Dental clinics in Minnesota that employed dental therapists saw more patients, provided more services, and increased gross revenues after integrating these midlevel providers into their teams, according to recently released research.
The quantitative study, conducted by researchers at the Center for Health Workforce Studies at the University of Albany School of Public Health in New York, was based on data from more than 76,000 patients who had over 250,000 visits at two Apple Tree Dental clinics between 2009 and 2019. The study analyzed patient data to compare the number of dental services provided, number of daily patient visits, and gross revenues generated before and after dental therapists started serving clinic patients.
Dental therapists provide preventive and routine restorative care, such as filling cavities and placing temporary crowns. In 2009, Minnesota became the first state in the U.S. to enact legislation authorizing their practice. Research shows these midlevel providers can help increase access to dental care for underserved communities.
Apple Tree has been a nonprofit community dental provider for 35 years, and currently operates seven clinics in urban and rural regions of Minnesota. About 80% of its patients are low-income or insured by Medicaid. The organization was one of Minnesota’s first to employ dental therapists in 2011 and hired its first advanced dental therapists, who have additional education and training to provide an expanded set of services in the state, in 2013.
After bringing on dental therapists and advanced dental therapists, the Apple Tree dentists spent more time performing complex procedures and providing higher value services. They also saw more patients per day, according to the study. The analysis also found that dental therapists’ productivity increased with their years of practice, suggesting that they became progressively more efficient as they gained clinical experience and were fully integrated into dental teams.
Using midlevel providers helps practices and patients
Data from two clinics run by Apple Tree Dental, a nonprofit community provider, from February 2009, before dental therapists were authorized to practice in the state, through July 2019, eight years after they joined the workforce, shows that:
Source: Study by the Center for Health Workforce Studies at the University of Albany School of Public Health
“Apple Tree’s experience shows how adding dental therapists improves the performance of the entire team,” said Dr. Michael J. Helgeson, the nonprofit’s chief executive. “Dental therapists have not only expanded access to care through their own work, but they also helped our dentists become more productive, providing higher value services each day. If you imagine how much less productive dentists would be without dental hygienists, it’s really easy to understand why adding dental therapists made such a big difference at Apple Tree.”
These clinics, one in rural Minnesota and the other in an urban area, serve as an example of how practices caring for traditionally underserved people, including low-income and Medicaid-enrolled patients, can use dental therapists to increase both patient caseloads and revenues, despite Medicaid’s low reimbursement rates.
Policymakers and advocates looking for cost-effective ways to expand access to oral health care should support authorization and implementation of dental therapy in their states. This study, funded by The Pew Charitable Trusts, proves once again that these midlevel providers help to stretch limited budgets, maximize resources, and expand workforce capacity, all while providing high quality care.
Kristen Mizzi Angelone is a senior manager and Allison Corr is an officer with The Pew Charitable Trusts’ dental campaign.