As patients continue to postpone dental care during the COVID-19 pandemic, some health systems are incorporating it into their medical appointments in hopes of having more teeth checked and filling in cavities.
The move towards medico-dental integration is not new, but providers on both sides have said it has taken on particular importance at a time when people continue to postpone care amid the latest wave of COVID -19. Dental care was the most ignored type of care in a new survey from the Robert Wood Johnson Foundation which found that 11% of adults had delayed or given up on care in the past 30 days due to coronavirus concerns.
“It’s incredibly more standardized than it was just five years ago,” said Jane Grover, director of the Council on Advocacy for Access and Prevention at the American Dental Association. “COVID kind of shed light on that.”
The Marshfield Clinic in Wisconsin, for example, has a long history of having an integrated system of electronic medical and dental health records in which medical and dental providers can communicate and refer patients to each other.
In addition, medical providers at the Marshfield Clinic regularly ask patients if they are seeing a dentist and when was their last dental appointment. For their part, dental providers check blood pressure and screen for prediabetes, said Tena Springer, administrator of the dental division at the Family Health Center of Marshfield, a federally accredited health center affiliated with the Marshfield Clinic. The pandemic has made suppliers particularly diligent on this matter.
“I think this was an opportunity to really fine-tune our systems to make sure that we are communicating effectively about this so that patients don’t fall through the cracks,” Springer said.
At the highest level, medico-dental integration can be like dental hygienists going to primary care visits and checking patients’ teeth, even adding sealants. But suppliers say it’s still relatively rare.
Overall, medico-dental integration is occurring in somewhat isolated pockets across the country in various health systems, insurers, universities, and federally funded health clinics. At the end of 2020, the CDC selected a group called the National Association of Chronic Disease Directors to put in place a national framework around medico-dental integration with recommendations and strategies for providers.
To date, the NACDD has reviewed over 700 scientific papers on medico-dental integration. The group plans to convene an in-person meeting in March to discuss the creation of the national framework, said Barbara Park, public health consultant for the NACDD and specialist in oral health.
Park said COVID-19 made the work particularly poignant.
“When people return to care, it is very important to maximize the time with this provider to assess a number of issues that they have ongoing,” she said.
At MetroHealth in Cleveland, dental clinics are integrated into the broader health system and dentists treat patients in hospital settings, said Gregory Heintschel, dentist and president of the dental system.
“We work alongside our fellow doctors every day, all day,” he said.
It helps that both medical and dental providers are employees of MetroHealth and have access to the same Epic electronic medical records platform. This setup encourages cross-referencing between specialties, Heintschel said.
MetroHealth’s integrated model even extends to operating rooms. Often times, when patients with developmental disabilities have scheduled dental procedures that require anesthesia, medical providers schedule services during the same visit, such as a patient who needs gynecologic intervention.
In such cases, however, MetroHealth must obtain coverage from medical insurers for the dental procedure, even though dental insurers do not require prior authorization, Heintschel said. This is where it gets difficult.
“It’s a huge problem right now, honestly,” he said. “It’s getting more and more problematic, more chaotic.”
Some research suggests that medico-dental integration can improve health system outcomes. Adding dental care to primary care facilities has an impact on a practice’s annual net revenue of approximately – $ 92,000 in the first year due to start-up costs and nearly $ 105,000 in subsequent years. according to a 2020 study by a team of researchers at Harvard University.
More than 40 state Medicaid programs pay medical providers to treat children’s oral health in one form or another.
For example, most states cover topical varnish, a fluoride gel that applies in seconds to children’s teeth. In Nevada, an office that applied varnish to 20 eligible children per week would increase its income by about $ 55,432. In Washington, that same service and frequency would add $ 73,102 in annual revenue, as the state separately pays for varnish application, oral exam, and oral health risk assessment.
HealthPartners, a nonprofit in the Minneapolis area, operates 23 dental clinics in the same buildings as the medical providers. Like other systems, HealthPartners’ Epic platform integrates patient medical and dental records, allowing both parties to communicate and refer patients.
While it is rare for Healthpartners dental providers to attend medical visits, this could happen in the future, said Todd Thierer, assistant dental director for primary care for the Healthpartners dental clinics.
Right now, HealthPartners is focusing on projects such as dental providers asking children about the second dose of the human papillomavirus vaccine that is often missed. The system is also working on training caregivers in the application of fluoride varnish for patients with dementia who cannot make it to the dentist, Thierer said.
“It’s one of the advantages of being an integrated system like HealthPartners, because there is a kind of synergy around these projects,” he said. “We’re able to work on them and integrate them a lot easier than a non-integrated system can. ”
