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Kansas works on filling the dental gap
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Thursday, Senators on the  Committee on Health and Human Services heard testimony from both sides of House Bill 2157 in Topeka.  The bill allows for the creation of a mid-level dental provider called a Registered Dental Practitioner.  It was introduced last week following a dental briefing for the committee.  Passage of this bill would increase access to dental care by allowing mid-level dental providers to work in dental practices and clinics, proponents say. It could also leave patients open to lower-quality care and botched procedures, opponents say.  
Dr. David Hart, DDS, Great Bend, hopes the bill passes.
“An RDP would allow us to essentially offer another practitioner to do the day-to-day stuff, freeing me up to do more complicated procedures,” he said.    An RDP could check the work of dental hygienists, in addition to performing various other procedures.  
Since the implementation of KanCare at the beginning of the year, more people now have dental benefits, so the demand for dental care is on the rise, especially for children.  In fact, many practitioners may choose not to take adult patients or limit their services to adults to emergency care only, he said.
According to research by Kansas Action for Children, many children do not receive proper dental care in Kansas because there are not enough licensed dentists in the state.  It claims 99 of Kansas’ 105 counties have too few providers, and some have none. Barton County and all adjoining counties are part of those without enough dentists.
Susan Wilke, Director of Policy and Research with Kansas Action for Children, sat in on discussion of the bill by members of the committee on Thursday.  She also offered testimony to the committee on Tuesday, Jan. 29 during a dental briefing.
“Adding RDPs to the dental workforce in our state will help to create jobs, lower costs and keep families healthy,” she said.
According to Wilke, this solution improves access while creating jobs and growing businesses.

What’s good for the doctor is good for the dentist
The KAC points out that physician assistants and nurse practitioners have already helped address the medical work force shortage, and foresees that RDPs will do the same for the dental work force.
State Rep. John Edmonds, R-Dist. 112, representing Hoisington and Great Bend  remembers when some doctors opposed allowing nurse practitioners to be licensed to work in Kansas.  But in 1996, his wife, Marta Edmonds, M.D. of Great Bend Children’s Clinic began hiring nurse practitioners.  “The nurse practitioners on our staff can deal with 70 to 80 patients during the day, freeing  Marta up to do higher skilled work,” he said.  “It has been very successful in our environment.”
Edmonds said a lot of parents of poor children have a hard time finding a dental practice that will take them as a client.
“Bottom line, in our part of the state we have more people needing work, particularly those on  Medicaid and Kan Care, than we have dentists.”
Because of low reimbursements from Medicaid, many offices will only accept a limited number of patients from these plans, he said.  
According to Wikle, dental decay is the number one childhood illness, five times more common than asthma.  While Edmonds admits his “feet are not yet set in stone” about which way he will vote, he said he would like to see kids get the kind of dental care that he received as a child.  Preventative care early should be a priority, he said, adding, “If you get kids on the right track, they can keep their teeth into old age.”  

Second time around
This isn’t the first time a the legislature has heard a proposal like this.  Last year, two similar bills, one in the house and one in the senate were introduced, limiting RDPs to working in either public practices, or private practices “where at least 20 percent of total patient revenues are derived from medicaid.”  This year’s more streamlined bill states an RDP can work in private practice as long as it accepts medicaid patients.  
Last year, the Kansas Dental Association disapproved of creating an RDP position because of concern over safety.  While it acknowledging there is a gap in access to dental care, it still felt certain procedures required the direct, not general, supervision of a licensed dentist.  It instead advocated for more dental education and for members to accept medicaid patients.    
If the bill passes, it would still be about two years before RDPs could start working in dental practices around the state.  Some colleges, like Fort Hays State University have already been looking at providing a program of study, but a curriculum would still need to be developed.  
An 18 month program is required on top of dental hygienist training.  
There are only two other states in the country that have created a mid-level dental practitioner.  They are Alaska and Minnesota.