Senate HCR & Advance Dental Hygenist Practitioner

[The Anhedonia]

i know this topic has been thrown around before, but it was only on a state by state basis. Now, the Senate version of the Healthcare Reform Bill institutes the establishment of Advanced Dental Hygenists:

SEC. 434. ALTERNATIVE DENTAL HEALTH CARE PROVIDERS DEMONSTRATION PROJECT.

sec 304h, lines 8 - 20
The Secretary is authorized to award grants to 15 eligible entities to enable such entities to establish a demonstration program to establish training programs to train, or to employ, alternative dental health care providers in order to increase access to dental health care services in rural and other underserved communities.
‘‘(2) DEFINITION.—The term ‘alternative dental health care providers’ includes community dental health coordinators, advance practice dental hygienists, independent dental hygienists, supervised dental hygienists, primary care physicians, and dental therapists.

any thoughts as to the implications of this?

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[The Anhedonia]

for reference, the current version of the bill can be found here:
http://help.senate.gov/BAI09A84_xml.pdf

 

[gryffindor]

The hygiene association is probably all over this and lobbying their reps right now while the ADA is busy planning the next GKAS gala.

 

[DrJeff]

The hygiene association is probably all over this and lobbying their reps right now while the ADA is busy planning the next GKAS gala.

Minnesota opened the flood gates on an ADHP. The reality is there will be more and more states and/or nationwide ADHP's over the next decade or so. The key will be to control the scope of practice. Additionally, atleast in the short run, the generalized massive state + federal budget deficits will in all likelyhood work in the favor of slowing the implementation of an ADHP since funding for the creation of the training programs and then the likely needed subsidies to keep them up and running is low, and as my local congressman put it at a fundraiser for him a couple of weeks ago, "when it comes to extra dollars and oral health, you guys are directly competing with the primary care general health guys right now"

 

[The Anhedonia]

the generalized massive state + federal budget deficits will in all likelyhood work in the favor of slowing the implementation of an ADHP since funding for the creation of the training programs and then the likely needed subsidies to keep them up and running is low

i was under the impression that part of the overall goal of this implementation was a cost-saving measure. by virtue of the fact that an ADHP would not be a fully qualified dentist, they wouldn't be reimbursed the same, so shouldn't that cut costs?

i admittedly don't understand the implications of this....

 

[DrJeff]

i was under the impression that part of the overall goal of this implementation was a cost-saving measure. by virtue of the fact that an ADHP would not be a fully qualified dentist, they wouldn't be reimbursed the same, so shouldn't that cut costs?

i admittedly don't understand the implications of this....

Insurance companies reimburse per procedure code, not based on the type of provider that does the procedure.

Doesn't matter if a nurse practitioner or an ER Doc sutures your finger in the ER, the hospital still bills the same amount to the insurance company.

What a mid-level provider, in theory, does is increase the number of providers that are treating, thus increasing access to care. The side effect is that for many "basic" things(especially in the lower fee medicaid population) the mid-level can accomplish them, thus freeing the more highly trained Doc up to do more technical procedures without having to bring in more Docs at a higher compensation level (in theory).

The problem often is that at the lower medicaid reimbursement rates, combined with what is often the slower speed of the mid level provider, a mid level provider often needs subsidies to not practice at an operating loss.

 

[The Anhedonia]

The problem often is that at the lower medicaid reimbursement rates, combined with what is often the slower speed of the mid level provider, a mid level provider often needs subsidies to not practice at an operating loss.

So how will an ADHP clinic be viable then? I assume that procedural costs are the same for anyone performing specific procedures, as well as the cost of overhead and all that jazz. So if Medicaid reimburses a ADHP clinician at lower rates when facing the same costs as a dentist would (for comparable procedures), how will they even keep these operations open?

 

[tennischamp822]

.

 

[Cold Front]

Insurance companies reimburse per procedure code, not based on the type of provider that does the procedure.

Doesn't matter if a nurse practitioner or an ER Doc sutures your finger in the ER, the hospital still bills the same amount to the insurance company.

What a mid-level provider, in theory, does is increase the number of providers that are treating, thus increasing access to care. The side effect is that for many "basic" things(especially in the lower fee medicaid population) the mid-level can accomplish them, thus freeing the more highly trained Doc up to do more technical procedures without having to bring in more Docs at a higher compensation level (in theory).

The problem often is that at the lower medicaid reimbursement rates, combined with what is often the slower speed of the mid level provider, a mid level provider often needs subsidies to not practice at an operating loss.

I was under the impression, if you are a specialist (say pedo), insurance would reimburse differently (lower) for GPs.

 

[tjaze]

I was under the impression, if you are a specialist (say pedo), insurance would reimburse differently (lower) for GPs.

actually, mid-levels in medicine like NPs or PAs get reimbursed less than an MD or DO for the same thing. i don't know how it works for dental things, but it sucks that mid-levels are trying to take over dentists jobs as well.
on a similar note, you guys won't have to worry as much about job security as physicians cause the ADA actually advocates for dentists' interests, unlike the AMA.

 

[DrJeff]

I was under the impression, if you are a specialist (say pedo), insurance would reimburse differently (lower) for GPs.

Nope, they reimburse the same fees for a GP as a specialists. Specialists tend to charge more though and as such the patient's co-pays are higher

 

[DrJeff]

actually, mid-levels in medicine like NPs or PAs get reimbursed less than an MD or DO for the same thing. i don't know how it works for dental things, but it sucks that mid-levels are trying to take over dentists jobs as well.
on a similar note, you guys won't have to worry as much about job security as physicians cause the ADA actually advocates for dentists' interests, unlike the AMA.

In dentistry now, it's the same. If I perform a cleaning on my patients or my hygienist perform a cleaning on my patients, the insurance company cuts my practice a check for the same amount

 

[DrJeff]

So how will an ADHP clinic be viable then? I assume that procedural costs are the same for anyone performing specific procedures, as well as the cost of overhead and all that jazz. So if Medicaid reimburses a ADHP clinician at lower rates when facing the same costs as a dentist would (for comparable procedures), how will they even keep these operations open?

ADHP's aren't designed to make $$, they are designed to put extra bodies in the chair to provide treatment. Most ADHP's are being designed to function in a publically subsized clinic in poor/rural areas where public money will subsize the more than likely operational loss that they will function at. In some high volume "dental mills" ADHP's will more than likely be incorporated as a cheaper alternative than hiring a dentist to perform basic restorations and periodontal therapies too.

As for the lower medicaid rates and business viability, there's a reason why there are so few, non publically subsized dental medicaid clinics in operation. When you reimburse in many places at typically less than 50 cents on the dollar for a procedure and your overhead is typically more than 50 cents on the dollar, that business model just doesn't work.

 

[Cold Front]

Nope, they reimburse the same fees for a GP as a specialists. Specialists tend to charge more though and as such the patient's co-pays are higher

It makes sense. I thought specialists had the edge when it came down to insurance compensating for specialty procedures (molar endo, wisdom teeth, etc). Although specialists can perform those procedures faster, they shouldn't be paid by insurance higher as well.