Trying to meet the demand for accessible, affordable dental care is a daily challenge for Susan Gile.
“I see it (the demand) everyday,” she said. “We probably get five calls a day from patients looking for some kind of dental help. We have a waiting list with tons of people on it.”
Gile is the dental coordinator at Volunteers in Medicine of the Olympics (VIMO), a nonprofit medical and dental clinic in Port Angeles. Just barely into February and Gile is having to schedule appointments in May in an attempt to keep pace with the number of people seeking dental care.
Unlike VIMO, the nonprofit medical center in Sequim, the Dungeness Valley Health & Wellness Clinic, doesn’t provide dental care. Instead if a patient comes to the clinic for pain and the diagnosis is dental-related, the clinic collaborates with about 11 local dentists to aid patients, Rose Gibbs, clinic director, said.
“We can give a single voucher (per patient) for dental emergencies if they live within the Sequim School District,” she said.
The clinic provided about 120 vouches in 2015, according to Gibbs.
For those on Medicaid, the state administered health care program aimed at serving low-income patients, finding a dentist is difficult, largely because of the low state reimbursement rates.
“We’re pretty limited here,” Gibbs said. “If the state wanted to put any more resources into something, they should subsidize dentists so they could serve more of the population.”
Washington had the fifth lowest Medicaid fee-for-service reimbursement rate at 28.7 percent relative to commercial dental insurance charges, according to the American Dental Association.
“It would help tremendously if Medicaid paid at a rate dentists could afford to take,” Gibbs said.
Three dental clinics, including Advanta Dental, Jamestown Family Dental Clinic and Zbaraschuk Dental Care, of about 12 dental clinics in the Sequim area, are listed by the Washington State Health Care Authority as contracted providers that may be take Medicaid patients.
Sea Mar Community Health Center in Port Angeles is among 11 other Sea Mar centers in surrounding counties that provides dental and health care to patients of all ages, religions, ethnicities or sexual preferences without regard to income, occupation, immigration status or citizenship. Clallam County’s Sea Mar center opened full time in 2014 and lessened the demand on clinics like VIMO.
Before Sea Mar opened, VIMO was getting about 25 calls a day from people seeking dental care, Gile said.
“Though, they’re struggling, too,” she said. “Sea Mar is having to close their doors every couple months because of the demand.”
VIMO is trying to be the best “safety net” it can, Gile said, “but there’s just too much.”
Mid-level dental professional
“I think everyone agrees there’s an access and cost issue,” Steve Tharinger, District 24 Legislative representative, said.
District 24 encompasses Clallam, Jefferson counties and most of Grays Harbor County. Along with Tharinger, the district is represented by Rep. Kevin Van De Wege and Sen. Jim Hargrove.
Despite the shared recognition of the issues surrounding dental care, how to best address those issues differs.
For the past five years there’s been a big push for dental therapists, but not without “a lot of concern from the Washington State Dental Association,” Tharinger said.
For many dentists, the problem with mid-level dental providers revolves around “scope of practice rights,” he said.
Mid-level dental professionals, often referred to as dental therapists, are similar to physician assistants or nurse practitioners in the medical field given they can provide a broad array of dental care, but are limited in the services they can provide compared to dentists.
Mid-level dental providers are practicing in Minnesota and Alaska, but haven’t been allowed in Washington.
Tharinger sponsored House Bill 1421, which “creates new mid-level dental professions. Attempts to increase access for all Washingtonians through the introduction of an evidence-based mid-level dental provider that is geared toward working in, and reducing oral health disparities within, the state’s communities with the greatest need,” according to the bill digest.
“We’ve heard this bill in the House before, but it’s been at least two years,” Van De Wege said. “There’s nothing scheduled for it.”
Although no action is expected in the House, its companion bill (SB 5465) was part of a public hearing in the Senate Committee on Health Care on Jan. 25.
“The first step is to get heard,” Tharinger said.
Recognizing mid-level dental providers in Washington would be “a major policy shift,” Tharinger doesn’t think it will happen this year, he said.
“These things take time,” he said.
Van De Wege remains cautious of allowing mid-level dental professionals to practice in Washington.
“Mid-levels would be doing invasive stuff with less education,” he said.
Among quality of care, Van De Wege also is concerned the bill, as is, doesn’t ensure dental therapists would charge less to provide care than dentists.
For people in Gile’s position at VIMO, however, dental therapists could make a big difference.
“To me community clinics are the exact place dental therapists need to be,” Gile said. “It’s such a needed position.”
If Gile were able to have one supervising dentist and hire about three dental therapists, the clinic would be able to serve far more people regularly she said.
“The majority of the work we do here are things a dental therapist could do,” she said. “Routine, preventive care is what we need.”
About five of the 25 dentists from the area participate with VIMO to provide the dental services it does, Gile said, “but when you’re talking about thousands of people that haven’t been to the dentists in years, it’s just too much.”
In Clallam County, including all ages, 21,015 were Medicaid eligible, yet only 25.7 percent (5,393) received dental services in 2014, according to the Washington State Health Care Authority.
Other avenues for improvement
Both Van De Wege and Tharinger are working to expand dental residency programs in their district.
“That will help bring more dentists to the area,” Van De Wege, said.
Additionally, through the residencies, more Medicaid patients can be accepted, Van De Wege said.
“My fundamental concern is access,” Tharinger said. “If it can be met through residencies, I am fine with that, but it (mid-level professionals) has worked well in the medical field so I can also see that being applied to the dental field.”
Efforts on a loan repayment scholarship program, where the state pays a portion of dentists’ student loans given they provide care to underserved populations is another improvement underway, Van De Wege said.
Both representatives also agree Medicaid reimbursements need to increase.
“I think we need to increase reimbursements and decrease the amount of paperwork and waiting time to get Medicaid reimbursements,” Van De Wege said.
Tharinger echoes Van De Wege, noting Medicaid simply “doesn’t pay enough” to allow dentists to afford to accept Medicaid.
However, to increase reimbursements is “complex,” he said. “That money has to come from somewhere — so do you take that from schools, state parks, increase cost of services? There’s a phrase down here (in Olympia) that, ‘everything is connected to everything else.’”
It would be great if community-supported clinics like VIMO and the Dungeness Valley Health & Wellness Clinic didn’t exist, “but that’s not the reality,” Tharinger said.
Although the “vision” doesn’t rely clinics like VIMO, until then, Tharinger said those kinds of clinics are “really important.”
Reflecting the importance placed on oral health, Gibbs said, some funding that supports VIMO and the dental care vouchers provided through the Dungeness Valley Health & Wellness Clinic is provided by Olympic Medical Center.
“They don’t do dental and they want to keep people out of the emergency room,” she said. “There really needs to be a focus on preventative care.”
“The biggest thing, and everybody knows it, is without good mouth care the potential of other illness is high,” Gibbs said. “We know healthier mouths means healthier bodies, but we’re not putting the needed resources into that.”
