Thursday, October 31, 2019

ADA Makes Their Position Known on Dental Care for Seniors


As our medical and healthcare system gets better and better, life expectancy AND quality of life continues to extend and improve.  However, with folks living longer, there is also the resultant problem of continuing with being able to function as we are accustomed to.

The problem for many is that they are now surviving longer than healthcare benefits were designed to last.  Actuarial tables are best guess estimates, but they are guesses none the less.  Because of that and the fact that many folks are going to need dental care throughout their extended lifespan, the American Dental Association made the current announcement today.  I feel it bears repeating here.  We *need* to take care of those who came before us.  We need to help those who are less fortunate and in need of our help.  I’m proud of the ADA for making their position known.

The American Dental Association has long recognized the importance of oral health care as a crucial part of overall health. For our senior population, those 65 and older, this statement is particularly relevant. Today's ADA strives to build upon previous leaders' efforts to educate and elevate this issue’s importance. Within the elderly cohort, who continues to expand numerically, it is imperative that the American Dental Association become the solution-based resource for this critical and time-sensitive issue.
The current discussions in Washington, DC, may have caught your attention. There are numerous House Bills attempting to add healthcare services to Medicare Parts A and B, and many include a dental benefit. The American Dental Association sees the pros and cons of individual aspects within these legislative bills, and we strive to yield positive results for both our members and the public.
Allow me to introduce the ADA Elder Care Workgroup.
The Current Landscape of Access to Dental Care for Seniors
Prior to introducing ADA efforts pertaining to elder oral care, it is useful to review the current landscape of dental care access for the elderly cohort. The ADA Health Policy Institute maintains the most robust data on the U.S. dental care system, drawing on publicly available as well as proprietary data sources.In 2018, the number of US citizens age 65 and over was 57 million, and that figure is anticipated to balloon to 84 million by 2050.

37% of seniors have some source of dental benefits coverage. Approximately 26% have private dental coverage, and 11% have public dental coverage (for example, Medicaid, Tricare, or the small number who receive dental benefits through Veterans Affairs).

63% of seniors do not have any form of dental benefits coverage.

What does coverage translate to in terms of oral health care use?43% of seniors had a general dental visit in 2016, up from 38% in 2000.

69% of seniors with private dental coverage had a dental visit in the past year.

16% of seniors with public dental coverage visited the dentist.

37% of seniors who are uninsured had a dental visit last year.

Dental care use also varies by household income.61% of seniors with household income above 400% of the federal poverty level visited the dentist.

24% of seniors with household income below 100% of the federal poverty level visited the dentist.

The disparities in dental care use and dental benefit coverage have clear implications for oral health. When it comes to various measures of seniors’ oral health, such as prevalence of untreated cavities or tooth loss, disparities by income, race, and dental insurance status are widening over time. That is, high-income seniors, in general, are seeing improvements in their oral health while for low-income seniors, improvements are either not as large or, in some cases, are non-existent.
The Time to Act is Now
As your president, I felt it was important that the ADA, as America's leading advocate for oral health, share this data with policymakerson the House Ways and Means Committee as they consider policy options to improve access to dental care among seniors, specifically through Medicare reform. Sharing data with policymakers in no way signals that the ADA supports any particular bill.

Data in and of itself is also not ADA policy. As a science-based organization, data is an extremely important input, but it is ultimately up to our esteemed House of Delegates to consider and vote upon resolutions to create ADA policy.

Looking back, the oral health success of Medicaid and CHIP for our youth has benefitted millions of young Americans. However, our elderly's oral health has not received the same discerning attention as our nation's children. This has been a widely discussed topic over the years within the ADA, and this topic's interest has escalated within the ADA House of Delegates over the past three years. In October, 2018, your ADA House of Delegates authorized Past President Dr. Jeffrey Cole to form the Elder Care Workgroup (ECW). Dr. Cole selected eleven dentists and one physician from varied backgrounds, and I reappointed the Elder Care Workgroup in September, 2019.

The Elder Care Workgroup felt strongly that in order for any dental program to be effective in improving the oral health of seniors and providing for their care, a robust network of providers is essential. If dentists are to be incentivized to enroll and provide care under a program, reimbursement must be at a level that accounts for the unique cost of dental care delivery.

After numerous meetings involving spirited, academic, informed and respectful debate, and secluded in their deliberations, The Elder Care Workgroup will present to the 2020 ADA House of Delegates a list of options. These options include a select portion of Center for Medicare and Medicaid Services (CMS) programs suitable for dentistry’s delivery model.

Thus, the Elder Care Workgroup has developed a multi-faceted approach, recognizing that the elder oral care issue's enormity requires innovative thinking. The ECW pursued solutions resulting in coverage for every elderly socio-economic level. The ECW's recommendations are not yet policy as the ADA House of Delegates has yet to vote. However, the ECW's work is progressing towards a presentable House of Delegates product next October.

I am proud to say that your ADA is on the leading edge of a solution, one involving private, non-profit and government programs.

The question is not, "should we do something." The question is, "how do we do it." The time to act is now.

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