Coalition Executive Director Participates in UMKC School of Dentistry Ethics Panel

Ashley Herrman, Community Outreach and Project Development Director

The Missouri Coalition for Oral Health was proud to be represented on a panel discussion at the UMKC School of Dentistry on September 24. The first-year dental students recently read “Teeth” by Mary Otto as part of an ethics class assignment. The panel discussion consisted of seven members from across the oral health arena including Tanya Moore, a patient navigating the Medicaid system searching for dental care; Dr. Jim Trotter, a clinical faculty member at UMKC and a Kansas Dental Association member; Jessica Hembree, a program and policy officer with the Health Care Foundation of Greater Kansas City and an advocate for health and health policies; Katie Schroeder, a UMKC dental hygiene program graduate, chair of the Kansas City Dental Hygiene Association, and outreach coordinator for the Cass County Safety Net Dental Clinics in Belton and Harrisonville MO; Dr. John Dane, a UMKC School of Dentistry graduate and current Missouri State Dental Director (Dr. Dane previously served as the dental director at Truman Medical Center Lakewood and the MO Elks Mobil Dental Program Director); Joni Adamson, the Manager of Recruitment and Workforce Development for the Missouri Primary Care Association with a primary role dedicated to increasing access to health care services for those in underserved areas; and Gary Harbison, Executive Director, Missouri Coalition for Oral Health. The mission of the Coalition is to improve the oral health of all Missourians through sound public policy and public awareness.

This diverse panel led the first-year dental students through several themes and components of the book during a guided panel discussion led by Dr. Michael McCunniff. Questions centered around three main themes: prevention, access to care, and separation of dentistry from medicine. Discussion was quite involved in each of these areas with the students adding several follow-up comments and questions. One topic that generated a wide range of discussion was from the question “The current dental surgeon model in the US is focused on repair and replacement. As the “disease model” of dental care is becoming more widely accepted, what role should risk assessment have in changing the dental disease management of dentists in the future?” This question allowed for the panelist to share where dental care has been and where it could be going in the future. Dr. Dane led the response on this topic explaining the current reimbursement system is based on fee for service, which incentives more costly procedures, such as fillings over sealants. The panel considered how this might change the future. Will the payment structure be altered to support prevention over restorative procedures?

Access to care was another significant topic that was interwoven throughout the two-hour panel discussion. Issues discussed included the small number of dental providers enrolled in Missouri Medicaid and Missouri’s Dental Health Professionals Shortage Areas (DHPSA). Dr. Dane and Gary Harbison explained fewer than 700 dentists in Missouri are Medicaid providers. Several factors contribute to this, but low Medicaid reimbursement rates are key. Missouri Medicaid pays about 40% UCR (usual and customary rate). Low reimbursement rates coupled with the high cost of providing dental care can make it problematic to base a private practice around Medicaid patients. The high cost of dental education is also a significant factor. While reinstatement of Medicaid adult dental benefits in Missouri has helped to open access for many Medicaid-eligible adults, access to dental care remains a challenge. There are currently long wait times for dental care appointments with Medicaid dental providers. Some students were surprised to learn that most Missouri counties are designated as a Dental Health Professionals Shortage Area. Some counties have no practicing dentists. The need to increase loan forgiveness programs for new dentists was discussed as a method to encourage dentists to practice in a DHPSA. While this program has proven to be successful, finding additional federal and state funds is always challenging. Another potential limitation with this type of program is around the willingness of the community to embrace a person from outside the community.

The discussion briefly addressed the dental team and how to effectively and efficiently utilize team members, including dental hygienists, in the community setting. Discussion included teledentistry and increasing access in rural and other underserved areas. Challenges were also discussed.

The broad-ranging discussion allowed students to gain insight into the issues around community oral health and modern dentistry and consider the complexity of finding solutions. The panel charged the students with being the generation for change in dentistry.

“This was a great opportunity to help students develop a greater awareness of the many oral health challenges facing Missouri, and the interface of community health and the professional practice of dentistry,” Harbison noted. “These challenges may seem daunting at times, but these are challenges we are working together to solve. It was a pleasure to highlight for UMKC students the work of establishing sound public policy,” he said.

Dr. Michael McCunniff, Joni Adamson, Dr. John Dane, Gary Harbison, Katie Schroeder, Jessica Hembree and Dr. Jim Trotter