By Andy Marso
October 17, 2014

Advocates of licensure for mid-level dental providers have been stymied in Kansas for five years. They say the need for dental care remains high, especially in the state’s rural areas, and they’re pushing for legislative movement next session.

Members of the Kansas Dental Project coalition met this week in Topeka to discuss the issue and hear from Steve Coen, president and chief executive officer of the Kansas Health Foundation, and Brenda Sharpe, president and CEO of the REACH Healthcare Foundation. Both groups are part of the Kansas Dental Project. The health foundation is the primary funder of the Kansas Health Institute, which is the parent organization of the editorially independent KHI News Service.

Sharpe said their response to those who have blocked mid-level providers by raising fears about their safety should be simple: Show me the studies.

“The mid-level providers can provide safe care,” Sharpe said. “Frankly, after five years I’m sick to death of hearing the ‘they’re not safe’ argument.”

The mid-level providers, tentatively called registered dental practitioners, would be trained and licensed to perform higher-level dental procedures than hygienists, but not as high as dentists. Advocates say they could fill a critical public health need in a state where 95 of 105 counties have a shortage of dental providers.

“That’s something we’ve heard again and again (in rural communities),” Coen said.

The state’s dentists have opposed the move. Kevin Robertson, chief executive of the Kansas Dental Association, did not respond by Friday afternoon to messages left for him Thursday, but in the past has said allowing mid-level providers would lower the standard of dental care in the state.

Sharpe said she’s seen no evidence that mid-level practitioners provide lesser care than dentists, while several studies show they have a favorable effect on public health.

Coen said groups are working on economic models that show dentists concerned about a financial hit how adding the mid-level providers to their practices actually can increase revenue. Sharpe said the goal in Kansas is for the providers to be “part of a dental team” rather than working solo.

Alaska has employed mid-level providers for 10 years, while Minnesota and Maine have approved them more recently.

Some at this week’s Kansas Dental Project meeting suggested that the advocates try to engage physicians who initially were wary of licensing for physician assistants and nurse practitioners, or the mid-level medical providers themselves, to try to calm fears about mid-level dental practitioner proposal.

But Shannon Cotsoradis, president and CEO of Kansas Action for Children, said those groups have been reluctant to wade into scope-of-practice issues on the dental side.

Cindy Luxem, president and CEO of the Kansas Health Care Association, confirmed that statement and expressed frustration with doctors who see patients in poor oral health but won’t advocate for expanded dental licensure.

“They will not talk to each other about this issue,” she said. “They don’t want to talk about it. It is unbelievable to me that the professionals at the top of the food chain of health care, we can’t get them to talk about this.”

Instead, Luxem said the best legislative strategy might be to encourage rural lawmakers whose districts have a strong stake in mid-level providers to promote the issue and work against urban lawmakers who oppose it. A similar battle occurred last legislative session in the discussion of whether to repeal the state’s renewable energy standards.

“If we can figure out how to make this a wedge issue between those two constituencies, we can win it,” she said.

Legislators have resisted having hearings on the mid-level dental provider for several years, but that may change next year.

Rep. Susan Concannon, a Republican from Beloit who is vice chairwoman of the House Health and Human Services Committee, said there has been enough study done to merit the next step.

“I think that’s got some legs,” Concannon said. “I think that’s going to come (next session) in the form of a bill.”

Concannon is unopposed in the November election and the current chairman of the health committee, Rep. David Crum, has said she would be his pick to succeed him in that role.

Cotsoradis, whose organization has made the mid-level dental provider a top priority for several sessions, said “meaningful policy change takes time.” But she thinks the issue is reaching a tipping point.

“I do believe we are on the cusp of change,” Cotsoradis said.

Read more from the Kansas Health Institute.