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Expanded Duty Proponents May Have New Ammunition

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hygienist treating patientCovering a cornucopia of hot-button issues, a recent National Bureau of Economic Research (NBER) report has implications for the Affordable Care Act, Medicaid, and scope-of-practice regulations. Spolighted this morning on NPR's Marketplace, the study evaluated how large increases in public coverage (like the ones resulting from the ACA) affect provider behavior and patient wait times. To make it digestable, here are 3 main points...

  • Dentists who practice in states that expanded Medicaid under the Affordable Care Act have seen about a 7% rise in income.
  • Many also experienced decreased wait times?except for dentists who practice in states with restrictive scope-of-practice laws. In those states, wait times generally increased.
  • The rise in income combined with shorter patient waiting times was directly attributed to the availability of dental hygienists to perform a wide range of procedures.

Now stick with me...just to clarify, and at the risk of over-explaining, here's the abstract directly from the NBER report:

We find that when states add dental benefits to adult Medicaid coverage, dentists' participation in Medicaid increases and dentists see more publicly insured patients without decreasing the number of visits provided to privately insured patients. Dentists increase the total number of visits they supply each week while only modestly increasing the amount of time they spend working. They achieve this primarily by making greater use of dental hygienists...Following the expansion of public coverage, dentists employ a greater number of hygienists and hygienists provide about 5 additional visits per week...As a result, dentists' income increases. Wait times increase modestly, with the largest increases in wait times observed in states with restrictive scope of practice laws governing dental hygienists. These changes are most pronounced among dentists who practice in poor areas where Medicaid coverage is greatest.

And here's the big take-away for healthcare in general, articulated beautifully by public health policy blogger Adrianna McIntyre, "This has pretty self-evident lessons for coverage expansion under the ACA. Just as dental hygienists were able to help meet new demand, researchers have highlighted that reorganizing how we deliver medical care?delegating more tasks to nurses, pharmacists, and other clinicians?could go a long way toward easing the primary care physician shortage. And like with dental hygienists, defining scope of practice falls squarely to the states."

So hygienists, you now have a new argument for expanded duties. Just tell the dentists it's good for their bottom line.

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