ASDA State Workforce Review September 23, 2011 Jon Holtzee, director – State Government Affairs.

ASDA State Workforce Review

September 23, 2011

Jon Holtzee, director – State Government Affairs

© 2011 American Dental Association, All Rights Reserved

11 States with Frontline Activity

• Kellogg– Vermont– Ohio– Kansas– New Mexico– Washington

• Pew– Maine– New Hampshire– California

• Others– Connecticut– Michigan– Oregon– Missouri


Vermont

• HB 398 – creates dental therapy– Two years of education

– Expansive scope

– To provide hygiene must have an additional year of hygiene education

– Supervision = collaborative agreement

– Dead for 2011• May 6th adjournment


Ohio

• No legislation to date– Kellogg grantee UCAHN has begun stakeholder

meetings across the state and media outreach.


Kansas

• HB 2208• SB 192

– Identical bills– Creates a registered dental practitioner– 18 months of education – Scope is expansive– Supervision = supervising agreement

– Dead for 2011• June 3rd adjournment


New Mexico

• HB 495– Created dental therapists, EFDAs, CDHCs &

therapy licensure for hygienists– Two years of education– Expansive scope– Supervision = dental therapy management

agreement– Therapist add hygiene w/1 added year & vice-

versa– Outlook for 2011 – Dead

• March 19th adjournment


Washington

• HB 1310– Creates dental therapy & advanced dental

therapy– Undefined initial education for basic; advanced =

hygiene license and completion of an ADHP type program

– Expansive scope; advanced adds hygiene– Supervision = collaborative management

agreement– Outlook for 2011 – Dead

• April 24th adjournment


Maine

• LD 266– Oral health practitioner

– Minimum of 750 hrs combined classroom & clinical

– Scope is expansive

– Supervision = 1 year of on-site supervision, then none

– Outlook for 2011 – Dead• June 15th adjournment


New Hampshire

• No legislation to date– On March 1st, Pew announced NH as the next

state in it’s dental workforce campaign

– Holding a series of six stakeholder meetings

– Final Report offers a “little bit for everyone”


California

• No legislation to date– The Pew Foundation is working with an organization

called “The Children’s Partnership” in a California Children’s Dental Workforce Campaign to enact a DHAT-style therapy model

– Other partners include the Atlantic Philanthropies, the Packard Foundation, the California Wellness Foundation, the Hilton Foundation, California Healthcare Foundation, First Focus, Verizon, the California Emerging Technology Foundation, the California Endowment and the Sierra Health Foundation.

– CDA Access Report to 2011 HOD


Connecticut

• HB 5616– Creates an ADHP “pilot” program– Education is an ADHP master’s program– Scope is expansive– Supervision = collaborative management agreement– Pilot to begin in Bridgeport on 01/01/2014 and end by

01/01/2015– Commissioner of Social Services reports on how to

expand by 07/01/2015– Outlook for 2011 – Dead

• June 8th adjournment


Oregon

• SB 227– Creates dental therapy

• Education – must have a hygiene license; other certification requirements undefined

• Expansive scope• Supervision = collaborative management agreement

– Outlook for 2011 – Held

• SB 738– Provides OHA with authority for pilots on workforce and

education pathways, CDHC, modifies Limited Access Permit Hygiene to Expanded Function Hygiene.

– Outlook for 2011 – Signed into law on August 2, 2011.• June 30th adjournment


Michigan

• No legislation to date– A faculty member from the Univ. of Michigan

School of Social Work is engaging stakeholders to foster a therapy model

– MDA worked with the individual and co-hosted a conference on Barriers to Care in August.


Missouri

• No legislation to date

• Dentist on the Dental Board advancing Minnesota style therapy program

• Greater Springfield Dental Society petitioned the Board to adopt therapist

• May 27th DOB endorsed therapist & ADHP for Governor to add to 2012 legislative agenda


Dental Care Delivery in the United States

• 182,000 practicing dentists (IOM, 2011)

– 82% are primary dental care providers (149,000)

• 79% general dentists• 3% pediatric dentists

– 93% in private practice• Of those, 90% are small practices with 1 or 2 dentists• Anticipated growth of 16% between 2008 – 2018 (BLS)

• 130,000 practicing dental hygienists– Most work as independent contractors or salaried

employees in dentists’ offices– 51% work part-time

• Anticipated growth of 36% from 2008 - 1018


Workforce Issues

• Size/number of providers• Distribution• Scope of practice• Supervision• Capacity/productivity• Composition

– Mix of providers– Characteristics (ethnicity, gender, etc.)

• Competencies (including cultural)• Participation in public programs• Delivery sites• Funding


Size/numbers of providers

• Often look at simple numbers– Growth of dental education

• End of the era of schools closing• Existing schools increasing capacity• New schools opening consistently; 9 between 1997 & 2011

– At least 8 other locations are developing or considering

– BLS estimate of 16% growth by 2018

– PPACA impact – Medicaid numbers not large, exchange impact could be


Scope of Practice

• A balance of comprehensive and analytical knowledge, technical ability, patient protection and politics


Supervisory Relationships

• One of the primary issues concerning dental workforce policy

• Semantics is a stumbling block

• Used to fully integrate the dental team

• Subject to review


Public Programs & the private sector

• No set of numbers will work if no one accepts public programs

• Private sector must be part of the solutions – it’s where the capacity exists– Medicaid

– CHIP

– Other programs


Medicaid Snapshot

• Percentage of Low-Income Children Receiving Dental Services, State by State– Pew Center on the States, The State of

Children’s Dental Health: Making Coverage Matter, May, 2011

• Between 2000 and 2009, only two states (FL and OH) saw the percentage of children receiving dental Medicaid services decline

• National increase 14% from 29.8% to 43.8%


Service Delivery Sites

• Traditional model of small offices– Works well for most, but not all

• To extend beyond today, services need to be taken to where patients in need are– FQHCs

– Mobile

– Non-dental professionals

– Unique opportunities

– Integration of Care


Funding

• The largest barrier to care

• Public programs traditionally underfunded and at greater risk today

• Public Health infrastructure for oral health too often ignored

• Decline in funding for programs like the Dental Lifeline Network – Donated Dental Services

• Resources ineffectively shifted to EDs


Last Slide

• Workforce and access are multi-factorial issues that are not simple

• Tangible solutions vary by people being served, location, need and resources

• If a hammer is the only tool, then only a hammer is used. That doesn’t work

ASDA State Workforce Review September 23, 2011 Jon Holtzee, director – State Government Affairs.

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Transcript of ASDA State Workforce Review September 23, 2011 Jon Holtzee, director – State Government Affairs.