Can VA Support an Increase in the Number of Dental Eligible Veterans?
VA Dentistry strives to provide exceptional oral health care being a benchmark for excellence and value in providing treatment that is patient-centered, and evidence based.
VA dental providers include many current and former members of the U.S. Armed Forces, who because of their own military experience, understand Veterans' unique health care concerns. Veteran dental care adheres to the highest standards of infection control.
This is important to note because the veterans currently provided dental care by VA are a subset of all veterans. There are different eligibility categories that afford a veteran dental care that ranges from one-time limited emergency care to lifetime comprehensive care. Most patients VA dentists see fall into 4 eligibility categories that provide comprehensive lifetime dental care. Of those 4 eligibility categories, greater than 90% of the veterans seen in VA Dental clinics fall into the category of those who are 100% service-connected disabled (whether that 100% is by total service connection, or by virtue of individual unemployability). Currently there are 9.2 million veterans enrolled in VA, and of that number approximately 1.4 million veterans, or 15%, are currently eligible for comprehensive VA dental care.
Due to a variety of factors, the main one being financial, most of these veterans will neglect their oral health while waiting for their service connection to reach 100%. This means when these veterans finally present to a VA Dental clinic for care, they present with neglected, mutilated teeth and oral structures, that require time-intensive and labor-intensive treatment just to get the veteran back to oral health and function.
Clinic access and utilization are of concern when treating these patients and trying to restore oral health and function. Chiefs of Staff, Directors and Associate Directors will question why VA Dental patients need on average 9-12 appointments when they themselves only go to the dentist twice a year for a dental cleaning and checkup. It is through this labor and time intensive delivery of high-quality dental care, and adherence to stringent infection control practices, that VA Dentists return their patients to normal function and optimal oral health, which impacts the overall physical and mental health of the veteran.
NAVAPD has learned that each year Congress puts forth initiatives to increase care provided by VA, which includes dental care. This year, Senator Bernie Sanders is proposing legislation that would increase the number of eligible veterans who can obtain VA Dental care. NAVAPD has learned the proposed legislation would make veterans with service-connected disabilities of at least 30% or higher eligible for comprehensive lifetime VA dental care. This would increase the number of eligible veterans to over 3.8million (or 40% of veterans currently enrolled in VA), resulting in a 271% increase in lifetime comprehensive dental care-eligible veterans.
VA currently employs approximately 1,000 dentists to support the mission of providing excellent, patient centered, evidence based comprehensive dental care. With such a small number of dentists, most clinics are currently working at full capacity restoring oral health to their currently eligible veterans. Increasing the number of eligible veterans to over 40% will create an enormous strain on a system that is already struggling. Most legislation passed regarding provision of healthcare by VA requires the VA Secretary to enact the law within one year of passage of the bill. How exactly does Congress propose to implement such a drastic increase in veterans eligible for VA dental care? No answers have been provided by the Senator’s office. NAVAPD has learned that one of the proposed solutions would be to send those additional 2.4 million veterans out on community care. If that is the case, VA Dental departments would have to hire additional staff just to manage community care referrals. Civilian dentists who are currently seeing VA dental patients often return overinflated treatment plans with the expectation that VA will pay tens upon tens of thousands of dollars per patient. This is not a sustainable plan, nor a fiscally solvent plan for the long term.
One might think then that if this plan passes Congress and is signed into Law, then the VA would need to hire a dentist workforce that is at least 4 times larger than it currently has in order to maintain reasonably sized patient panels, access to timely care, as well as to be able to maintain high quality dental care without having to limit care. The hiring process in the VA, and all the roadblocks and backlogs with Human Resources, would make this task take years for the dental clinics to be properly staffed; that is if the VA can find that many dentists, dental hygienists, and dental assistants to support the mission of keeping the veterans in VA. Does VA plan to pay off dental school student debt to attract and retain the dentists it would need to take care of these patients? Is that a fiscally solvent solution?
If VA can hire a dental workforce 4 times larger than it currently has, that then brings up the question of where would this enlarged dental staff work? VA Dental clinics currently are too small for the existing number of eligible veterans. Most dental clinics are housed within the parent hospital where space is always at a premium. Logically, it seems then that VA would have to look at building standalone dental clinics to take care of this influx of patients. But where would those clinics be located? Would they be located near an existing medical center, or, centrally located in a county or region? How big would those clinics need to be? How long would it take for them to be built? If they are not near the parent hospital, would patients want to travel to that other location for dental care? What happens when medical consultations are needed from this facility if it is not in the parent hospital?
If VA does not want to build new dental clinics to manage dental operations in house, which is logically at a much more nominal cost than community care, does VA plan to corporatize dentistry the way Aspen Dental, Sage Dental, and Heartland Dental and others have done by purchasing existing dental practices, and employing those dentists to take care of the increased patient load? How would VA mandate and manage its infection control criteria on these outside providers? Will VA then have to insurance incentive dental care and limit the type of care provided the way Medicaid dental clinics have done? Most VA Dentists enjoy the freedom of being able to provide the best patient-centered, evidence-based care possible without worry as to whether the patient can financially afford that care. With a dramatically huge increase in patients would VA then dictate that care be limited to exams, cleanings, extractions, and dentures? Do we want VA dentistry to be no better than Medicaid dentistry?
NAVAPD believes that all veterans eligible for comprehensive VA dental care should be able to seek that care at a VA medical center or CBOC which provides for the best continuity of care, and the best patient-centered, evidence based, high quality, exceptional dental care in an environment of strict infection control practices designed to protect our veterans. VA dentists should not have to compromise on treatment to accommodate an influx of newly eligible patients. Before Congress mandates, and increases eligibility for dental care, serious consideration needs to take place as to how best to deliver that care that would be fair and equitable, but still maintain the standard of high-quality, world-class care. NAVAPD believes that is what our veterans deserve.