Second Opinion: Data needed now for dental Medicare plan

"Oral Health Can't Wait" was an oral health campaign sponsored by the Dental Trade Alliance a few years back. That campaign is just as relevant today, especially when it comes to seniors.

Adding dental benefits to Medicare appears to be a waiting game. As of this writing, the U.S. House of Representatives has yet to vote on the $3.5 trillion reconciliation bill that contains authorization for dental benefits before it is sent to the Senate for a simple majority vote. House Democrats appear split in their support, and two senators hold the keys to negotiations to pass it in the Senate.

What this political lobbying misses is that even if the budget includes Medicare dental coverage, those benefits wouldn't kick in until 2028. Can seniors really wait for dental benefits until 2028? We need a better plan.

More questions than answers

In the midst of all this sausage making, a coalition of organizations, including Families USA and the AARP, supports this new dental benefit in Medicare. However, the ADA is opposed to including the benefits in Part B, largely because this is highly regulated for physicians. The ADA is instead encouraging a new subpart of Medicare, a Part T.

Dr. Margaret Scarlett.

Regardless of how dental benefits are implemented, the proposals state that prevention and routine dental examinations will be paid at 80%, with treatment price set by the secretary of the U.S. Department of Health and Human Services (HHS). Those treatment reimbursements will begin with about 10% of treatment reimbursement fees in 2028, going up to 50% by 2032. Are those fees high enough for participation? We just don't know, really.

Meanwhile, a few weeks ago Sen. Bernie Sanders (I-VT) called for a voucher of $1,000 for dental benefits. Similar to the COVID-19 pandemic stimulus payments, individual seniors would be eligible if they make less than $75,000 per year. Do we know if that will work for participating seniors and dentists?

I'm uncomfortable living in a data-free zone. I also worry that leaving the details of implementing dental benefits to the HHS secretary might subject those benefits to political will -- not better oral health outcomes for seniors, especially those with disabilities.

Let data guide the way forward

What we need is a compromise between the various dental groups and contingencies so that seniors, especially those with disabilities, win dental benefits. Those benefits should provide prevention and care, including monitoring to improve home-based care for older adults with teledentistry -- just like telemedicine.

I have a compromise that works for seniors and small business dentists: Let's collect data.

I propose 2021 authorization of multiyear HHS demonstration projects designed to inform the Medicare coverage for dental disease prevention and treatment for seniors that is currently slated for 2028. The focus of these demonstration projects should be various payment models among private dentists in all major regions of the country.

Examples may include (but would not be limited to) fee-for-service and value-based care. The major outcome measures of the demonstration projects would be cost-efficiency, cost-effectiveness, and participation rates for providers and patients.

The projects may also address current issues in dental care for seniors, including the effect of types and levels of care on dental function, esthetics, disease, and comfort. They are encouraged to provide evidence relevant to the reliable assessment of oral health status among seniors, especially those with disabilities.

Findings from the projects should be delivered to the HHS secretary in sufficient time to inform the U.S. Centers for Medicare and Medicaid Services (CMS) appropriations anticipated to be in excess of $200 billion over 10 years, as estimated by the Congressional Budget Office, for implementation prior to 2028.

I'm not in favor of waiting until 2028 for seniors to get a benefit. And I'm not willing to let the government operate once again in a data-free zone, like it did for Medicaid.

We need evidence now to make sure that both senior patients and dentists participate as if their lives depended on it. In fact, with the interaction between oral health and overall health becoming clearer, they just might.

Dr. Margaret Scarlett is a practicing dentist, author, and consultant. As CEO of Scarlett Consulting International (SCI), a health outcomes company, Scarlett provides a range of consulting services to advance technology, oral health, and overall health. She served for more than 20 years in U.S. Public Health Service, including at the Centers for Disease Control and Prevention and the HHS' Office of the Surgeon General.

Contact Scarlett at [email protected] or 404-808-9908.

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