Last month, Sen. Tim Kaine (D-VA) questioned dentists on dental coverage during a Senate Health Committee hearing.
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00:00 >> Both love, you're from Appalachian, Tennessee, and I appreciate your continued dedication to the region.
00:05 I'm going to be in Appalachian, Virginia tomorrow visiting the Allegheny Highlands Dental Center.
00:12 A dental center that serves folks in Appalachia that we were able to receive a significant congressionally directed expenditure to help them.
00:21 But in particular, I want to thank you for your work on remote access medical.
00:24 So just to paint the picture for my colleagues and those who are here.
00:28 Remote access medical does dental clinics and other medical clinics in remote areas.
00:34 One of the first sites and continuous sites, annual sites for
00:38 RAM is the Virginia Kentucky Fairgrounds in Wise County, Virginia.
00:44 And beginning when I was Lieutenant Governor, I will often go to volunteer on this three day weekend of service.
00:50 And what happens is people start arriving about Tuesday or Wednesday to park their car in a dusty
00:56 county fairgrounds parking lot to get a number so that when it opens Friday morning, they can go in and get medical care.
01:02 The first time I came, I was struck when I walked through the parking lot.
01:06 I would have expected to see vehicles from Virginia and Kentucky and Tennessee and West Virginia and North Carolina.
01:14 But I was surprised to see vehicles with license plates from Georgia and Florida and Alabama and
01:19 even Oklahoma because people, low income people at that point beginning in 2002,
01:24 2003 had to drive that far to get medical care.
01:29 The clinic offers all kinds of medical care, but
01:32 by far the most significant usage of the clinic are folks who are seeking dental care.
01:38 And the most significant thing is teeth extraction.
01:40 If you just look at the bucket where the teeth are extracted at the end of each day, I mean,
01:44 it's just staggering the number of people who have to drive state through state just to have that happen.
01:50 The numbers of people going to the RAM clinic declined when Virginia embraced Medicaid expansion.
01:56 Medicaid expansion, excuse me, that was positive, but because it's a border community and
02:00 many of the surrounding states haven't done Medicaid expansion, there's still a lot of folks.
02:03 But the numbers didn't decline on the people coming to seek dental care for a variety of reasons.
02:10 Dental care not being part of the essential health benefits yet.
02:13 And Virginia has embraced in 2022 a Medicaid expansion for
02:19 dental care and Virginia has also done a salary supplement under Medicaid for
02:25 those who are serving and yet still only 27% of our dentists accept Medicaid patients.
02:31 So it's clear that we have an awful lot to do.
02:33 Medicaid expansion has really helped the folks who came to that clinic and come every year.
02:38 But on the dental side, we need more operations like the Allegheny Highland Center that I'm going to tomorrow and others.
02:45 And I just appreciate the role that RAM has played in this safety net.
02:51 It's kind of RAM is at the first rung of the safety net and then free clinics and community health centers.
02:56 But in a nation that's probably the most powerful and wealthiest nation on the world,
03:01 the fact that you'd have to drive through three or four states and park in a dusty parking lot and
03:05 wait three days to get in line so you can have your teeth pulled.
03:08 I mean, I was a missionary in Honduras when it was one of the poorest countries in the Western Hemisphere next to Haiti.
03:16 This was in 1980 and '81 and it's not that different from what you might see in the dusty parking lot in Wise County, Virginia,
03:24 which is the area of the state that my wife is from.
03:26 You said something, Dr. Simon, I wanted to follow up with you on, which is, it's not just reimbursement, there's a cultural thing.
03:34 because you're right, if Virginia, we embraced Medicaid for dental services, we expanded it.
03:40 And then the legislature put more money into increased reimbursement rates.
03:44 And that's showing some success, but we still only have 27% of our dentists that accept Medicaid patients.
03:51 How do you view this cultural shift, any of you, and what might we do in addition to reimbursement increases to try to change that?
04:01 I like who said if we can just get each dentist to take five Medicaid patients, right?
04:08 And then that plus the safety net would help, but what can we do?
04:11 >> I would also point out that the 27% number doesn't even paint the whole picture,
04:14 because only 5% of Virginia dentists see more than 100 Medicaid patients a year.
04:19 So you have an extraordinarily small workforce who's really doing the work.
04:24 100 Medicaid patients is not very many when the average dentist has a patient panel of 1,500 plus patients.
04:29 So really, it's an incredibly small group.
04:32 So I think understanding from that group themselves how they're able to do that.
04:35 I would imagine many of them work in community health centers or
04:37 other settings where they have sort of more infrastructural support in order to provide this amazing care.
04:42 But understanding that dentists are able to do it is probably the first thing.
04:46 The other thing more big picture would be to make a shift between fee for service to a value based care model.
04:51 Right now, dentists feel like they're not getting enough money for each procedure they do.
04:55 But patients would benefit if they didn't need any procedures, and dentists make nothing if that's the case.
05:00 So a model that aligns patient and provider perspectives and
05:03 lets dentists actually practice in a way that's more meaningful and preventive focused, I think is also-
05:07 >> Other nations do that, and they have much better health outcomes than we do.
05:12 Any others that might want to comment on this issue about the culture shift,
05:14 if my chair would enable me now that I'm over time to hear the answer.
05:17 >> Part of the culture shift is a shift more towards prevention.
05:21 But to be able to teach people how to prevent disease and
05:25 how disease are interacting with one another really requires increasing health IQ.
05:30 And it means that you have to do it in a culturally sensitive way, even in appalachia.
05:35 That's a culture.
05:36 And you have to be able to use that as a way to be able to educate people about prevention.
05:40 If we don't do that, we're never going to be able to fix and put band-aids on all these situations.
05:44 >> Dr. Minnichorn.
05:46 >> Certainly would agree with everything that's been said.
05:48 The focus on prevention, increasing and leveraging the use of ancillary providers within dental practices,
05:53 so that the dentist is focused on working at the top of their licensure, and aided by ancillary providers in the office
05:59 that helps provide more access to Medicaid patients.
06:02 >> And then Dr. Isbell.
06:04 >> You know, I think it comes down to education, Senator.
06:07 I think it's about treating every patient that we can.
06:11 I mean, there's, in a practice like he's had and I've had, there's only so many patients you can see.
06:17 We treat, one of my associates treats the patients in the jail.
06:21 Who wants to go do that?
06:22 I mean, if you were a dentist, you're not going to want to do that.
06:25 But guess what?
06:26 They deserve care.
06:27 How about our nursing home patients?
06:28 We treat numerous nursing homes.
06:30 We bring them in as stretchers into our office to take care of them.
06:33 And many of our elder care, they're coming in in wheelchairs, but having the structure where it can be there.
06:40 So, it gets down to how much you do.
06:42 Our children, we see so many of our children.
06:44 We go into the grammar schools and teach oral health literacy to our children.
06:50 And then we send brochures home to try to get to the parents.
06:53 How do you get to the parents?
06:54 Because guess what?
06:55 They weren't raised with that, Senator.
06:57 And the parents don't understand.
06:59 So, it starts from the bottom level, teaching the child, teaching the parent in every access that we can to give them an opportunity to understand what Dr.
07:08 Swan has said.
07:10 There's so many things that we do in dentistry that by education and getting on there with this simple prevention, we can save so much for every family and prevent the catastrophic stories that we're all telling.
07:24 Well, I appreciate your service, your testimony, and thanks, Mr. Chair.
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