosing and writing prescriptions. That's straight up medicine in my opinion.
 
KinKs said:
I have a huge problem with that one - please explain you rationale
Click to expand...

The rationale is that the ADHP was created under the guise of the underserved not having access to care. Then the bill was written to including NOTHING about any kind of mandatory treatment of the very population they claim to care about.

This bill was also created with the help of dentists who are proponents of this legislation. Some say the reason is due to kickbacks from select insurance providers as incentive for their help and cooperation. The thinking being that coverage will require the insured to first see a mid-level provider at a reduced fee and the GP will then require a referral from the ADHP.
 
If the ADHP gets approved it will surely be a situation where they can practice anywhere. There's no other medical field where certain practioners can only practice within certain geographical confines. What will almost certainly happen is that if and when the ADHP passes, the schools will open, the grads will get out and start practicing whereever they say they can, and then they'll realize how difficult it is to determine what parameters are necessary to define what is an underserved area. Then the gov't will say we already set up all this stuff and have the people trained to do it so let's just open it up and make it viable everywhere. If they go through all the BS to get this thing pushed through then I think they should make it acceptable everywhere. Look at urban areas for instances where in one area of low income housing you have a high need for this service and then four blocks away in the business district you have high end cosmetic offices going. It's impossible to draw lines and say this is where you can and can't practice. My point is that if we don't find alternatives as a profession the politicians are going to push this through to appease their constituents. When the see how expensive the overhead of an office is to maintain a semblence of any type of quality with patients that no-show 40% of the time they'll finally realize why dentist gripe about treating these people at the rates the med assistance program reimburse. I was seeing these patients at 100% of our rates in the office I was working in because the state couldn't get anyone else to take them and it still wasn't cost effective because of the high failed app't rate. Gov't is looking for the easy fix and there is none. 25% of dentists in private practice who haven't done GPRs I would guess-timate are not adequately trained to do significant oral surgery and now we're looking at someone with even less training to do it? Sounds like a recipe for disaster and I'm surprised oral surgeons aren't taking a stronger stance on this... probably too busy sticking implants in jaws to care.
 
My colleague Taurus has already spoken eloquently about how these ADHPs will try to replicate the NPs and CRNA model for stealing turf. So I wont belabor that point anymore.

But I also want to point out that there's more at stake than just duplicitous midlevels expanding scope. They will also expand their DEGREE too.

Sure, they'll start out as a bachelors or masters program, but I guarantee you that 10 or 15 years down the road, they'll start floating proposals for "doctorate" ADHP programs. Think I'm joking?

Consider this--every single midlevel position has started out as a bachelors/masters and later expanded to doctoral programs. Not just 10% of them, not half of them. EVERY SINGLE ****ING ONE OF THEM HAS EXPANDED INTO DOCTORATES.

Now, its happening with the NPs and the PAs too. I guarantee you that the ADHPs will try the same thing. Its only a matter of time. They'll use that degree to expand scope further, hell they'll even go after the dental subspecialties like OMFS and orthodontics.
 
MacGyver said:
My colleague Taurus has already spoken eloquently about how these ADHPs will try to replicate the NPs and CRNA model for stealing turf. So I wont belabor that point anymore.

But I also want to point out that there's more at stake than just duplicitous midlevels expanding scope. They will also expand their DEGREE too.

Sure, they'll start out as a bachelors or masters program, but I guarantee you that 10 or 15 years down the road, they'll start floating proposals for "doctorate" ADHP programs. Think I'm joking?

Consider this--every single midlevel position has started out as a bachelors/masters and later expanded to doctoral programs. Not just 10% of them, not half of them. EVERY SINGLE ****ING ONE OF THEM HAS EXPANDED INTO DOCTORATES.

Now, its happening with the NPs and the PAs too. I guarantee you that the ADHPs will try the same thing. Its only a matter of time. They'll use that degree to expand scope further, hell they'll even go after the dental subspecialties like OMFS and orthodontics.
Click to expand...
You don't even have to wait 10-15 years. Check out www.adha.org and you'll see they're already openly planning for their "hygiene doctorate" curricula.
 
Liability has been mentioned a few times. I don't believe that liability potential is that much of a deterrment in dentistry as it is in medicine. Death and serious injury are much more common and likely if the physician screws up than if a the dentist screws up. You can repair's someone's smile with fillings, implants, etc. If someone has brain damage, nothing in the world can fix that. Some ob-gyn's pay up to 80k or more for malpractice insurance per year.

That's why the ADHP will eventually push hard for autonomy and equal scope with dentists without much worry about liability.

The solution to the ADHP is:
1) Don't hire them.
2) Promote their counterpart, the dental assistants. Never, ever rely on one group. Play them off each other.

The pattern that the ADHP is following is eerily similar to the NP's and CRNA's, even down to the "doctorate" that they have for themselves. Keep in mind that their "doctorate" is a joke because it consists of just a bunch of research seminar classes. If the ADHP does gain traction, expect more and more people interested in that path, especially if they can call themselves "Dr.", because it will be an easier path.
 
A doctorate for a CRNA, doesn't that just defeat the entire point of why the profession was created in the first place!?!

A doctorate in hygiene, no disrespect to hyg but you have go to be kidding me! It's a job that requires a 2 year assoc degree from community college. If you want to further your education then go for the bachelor's degee. But a freakin' Ph.D... we already have them anyways, they're called PERIODONTISTS. If I interviewed a hygienist and she put that on her resume, I'd laugh out loud and promptly toss it in the can... actually maybe I'd call her just to see what the deal was as to why she didn't just go to dental school in the first place out of curiosity. I can only imagine the ego of a phD hygienist running around and office. She's probably too good in her mind to do prophies on anyone under the age of 18 and wants to do subgingival cultures on every patient. God help the whole profession if there's a bunch of these folks running around, ADHP will look like a walk in the park compared to these people.
 
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