The state of Georgia could save millions of dollars a year and serve thousands of children from low-income families by increasing access to basic dental care, researchers told key lawmakers Monday.
But one suggested solution appears to be stalled in the kind of fight between health care professionals that often eats up weeks of every General Assembly session.
Dental hygienists say the dentist lobby — a big campaign contributor to lawmakers — held up legislation earlier this year that would have allowed hygienists to do basic cleaning and preventive care at so-called “safety-net settings,” qualified health centers and school-based health clinics, without a dentist present.
The work would have to be authorized by a dentist. Currently, Georgia law requires that a dentist actually be present in the facility for a hygienist to do such work.
Dentists say they are concerned about the safety of patients; dental hygienists say they are trying to get basic care to more Georgians.
Nicoleta Serban, a Georgia Tech researcher, told state lawmakers at a hearing Monday that more than 600,000 Georgia children with families on Medicaid do not live within what the state considers an acceptable distance to a dentist who accepts Medicaid patients.
Out of 4,044 dentists actively practicing in Georgia in 2012, about 22 percent accepted patients on Medicaid, the state-federal health care program for the poor and disabled. Georgia ranked 49th in the country in dentists per capita, she said.
“Access is the issue in Georgia,” Serban told the committee.
Families with children on Medicaid may have to travel much farther for dental care than, say, for primary medical care, she said. That adds to the likelihood that they won’t get basic treatments, she said, leading to bigger, more costly health problems down the road, such as infections and tooth decay.
Serban told the committee the state could save millions of dollars annually by delivering basic preventive dental care to children of Medicaid-eligible families who don’t get services now.
Earlier this year, hygienists said that in 2013, about 66,000 Georgians wound up in hospital emergency rooms because of dental problems that could have been prevented by basic care. Those ER visits cost the state $47 million, they said.
One of the problems in terms of obtaining care, House Health & Human Services Chairwoman Sharon Cooper, R-Marietta said, is that Medicaid reimburses dentists so poorly that they can't afford to fill their patient rosters with Medicaid recipients.
Cooper supported House Bill 684, which would give dental hygienists the ability to provide basic care in certain settings without being under direct supervision of a dentist.
The bill passed Cooper’s committee but stalled in the House Rules Committee.
Scott Lofranco of the Georgia Dental Association said, “We felt there was a lot to be addressed as far as patient safety.
“We felt it was one of those things where the dentists needs to be involved and see the patient first or at least conduct an exam before any other services take place,” Lofranco said. “You are dealing with pre-existing health conditions, infections, massive decay that needs to be treated with antibiotics before cleaning can take place.”
Lofranco said some of the low-income clients dentists see may have never had their teeth professionally cleaned or worked on. So dentists, he said, may get only one chance to fix what’s wrong.
But Charles Craig of the Dental Hygienists’ Association said 47 states allow dental hygienists to clean teeth without a dentist being physically present. Under the legislation, a dentists would still supervise the hygienists, they just wouldn’t physically have to be on site, he said.
Craig said the battle over HB 684 appears to be the kind of medical profession turf battle that lawmakers referee virtually every legislative session. One profession wants to expand its practice and bumps into the professional territory of another.
If HB 684 passes, dentists may fear it will open the way for legislation allowing dental hygienists to open their own practices and do dental care outside the supervision of a dentist.
The dentists are a politically powerful lobbying force, as are many health care associations. An Atlanta Journal-Constitution review of campaign records found the group’s lobbying association and dental practices contributed more than $800,000 to state candidates and political action committees over the past five years. And the association typically spends $7,000 to $8,000 each summer hosting key lawmakers at its annual beach-side convention.
Cooper often finds herself in the middle of health care turf battles, and she noted that she wasn’t the sponsor of HB 684. But when she saw the scope of the problem, and the number of children from poor families going without dental care, she said, “It became an issue that I am very concerned about.
“I expect us to look at it again this (upcoming) session,” she said.
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