Fast-Track to Teledentistry: Removing Barriers to Care While Maximizing Overall Health
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White Paper FAST-TRACK TO TELEDENTISTRY Removing barriers to care while maximizing overall health SUGGESTED CITATION: DentaQuest Partnership for Oral Health Advancement. March 2020. Fast-Track to Teledentistry: Removing Barriers to Care While Maximizing Overall Health. Boston, MA. DOI:10.35565/DQP.2020.2010 TABLE OF CONTENTS Executive Summary 3 Introduction 4 Impact of Not Receiving Care 6 Telehealth: A Growing Trend 7 Potential Savings for States 9 Teledentistry Shows Promise 10 What States Can Do 12 Expanding the workforce . .12 Updating reimbursement policies . .12 Enhancing legal clarity . .13 Making it easier for providers to share patient information . 13 Seizing an Opportunity 14 Conclusion 15 Contributors 16 References 17 EXECUTIVE SUMMARY 1 In times of crisis, telehealth can avoid 4 Telehealth offers multiple forms of technology disruptions in care that would otherwise send to improve health people to already overwhelmed clinics and Telehealth can connect patients and providers hospitals In addition to COVID-19, hurricane in different physical locations, as well as enable damage, earthquakes and terrorist attacks are different providers who treat the same patients other examples of events that can disrupt or to share information. Telehealth includes an array delay care, or prompt patients to visit hospital of digital tools, ranging from Fitbit — a wrist band emergency departments (EDs), quickly that tracks physical activity — to much more overwhelming these facilities. Greater access sophisticated programs. In Oregon, for example, to telehealth can allow the elderly, medically a rural teledentistry program enables dental compromised, or other vulnerable populations to hygienists to assess schoolchildren’s mouths remain safely at home without losing all access visually, chart likely areas of tooth decay, take to medical or dental services. Even in a crisis, pictures and X-rays of a child’s mouth, and use dental providers could use telehealth to consult laptops to transmit this information to a remote with patients, triage their needs, and offer limited dentist, who reviews these materials and develops emergency services. a treatment plan for each participating child. 2 Even in normal times, many Americans aren’t 5. Teledentistry helps close the gap in access getting the dental care they need Millions of to dental services From Missouri to California, Americans live in areas with a shortage of dental teledentistry efforts are expanding access to care. professionals, and even outside these shortage An analysis of a teledentistry program in Colorado areas, many people struggle to get care because found that most of its patients had not received of transportation or other hurdles. Dental access dental services in more than a year, and 10 percent is a particular concern in rural communities. Rural had never obtained such care before this program adults are more likely to have untreated dental began. These data show how teledentistry decay and more likely to be missing all of their reaches many people who otherwise would go teeth. A federal report cites telehealth as a vehicle without care. for improving dental health in rural America. 6. Teledentistry can save money for states and 3. When people don’t receive dental care, both oral consumers Using telehealth approaches in health and overall health deteriorate A lack of dentistry would save money by getting people access to dental care can lead to untreated tooth the care they need, keeping them healthy and decay or other infections that leave Americans reducing the need for costly treatments — with no viable options other than visiting hospital especially by curbing visits to hospital EDs. emergency departments, where treatment is Research from multiple states demonstrates costly and can disrupt more urgent needs in a telehealth’s ability to reduce health care costs. time of crisis. Growing research has connected More specifically, teledentistry can save money poor oral health with diabetes, stroke and other in various ways, including managing oral health health conditions. Untreated periodontal (gum) conditions that might otherwise make it harder disease makes it harder for people to manage to control diabetes or raise seniors’ risk of their diabetes. aspiration pneumonia. Fast-Track to Teledentistry: Removing barriers to care while maximizing overall health 3 7. Teledentistry and other telehealth initiatives 8. States should take steps now to address can create and preserve jobs, especially in rural barriers to teledentistry There are four key areas Job growth in the health care sector is areas that state policymakers should examine. expected to rise faster than other industries, and These areas include ensuring that policies permit states can benefit from this trend by establishing all members of the dental workforce to practice a legal and regulatory environment in which at the highest level of their skill and training. teledentistry can flourish. In recent years, many In addition, reimbursement policies should be rural hospitals have closed. Hospitals are usually updated so that both public and private insurers among the largest employers in rural areas, and cover remote provider-patient interactions their financial stability could be enhanced by through live video or store-and-forward mechanism. serving as a hub for teledentistry programs. States can also help teledentistry expand by bringing clarity to legal issues such as liability coverage for dental providers, data security and rules of compliance with the Health Insurance Portability and Accountability Act (HIPAA). INTRODUCTION At a time when the COVID-19 pandemic has kept these chronic diseases millions of Americans at home, federal health officials are associated with MORE THAN have taken urgent steps to promote telehealth as oral health. In recent a way to connect Medicare and Medicaid patients years, most states 56 MILLION with the care they need1. These officials recognized have expanded their AMERICANS that services provided through telehealth help to Medicaid programs, in shortage areas free up medical offices and hospital EDs for patients opening the door to ONLY 6 STATES HAVE with coronavirus or other truly urgent conditions. health care for millions MOST OF THE DENTISTS Insurers are following suit, acting quickly to ensure of new individuals. needed to eliminate shortages coverage and awareness of telehealth options among Unfortunately, many of their members, even where telehealth was previously these newly-insured available, to maximize its immediate benefit2. people struggle to obtain dental services for two COVID-19, hurricanes, earthquakes and terrorist attacks reasons: 1) most states don’t offer comprehensive dental are among the events that can disrupt or delay care for benefits for adults, and 2) the nearest dental provider publicly- and privately-insured patients — or prompt is located many miles away or doesn’t participate in patients to visit hospital EDs, which may already be Medicaid. In fact, a Pennsylvania study revealed that overwhelmed with critically ill or |injured patients. newly Medicaid-insured adults are much less likely to have a dental home (a regular dentist) than they are Even before COVID-19 reached our nation, there to have a medical home (a regular physician)3. were excellent reasons for states to encourage telehealth. These technology tools can help prevent Yet access to dental care is a major problem for all disease and, equally important, assist Americans states, regardless of whether they have expanded in managing diabetes and other chronic diseases, Medicaid or not. More than 56 million Americans live which, if uncontrolled, can be life-threatening. Many of in an area with a shortage of dental professionals, and Fast-Track to Teledentistry: Removing barriers to care while maximizing overall health 4 only six states have most of the dentists they would It doesn’t have to be this way. For example, take a need to eliminate these shortages if those dentists look at online banking and how it’s taken for granted. were distributed more evenly4. Through Amazon and other companies, e-commerce Dental access is especially a concern within rural enables consumers to quickly purchase products communities. Roughly 27 million Americans live in what they could not have bought 25 years ago because are called “micropolitan statistical areas,” which are they lived far from these retailers. The health care areas of small towns and rural communities5. Nearly industry has started to take similar steps to leverage one in four rural residents is at least 65 years old, technology that will connect more patients to the and many of them are medically compromised due medical, dental and behavioral health services they to one or more chronic need to live healthy lives. diseases. Between 2006 Telehealth is not a specific service; this term describes and 2016, rural seniors a range of technology-based tools that enable a health were at least one-third provider to offer services to a patient in a different more likely than their physical location, or for a provider and patient in one non-rural peers to have location to gain remote access to a specialist who received no dental can offer advice. One example is a care team using a Between 2006 and 2016 care6. Additionally, rural web-based connection to consult with a person with RURAL SENIORS adults are more likely to diabetes using an internet-based monitoring system were at least have untreated dental to keep track of their blood glucose levels.