Ryan Hansen1, R Mike Shirtcliff2, Sharity Ludwig3, Jeanne Dysert4, Gary Allen5, Peter Milgrom6. 1. Dr. Hansen is an assistant professor, Comparative Health Outcomes Policy and Economics Institute, School of Pharmacy. 2. Dr. Shirtcliff is president of RMS Dental Director, Inc., Redmond, Ore., USA. 3. Ms. Ludwig is director of Community Programs, Advantage Dental Services, LLC, Redmond, Ore., USA. 4. Ms. Dysert is retired, a former vice president for operations advantage Dental Services, LLC, Redmond, Ore., USA. 5. Dr. Allen is vice president and dental director, all at Advantage Dental Services, LLC, Redmond, Ore., USA. 6. Dr. Milgrom is Emeritus professor, Department of Oral Health Sciences, School of Dentistry, both at the University of Washington, Seattle, Wash., USA;, Email: dfrc@uw.edu.
Abstract
Purpose: This study evaluated the impact of silver diamine fluoride (SDF) by investigating coverage and reimbursement policies. Methods: We performed a population-level retrospective cohort analysis (N equals 117,599) using claims. We evaluated two policy events: (1) dental board approval permitting SDF use by expanded practice dental hygienists (EPDHs); (2) approval of SDF by Medicaid. Coincident with coverage, Advantage Dental Services instituted EPDH practice algorithms. To evaluate changes, we: estimated CDT code 1354 utilization and average quarterly costs; stratified the population into patients who initiated preventive care from an EPHD or dentist; estimated outcome differences with either policy in quarterly trends; and counted SDF use with claims by quarter and calculated utilization per 1,000 patients. Results: Average per-patient quarterly dental costs (June 2017) ranged from $384 to $423. SDF use grew associated with Medicaid policy: rates increased from $0.32 per 1,000 to $156 per 1,000 in six quarters. Care initiated by EPDHs had lower costs, with quarterly savings of $201 (P=0.011) per patient, without differences in SDF utilization. Conclusions: Policy makers can use our results to improve access and reduce costs. Clinical experts should address more clearly when SDF substitutes for or is used in conjunction with restorative treatment.
Purpose: This study evaluated the impact of silver diamine fluoride (SDF) by investigating coverage and reimbursement policies. Methods: We performed a population-level retrospective cohort analysis (N equals 117,599) using claims. We evaluated two policy events: (1) dental board approval permitting SDF use by expanded practice dental hygienists (EPDHs); (2) approval of SDF by Medicaid. Coincident with coverage, Advantage Dental Services instituted EPDH practice algorithms. To evaluate changes, we: estimated CDT code 1354 utilization and average quarterly costs; stratified the population into patients who initiated preventive care from an EPHD or dentist; estimated outcome differences with either policy in quarterly trends; and counted SDF use with claims by quarter and calculated utilization per 1,000 patients. Results: Average per-patient quarterly dental costs (June 2017) ranged from $384 to $423. SDF use grew associated with Medicaid policy: rates increased from $0.32 per 1,000 to $156 per 1,000 in six quarters. Care initiated by EPDHs had lower costs, with quarterly savings of $201 (P=0.011) per patient, without differences in SDF utilization. Conclusions: Policy makers can use our results to improve access and reduce costs. Clinical experts should address more clearly when SDF substitutes for or is used in conjunction with restorative treatment.
Authors: Douglas A Conrad; Peter Milgrom; Yuxian Du; Joana Cunha-Cruz; Sharity Ludwig; R Mike Shirtcliff Journal: BMC Health Serv Res Date: 2021-06-08 Impact factor: 2.655
Authors: Sarah E Raskin; Eric P Tranby; Sharity Ludwig; Ilya Okunev; Julie Frantsve-Hawley; Sean Boynes Journal: BMC Oral Health Date: 2021-01-20 Impact factor: 2.757