"Smitty" Pignatelli: A way to assure dental care for all

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LENOX >> Last year, 47 percent of children with MassHealth coverage — more than 300,000 kids — did not see a dentist. Additionally, 59 percent of seniors in long-term care facilities have untreated dental disease. That is simply unacceptable, and is why Sen. Harriette Chandler and I have filed and advocated on behalf of a state policy change which evidence has shown improves access to quality care for children, the elderly, and low-income people.

S2076, the bill that Sen. Chandler and I filed together, would authorize a new type of dental professional in the commonwealth: a Dental Hygiene Practitioner (DHP). These dental providers — similar to physician assistants — would work under the supervision of a dentist and perform routine, critically needed care such as filling cavities and pulling badly diseased teeth. Similar providers have been practicing successfully in Minnesota and Alaska for years, expanding care to people in rural communities, reducing wait times, and improving the ability of dentists to treat more low-income patients.

The Health Policy Commission recently released preliminary findings which found that people insured through MassHealth disproportionately go to the emergency department for preventable oral health conditions, and the Berkshires has the second-highest rate of hospital visits for dental conditions in the state. Put another way, people in the Berkshires and across Massachusetts aren't getting the dental care they need, and they end up in the emergency room because they are experiencing pain that could have been prevented if they had received regular dental care.

Dental access is a particular problem in the Berkshires in part because we are more geographically dispersed than other parts of the state and have little public transportation, so it is harder to get to the dental office. We also have an aging population of dentists with little help on the way.

Consider these facts: nearly half the dentists in the Berkshires are nearing retirement, our county only has two percent of all private dental practices in the state, and dental students are now facing hundreds of thousands of dollars in loan debt. That's a recipe for a severe dental provider shortage for our region.

Additionally, many dentists in the Berkshires and across the state (79 percent) are not active MassHealth Providers, meaning they either do not accept MassHealth patients or they have a few established MassHealth patients and are not accepting any more. In other words, if you have MassHealth in the Berkshires and you're trying to access dental care, you are likely to be turned away by roughly 4 out of the 5 dentist offices that you call.

Saddened by foes

The bottom line is that we will have fewer dentists in the future, and the dentists we have now are often picking and choosing their clients. Therefore, it saddens me that the primary organized opposition to this bill has been from dentists. Many dentists are not serving people who are in need, but they don't want someone else — even a type of provider that a recent meta-analysis of studies around the world found do good, safe work — filling a simple cavity before it becomes an abscess and lands someone in the ER.

Several weeks ago, the Berkshire District Dental Society and the Massachusetts Dental Society took out a full page ad in the Sunday Berkshire Eagle. The ad commends me for bringing attention to oral health care, but says that I have it wrong: this legislation will not fix the problem by getting care to those who need it. However, of the 39 Berkshire County dentists who signed the ad, only 19 of those dentists are general dentists, and of those general dentists, only three are currently accepting new MassHealth patients.

In fairness to dentists, the reason so many of them will turn you away is that MassHealth pays significantly less money for the same services than private insurers, so it is very difficult for a dentist to make a living providing care to only MassHealth patients. However, public reimbursement rates will never catch up with private rates, and Massachusetts already has one of the highest Medicaid reimbursement rates for dental care in the country.

That is why we need a creative, evidence-based solution to this problem, and creating a mid-level provider has been shown to increase access to care, especially for the neediest populations. That is why Maine and Vermont recently passed bills to create a similar mid-level dental provider.

Sen. Chandler and I invited the Massachusetts Dental Society to sit down and talk to us about how we can make this legislation stronger, because we value their expertise. However, after a lengthy negotiation session, which, at the time, both sides agreed had been productive, the Dental Society said it no longer wished to talk with us.

I was saddened by that development, but there is always resistance to change in how medical care is delivered. Just as doctors resisted the creation of physician assistants and nurse practitioners, dentists are now fighting the creation of a mid-level dental provider. But if we are going to provide quality care to everyone who needs it, we need innovative solutions, and evidence from other states and around the world shows that this approach works.

There is no silver bullet that will magically get care to everyone in need, but this is a piece of the puzzle, and I will continue to fight for this strategy as a piece of the larger fight for dental care for all.

"Smitty" Pignatelli is state representative, 4th Berkshire District.


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