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As a growing body of research suggests a link between oral health and chronic health conditions, the benefits of physician-dentist partnership become even clearer.
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Consider a study of dental claims from more than 130,000 plan participants by UnitedHealthcare. The study showed that improving the oral health of individuals with chronic medical conditions, such as diabetes, asthma and cardiovascular disease, reduced their annual healthcare claims by nearly $1,300.
“A dentist who doesn’t know about a patient’s diabetes may not think to encourage more regular cleanings,” says Richard Klich, DMD, chief dental officer at UnitedHealthcare. “And a physician who isn’t able to collaborate with his or her patients’ dentists can’t share the patients’ in-depth medical histories.”
Ruth Hertzman-Miller, MD, MPH, an internist, and deputy editor, systematic literature surveillance at Dynamed, recalls a female patient with diabetes. The woman wasn’t eating properly, so Hertzman-Miller suggested getting more vegetables in her diet. The woman explained that she wasn’t able to chew vegetables.
“The health of the patient is something we all want to accomplish,” Hertzman-Miller says. To accomplish that “…physicians have to be aware of the dental aspect, and dentists have to be aware of the medical aspect.”
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Hertzman-Miller points to the shortage of primary care physicians as another reason for physician-dentist collaboration. Dentists, she says, are highly trained healthcare professionals who, while not specializing in managing blood pressure, could be taught those techniques.
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“There is a subset of people who will go for dental care who never show up in a primary care office,” she explains. “And so you can capture that population and do a better job taking care of them if everybody is on the same page, and everybody has a certain set of basic skills for some of the basic primary care diseases.”
One of the key challenges to effective collaboration is the issue of territoriality. Hertzman-Miller says if she refers a patient for dental work, she’s not at all concerned about the patient coming back because that patient is seeing her for other issues. But if the dentist noticed the patient had high blood pressure-and that was something dentists were able to address-and started them on medication, it might prompt a different reaction.
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“Even though I’m in the business of promoting this collaboration, I think some part of me would go, ‘Who the heck are you? Why did you do that?’” Hertzman-Miller says. “So I think the challenge in cementing this relationship is to be clear what is a reasonable scope of practice.”
Education is another important component.
Eve Kimball, MD, with Reading, Pennsylvania-based All About Children Pediatric Partners, PC, has been piloting a program for the past year called Oral Health Education in Captive Spaces, or OHECS. The practice has two dental hygienists on site, for a total of 20 hours per week, to provide oral health education to parents while their children are in the exam room.
“They do a brief risk assessment,” Kimball says. “Then pick up the phone in the exam room, phone the dentist and hand the phone to the parent to make an appointment. And we know that 90% of these folks will keep the appointment if they have the appointment in their hand when they leave the office.”
Kimball stresses the importance of physicians and dentists working together in other respects as well. She says that physicians are pressured to improve the care of diabetics and asthmatics, but that won’t happen, for example, “until we get rid of the chronic infection that’s in their mouth.”
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And a physician-dentist alliance, adds Hertzman-Miller, could provide financial benefits for physicians.
“If you’re being compensated in part on blood pressure readings among patients of a certain age, and somebody else is starting the blood pressure medication, well, you’re still getting credit for it,” she says.
What’s the first step for physicians wanting to maximize the medical health-oral health collaboration? UnitedHealthcare’s Klich suggests that physicians consider dentists as another specialist for consultations and referrals just as they would a cardiologist or orthopedist. Physicians can also enroll in online training through programs such as Smile for Life, a nationally recognized program designed to enhance the role of primary care physicians in the promotion of oral health for people of all ages.
“Primary care clinicians can better serve their patients by developing deeper knowledge of oral health issues and practices,” Klich explains.
Kimball recommends physicians talk to their dentists, but then go one step further and talk to their health insurance carrier about ways they can improve their dental HEDIS scores.
“They can get compensated for that,” she says. “That’s a pay-for-performance issue.”