Over the past decade, health centers have rapidly expanded the availability of dental services to meet increasing demand from patients and payors for high-quality, low-cost, comprehensive preventive and primary care. However, when NACHC surveyed member health centers last year, they reported that dental health staff represented their third-highest loss in clinical workforce. Given these challenges, health centers expressed concerns that some of the proposed changes to dental accreditation standards could undermine their ability to grow the dental health workforce appropriately to meet patients’ needs. In response, NACHC took steps to elevate these concerns for the Commission on Dental Accreditation (CODA).
Expanding dental services is a priority for Community Health Centers
Since 2010, health centers have increased their dental services by 60%. They have also outperformed other outpatient care providers in expanding access, such that only 13% of health center patients report unmet dental care needs, versus over 20% by patients of other care providers. Health centers achieved this improvement in access by investing in doubling the dental workforce from 2010 to 2021.
However, growing the health center dental workforce adequately remains a challenge, due to several factors such as higher private sector pay, pandemic-related stressors, seeking professional growth opportunities elsewhere etc. A few health centers currently utilize Teaching Health Center Graduate Medical Education (THCGME) funds to support advanced dental training activities that can alleviate some of these factors. The THCGME has immense potential for future growth in the dental workforce, with 23 or 92 THCGME Planning and Development grantees intending to create dentistry training programs. NACHC is leading federal advocacy efforts with health centers and PCAs to request Congress to fully support this program through increased federal funding.
Proposed changes in dental accreditation standards could hurt health centers
CODA is the national organization that develops accreditation standards for dental education programs. These standards are followed by all major U.S. organizations, including health centers, when providing dental education, and influence which dental care professionals are reimbursed by large payors such as the Centers for Medicare and Medicaid Services, Affordable Care Act Marketplace plans, TRICARE, and group health plans. Health centers have contributed meaningful feedback when CODA proposes revisions to its standards to help further improve the quality of dental education in the country.
Health centers shared with NACHC that recent proposed revisions to CODA’s standards for Advanced Dental Education Programs — including Advanced Education in General Dentistry (AEGD) and General Practice Residency (GPR) — may impose a redundant compliance burden on their advanced dental training programs, thereby limiting the potential for dental workforce development, consequently broadening the gap in access to dental care. AEGD and GPR, along with Pediatric Dentistry (PD), account for most of the advanced dental education offered at health centers. These programs can be effectively designed around training in community-based settings, unlike other dental training which is focused on interventional settings, such as maxillofacial surgery. Under the current accreditation standards, only 3.7% of THC grantees offer dentistry training. As noted above though, many more health centers are gearing up to start advanced education in dentistry, provided accreditation standards are not overly burdensome.
NACHC elevates health centers’ concerns for CODA
Upon hearing and understanding health centers’ concerns with the proposed CODA standards, NACHC’s President and CEO, Dr. Kyu Rhee, M.D., M.P.P, sent a letter to CODA with three specific requests to:
- Add HRSA-recognized accrediting organizations to its list of allowable accrediting organizations who may accredit AEGD, GPR and PD program-sponsoring health care organizations, such as Community Health Centers.
- Add achievement of compliance with HRSA’s Operational Site Visit/certification of completion of HRSA’s Operational Review as equivalent to such accreditation.
- Strike proposed revisions to CODA standards to require that AEGD, GPR and PD program-sponsoring health care organizations, such as Community Health Centers, must obtain a state license or federal authority or institutional accreditation to document the organization’s approval to confer a credential or certificate.
This letter is the latest in a series of continuous engagement by NACHC on behalf of our membership to encourage CODA to give due consideration to stakeholder health centers’ feedback when revising accreditation standards, so that they support vibrant dental workforce development efforts, rather than limit them inadvertently. NACHC will continue to engage with health system partners, national organizations, and Congress to ensure that health centers’ aim of becoming health care providers and employers of choice is successful.