Member and Provider Services Unit: Provider Member Relations

Access to Care: # of dentists per 1500 Medicaid members

3.19Oct 2020

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Notes on Methodology

The target for this measure is 1 dentist per 1500 members per county in Vermont.

                                         
  Access to Care:  # of Dentists per 1500 Medicaid Members   
    SFY20 SFY21  
  May-20 Jun-20 Jul-20 Aug-20 Sep-20 Oct-20  
  County #
Medicaid Members
# dentists # dentists per 1500 members #
Medicaid Members
# dentists # dentists per 1500 members #
Medicaid Members
# dentists # dentists per 1500 members #
Medicaid Members
# dentists # dentists per 1500 members #
Medicaid Members
# dentists # dentists per 1500 members #
Medicaid Members
# dentists # dentists per 1500 members  
  Addison 8359 16 2.87 8473 16 2.83 8622 16.00 2.78 8718 17.00 2.92 8806 17.00 2.90 8877 17 2.87  
  Bennington 12108 41 5.08 12228 42 5.15 12368 42.00 5.09 12431 42.00 5.07 12562 42.00 5.02 12610 43 5.11  
  Caledonia 10590 27 3.82 10685 27 3.79 10773 28.00 3.90 10829 28.00 3.88 10954 28.00 3.83 10972 29 3.96  
  Chittenden 32091 106 4.95 32409 106 4.91 32888 104.00 4.74 33193 104.00 4.70 33700 105.00 4.67 34010 105 4.63  
  Essex 2288 2 1.31 2317 2 1.29 2332 2.00 1.29 2347 2.00 1.28 2356 2.00 1.27 2390 2 1.26  
  Franklin 14385 20 2.09 14535 20 2.06 14643 21.00 2.15 14754 21.00 2.14 14933 21.00 2.11 14999 21 2.10  
  Grand Isle 1853 0 0.00 1871 0 0.00 1884 0.00 0.00 1896 0.00 0.00 1921 0.00 0.00 1932 0 0.00  
  Lamoille 7339 12 2.45 7425 12 2.42 7549 12.00 2.38 7605 12.00 2.37 7708 12.00 2.34 7760 12 2.32  
  Orange 8101 18 3.33 8167 18 3.31 8249 18.00 3.27 8309 18.00 3.25 8443 17.00 3.02 8504 17 3.00  
  Orleans 11068 13 1.76 11181 13 1.74 11295 14.00 1.86 11370 15.00 1.98 11482 17.00 2.22 11566 17 2.20  
  Rutland 18721 35 2.80 18894 35 2.78 19141 36.00 2.82 19280 36.00 2.80 19500 37.00 2.85 19658 36 2.75  
  Washington 14863 26 2.62 14993 26 2.60 15196 26.00 2.57 15323 26.00 2.55 15511 28.00 2.71 15569 29 2.79  
  Windham 12552 31 3.70 12706 32 3.78 12867 33.00 3.85 12981 33.00 3.81 13199 34.00 3.86 13291 35 3.95  
  Windsor 16813 18 1.61 17022 18 1.59 17205 18.00 1.57 17318 18.00 1.56 17533 19.00 1.63 17691 20 1.70  
  Total 171,131 365 3.20 172,906 367 3.18 175,012 370 3.17 176,354 372 3.16 178,608 379 3.18 179,829 383 3.19  
                                         
Partners
  • DVHA Data Unit
  • VT Dental Society
  • Vermont Department of Health
Story Behind the Curve

Vermont is experiencing a physician shortage in key specialty areas. DVHA has chosen to monitor 5 key groups with dwindling provider counts in order to work with multi agencies to address issue proactively: behavior and mental health and substance abuse providers, cardiologists, dentists, pharmacies, and primary care providers (PCPs).

Dentists:

Vermont has been designated a Dental Care Health Professional Shortage Area (HPSAs). HPSAs are geographic areas where the ratio of the population to the providers - measured in full time equivalents, or FTE - is high enough for the Health Resources and Services Administration (HRSA) to designate the area as having a greater need for services. This allows providers working in those areas to access benefits and incentives such as bonus payments for Medicare services, National Health Service Corps (NHSC), State Loan Repayment Program (SLRP), and the J-1 Visa waiver program. These benefits are intended to steer providers to underserved areas. HPSAs are also awarded to safety net providers including Federally Qualified Health Centers and Rural Health Clinics.

Many Dentist in Vermont have stopped accepting new Medicaid patients and many Dentists are nearing retirement age. Per the Vermont Dental Society in the past several years there have been as many as 18 dentist retire or move elsewhere. Currently the average dentist provides 31 hours per week of patient care. 95% accepted new non-Medicaid patients, 65% accepted new Medicaid patients. Orleans, Windham and Windsor Counties have lost FTEs since 2005. To address this problem, the state's dental community has come up with an ambitious approach to replace the dentists who leave or retire (see Strategy note below).

The average wait time as a new Medicaid patient to see a dentist is often 90-120 days. Per the Affordable Care Act, Vermonters have increased access to insurance for dental services, including Medicaid, but many dentists do not accept new Medicaid patients. This is predominantly due to the fact that the reimbursement rates are too low. It’s also hard to recruit new dentists to rural areas. We have recently started to enroll Dental Hygienists; we currently have 6 as of August 2019. Please also see the Strategy note below about dental "therapists".

The American Dental Society suggests that there should be 1 Dentist to every 1500 members in a 60 miles radius. In many areas of Vermont that is not feasible or if the dentist exists it remains a long wait to see the dentist.

In order to address this situation Provider Member Relations is doing targeted outreach in collaboration with the Vermont Dental Society to engage Dental providers who currently do not participate with Medicaid or have a very low volume of Medicaid members.

Last updated: 10/15/2020

Strategy
  • In collaboration with VDH and the Vermont Dental Society, PMR is outreaching to underutilized providers and providers not accepting Medicaid to solicit more participation. 
  • Educating providers on the new dental benefits available 01/01/20 should assist in encouraging more participation. 
  • The Vermont State Dental Society now has a full-time dental recruitment coordinator, who travels New England trying to sell dental students and established dentists alike on the benefits of working in small towns. This work is partially funded by a grant from the Vermont Department of Health, "plants the seeds" about setting up shop in Vermont with dental students while they're still in their first or second year of study.
  • Vermont’s Department of Health and DVHA also support a proposal to license a whole new class of dental providers called "therapists". Their training is received at Vermont Technical College in Randolph. They would provide basic care at a lower cost than professionals with more advanced training. Therapists may be able to serve some of the Medicaid population, not just in dentists’ offices, but in schools and nursing homes.
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