Media Release

4th November 2008
Hans Zoellner, Chair APOH

Analysis of Dental Medicare Statistics
Reveal Good Use of Public Funds

The Association for the Promotion of Oral Health has recently completed a detailed analysis of the Dental Medicare EPC services based on data from the Medicare Website. The anaylsis reveals that on balance the current EPC Scheme seems to be working well in delivering balanced care.

A brief summary of the main points is outlined here but to see the full media release please download it from the link below.

Analysis of Dental Medicare Statistics Reveals Good Use of Public Funds

• Analysis of Most Recent Medicare Statistics Reveal a Generally Balanced Use of Medicare Funds

APOH's analysis of the most recently available dental Medicare statistics reveals that almost 80,000 people have benefited from the scheme. Some groups have suggested dental Medicare is poorly spent, but the data (Table 1) indicate otherwise.
Hans Zoellner, Chairman APOH, says;

"Most patients have from 3 to 4 extractions, surgery or other treatments for pain – it’s not cosmetic or for fun.”

Patients average 2.7 preventive services, 0.14 root therapies, 0.76 dentures, and 2.26 routine fillings each.

Overall, data indicate a reasonable use of public Medicare funds for delivery of dental services, but also confirm a need to establish regulation for indirect (complex) restorations.

APOH suggests an alternative approach, some of which is detailed below, which would provide Dental Medicare support in a comprehensive way to the entire population, in a cost-effective and affordable way;

Development and implementation of National standards for dental diagnosis and treatment planning.

Required not only to ensure that public Medicare funding is appropriately spent, but also to establish improved clinical care.

The Department of Veteran's Affairs (DVA) Treatment Plan Approval Process: An Interim Measure:

The DVA has long had a procedure in place, in which treatment plans for advanced restorative procedures (crowns, bridges etc) must first be approved by the department before funding. This is currently established and well accepted by the dental profession, so that the DVA is able to support dental Medicare while National Standards are developed and implemented.

Dental Medicare should not be means-tested, similar to arrangements in other areas of health.

Recognizing that suffering from dental disease has similar impact to disease elsewhere in the body.

Dental Medicare should not be limited in amount per patient per year, but instead guided entirely by strict application of the specific clinical guidelines as detailed in above.

In this way, over servicing would be prevented, greatly limiting costs and ensuring that Medicare spending and treatment are only for services needed to preserve health. As noted above, DVA mechanisms could be used as an interim measure.

Dental Medicare should be focused on:

a: preventive services

b: treatment of active infection including caries control and periodontal infection

c: treatment of pain

d: prosthetic services as needed according to strict clinical guidelines

e: oral medicine / diagnostic services

MEDIA RELEASE

9th October 2008

COMPROMISE SOUGHT TO SAVE NEW COMMONWEALTH DENTAL PROGRAM

The Public Health Association of Australia (PHAA) has joined calls for a. The implementation of the initiative is under threat after the Senate blocked the closure of the previous government’s Medicare scheme funding dental care for people with chronic illnesses.

“We understand why Senators wanted to save the current Medicare scheme that provides courses of dental care for people with chronic illnesses. However, it is also very important that the new Commonwealth Dental Health Program goes ahead because it will provide more services to disadvantaged groups that currently can’t afford basic and essential dental treatment. We would like to see the Health Ministers Advisory Committee adopt a compromise position that would allow the best parts of the old scheme to stay, while cutting out the cosmetic procedure rorts that are currently occurring. These savings could then be used to ensure that the new Dental Health Program can also be implemented,” explained Michael Moore, Chief Executive Officer of the PHAA.

“In the past year, ‘enhancements’ to the Medicare-funded scheme have seen cosmetic procedures like implants and crowns increase, blowing out costs. The Medicare scheme is not means-tested, so can be accessed by the wealthy and the definitions of what constitutes a chronic disease are very broad. If the criteria could be tightened to exclude such expensive cosmetic procedures and focus on the most critical of chronic illnesses, the savings could be used to ensure that the planned Commonwealth Dental Health Program can also be implemented.

“It just doesn’t seem fair that wealthy people will continue to be able to have their crowns and implants funded by taxpayers while pensioners and other disadvantaged people in our community can’t afford to access basic dental health services at all.

“If access under the current Medicare scheme is tightened up in this way, those with chronic illnesses could still receive the treatment they need while access to basic dental services could also be extended to those who most need it around the country. This approach seems to offer an appropriate compromise for all,” added Mr Moore.
 

The Australian Healthcare and Hospitals Association (AHHA) today urged the Government to ensure that people with chronic illnesses can still receive treatment for related dental problems under the Government's Commonwealth Dental Health Program.

The AHHA is the peak national body for public hospitals, area health services, community health centres and public aged care providers.

"AHHA understands that the Government has written to dentists asking them not to treat patients with chronic disease under the Medicare dental rebate scheme, as this will soon be replaced by the new Dental Health Program and the Teen Dental Program," Ms Prue Power, Executive Director, said today.

"While the AHHA supports both these Government programs, and believes that they will increase access to dental care to important groups in the community, we are concerned that they will leave some people with chronic illnesses without access to affordable dental care.
"Many people with chronic illnesses experience associated dental problems which can exacerbate their condition. If they do not have adequate access to dental care these problems can become more serious and sometimes require hospitalisation. This causes unnecessary pain and suffering and imposes a burden on our already stressed public hospital system.
"In fact, in 2007 the Australian Institute of Health and Welfare estimated that over 43 000 avoidable public hospital admissions a year are due to dental problems which could have been prevented through better community-based dental care.
"The new Commonwealth Dental Health Program will provide enhanced access to dental care for concession card holders with chronic medical conditions, however, unlike the previous Medicare-based program, people with chronic illnesses who do not have concession cards will not be eligible for subsidised treatment. This is likely to cause problems of access to affordable dental care for low to middle income earners, particularly those with chronic illnesses who often face substantial additional health care expenses.
"AHHA believes that establishing a permanent advisory body to the Commonwealth on dental health issues would assist in identifying and addressing any gaps in the implementation of these new dental programs. We encourage the Government to establish such a body and to work with dental health experts, practitioner and consumer groups to ensure that high quality, preventive dental care is available to all in the community," Ms Power said.

From:                 Senator Rachel Siewert, Senator for Western Australia
On Behalf of:     Australian Greens

Tuesday 16th September 2008

Greens hold out for comprehensive dental plan

The Australian Greens today voted to continue the Medicare dental scheme for the chronically ill, after the Government failed to fix obvious gaps in their planned rollout of the proposed Commonwealth Dental Health Program (CDHP).
“The Medicare dental scheme has helped thousands of Australians suffering from chronic health problems directly related to dental problems since it was improved in November 2007,” said Australian Greens Senator Rachel Siewert.
“The Government claims it is essential to close down the chronic disease dental scheme and redirect funds to the CDHP – a program that will not be operational for months to come.”

“The Greens won’t support half-measures that will see some low-income earners with urgent dental problems losing vital services,” said Senator Siewert.

“The Government has been unable to assure us that people currently receiving treatment will receive the same level of dental health care under the CDHP. It is sheer hypocrisy for them to cry poor about being unable to fund both these programs… particularly in light of the $31 billion of tax cuts that have left these people behind.”
“If the Government is serious about helping low income earners with serious dental problems, they would maintain both of these programs. The reasons behind this move have nothing to do with addressing the pressing needs of low income earners for chronic dental care and everything to do with minimising Commonwealth expenditure.”
“It’s quite clear that the Government needs to go back to the drawing board. When they can present to the Senate a comprehensive Commonwealth Dental Scheme that meets the needs of low income earners, perhaps we will be able to move forward and create a truly comprehensive dental support system,” she concluded.

From:                 Dr Geoffrey Bird, Executive Director
On Behalf of:     Council on the Ageing Over 50’s

Wednesday 17th September 2008

Dental health reform needs bite not bickering

The Council of the Ageing has long called for improvements in dental and oral health care. The current spat over Medicare benefits for chronically ill patients suffering dental disease must not be allowed to distract the government from delivering much-needed improvements to the availability of dental services to all Australians.
“For older Australians, dental health is a fundamental element of wellbeing. Sadly, many are suffering unnecessary pain and deteriorating oral health not only because of a shortage of dentists, but because of unhelpful professional arrangements about how dental hygienists and therapists can offer oral health services,” said Executive Director, Dr Geoffrey Bird.
“Clearly people who are chronically ill and have associated dental disease should have ready and regular access to treatment. So too should pensioners, and there are far too many of them on dental waiting lists. Some of them have been waiting for ten years.

The Medicare scheme providing dental care to patients with chronic conditions and complex care needs remains open at present and eligible claims will be paid.

The Senate voted on 16 September 2008 to prevent the closure of the scheme.

It remains the Government's intention to close the scheme in order to make funding available for its dental programs, and the Government will continue to negotiate with the Senate in an effort to achieve this.
Dental Prosthetists will be advised if and when the Senate agrees to the closure of the scheme.

If dental providers or patients are uncertain about whether a claim will be paid, they can call Medicare Australia on the day of the appointment to check whether the scheme is still operating.
The Medicare Australia number for patients is 132 011, and for providers 132 150

Please Note: The ADPAQ sent many letters to members of the Senate requesting that they look closely at the benefits available to the public prior to choosing to close the scheme and follow the wishes of the government. We would like to thank all those members who sent letters and emails and congratulate them on the outcome.

In reply to the Australian Dental Prosthetists Association correspondence concerning the discontinuation of the Medicare scheme providing dental care to patients with chronic conditions and complex care needs the Hon Nicola Roxon MP writes;

Mr Martin Dunn,

President Australian Dental Prosthetist Association

Dear Mr Dunn

The Rudd Government was elected in November 2007 on a platform including major reforms to dental care in Australia. These reforms include the introduction of the Commonwealth Dental Health Program and Medicare Teen Dental Plan, involving a total investment of $780 million over five years, and the discontinuation of the previous Government’s chronic disease dental scheme.

The Rudd Government made clear its intention to discontinue the chronic disease dental scheme as it was not targeted to patients most in financial need, complex for patients to access, and has had limited take up in many areas and from many needy populations.

Consistent with the Government’s commitment to responsible economic management, savings from the discontinuation of the chronic disease dental scheme were planned to offset the cost of the investments in the Government’s better targeted Commonwealth Dental Health Program and the Medicare Teen Dental Plan.
As you may be aware, the Liberal Opposition blocked the discontinuation of the chronic disease dental scheme in the Senate. This means that, from 19 June 2008, all eligible patients again have access to the chronic disease dental items (85011-87777), and the scheme cannot close, as originally planned, on 30 June 2008.

The action in the Senate will create confusion for patients and health professionals. I need to make clear that the Government intends to honour its election commitments and remains strongly committed to responsible management of the Budget and the economy. The Opposition’s actions on this issue put this at risk, to the detriment of the economic and social welfare of all Australians.

You should be aware that, subject to Parliament’s agreement, the Government intends to close the chronic disease dental scheme to all patients at the earliest opportunity once Parliament resumes.

Decisions on the care of a patient should, of course, be made on the basis of what is clinically appropriate and necessary. Practitioners should, however, be aware of the anticipated funding changes and consider carefully whether to commence a course of dental treatment for a patient under the chronic disease dental items. Medicare rebates for dental services under these chronic disease items will not be available for any patients once the scheme has been closed. The Government does not anticipate there will be any transition period after the closure date during which patients would be able to complete treatment.

In the interim period while the chronic disease items remain available, the Government, through Medicare Australia, will continue to closely monitor their usage to ensure that it remains appropriate and consistent with the items’ legal eligibility requirements. Questions about whether individual patients are eligible for Medicare rebates for the chronic disease dental items should be addressed to Medicare Australia on 132 150.

I would be grateful if you would ensure that your members are aware of this information.

Yours sincerely
NICOLA ROXON

TAKE HOME MESSAGE

If you are treating people under the scheme when it is closed this time there will be NO RUN OFF PERIOD, hence it is recommended all treatments be finalised by the date the senate is to resume sitting in late August. ADPAQ Exec.Add Content...

It's Back
Enhanced Primary Care for patients with Chronic and Complex Care Needs
Items 85011 - 87777

The Health Insurance (Dental Services) Amendment and Repeal Determination 2008 was disallowed by the Senate on 19 June 2008.Members will recall notification being provided that it was anticipated that the availability of dental services under this Scheme would discontinue under the Rudd Labor Government, with the introduction of the Commonwealth Dental Health Plan, and the Teen Dental Plan.

Accordingly, the Medicare Chronic Disease Dental Scheme that was scheduled to close on 30 June 2008 will now continue. The restriction that was imposed indicating that only patients who had received dental services under the scheme prior to 30 March 2008 would continue to be eligible for benefits for services to 30 June 2008 has also been removed.This means that the original Medicare Dental Scheme will now continue without these restrictions and in the format that was envisaged when the scheme was introduced as from 1 November 2007.The Department of Health and Ageing have informed us;

‘eligible patients again have access to the Medicare
chronic disease dental items (85011 - 87777) as originally
implemented on 1 November 2007.
The scheme is therefore now available to both new and
existing patients, and services will continue to be
available to all eligible patients after 30 June 2008’

The Department is working to have all supporting information put back on their website at www.health.gov.au/epc
Medicare Australia has also made the necessary changes to allow for payment of benefits under the arrangements as previously available.

Discontinuation of Medicare Dental Items for People
with Chronic Conditions and Complex Care Needs (Items 85011-87777)

This notice is to advise that the Medicare dental items for people with chronic conditions and complex care needs, introduced by the previous Government in November 2007, are to be withdrawn from the Medicare Benefits Schedule (MBS). This affects referrals by GPs, and services by dentists, dental specialists and dental prosthetists.

This is the first step in establishing the Government’s new Commonwealth Dental Health Program, which will be introduced from 1 July 2008. The Government is replacing the previous Government’s limited chronic care dental scheme with a scheme that works cooperatively with States to address public dental waiting lists and provides up to one million additional services.

In introducing the Commonwealth Dental Health Program, the Government will negotiate with the States and Territories to provide priority services to patients with chronic disease, allowing patients who previously qualified for the closing chronic care dental items to access treatment where they are eligible for publicly funded care.

Arrangements for discontinuation of the Medicare dental items

Patients who have already commenced treatment under Medicare dental items 85011 87777 (ie patients who have received services between 1 November 2007 and 30 March 2008) will be able to continue to receive Medicare benefits for dental services provided up to and including 30 June 2008. A GP referral dated before 30 March 2008 is not, by itself, sufficient for a patient to be considered to have commenced treatment.

The Medicare dental items will be closed to new patients after 30 March 2008. This applies to any person who has not any received services under the Medicare dental items 85011-87777 on or before 30 March 2008. This means that no Medicare benefits will be payable for dental services to new patients after 30 March 2008.

No Medicare benefits will be payable for any dental services provided under items 85011-87777 after 30 June 2008. The cost of any future services identified in the patient’s treatment plan will need to be met by the patient.

GPs are being encouraged not to refer new patients to dentists or dental prosthetists if the patient is not able to commence the dental treatment by 30 March 2008.

Dental prosthetists are encouraged, wherever possible, to contact patients who may be affected by the discontinuation of the Medicare items.

Medicare Australia registration

Eligible dental prosthetists will be able to continue to register with Medicare Australia to provide services under the Medicare items 87011 87777 up to and including 30 June 2008. After 30 June 2008, dental prosthetists will no longer be able to register with Medicare Australia for Medicare purposes. Dental prosthetists who are already registered will not need to take any further action.

DVA dental arrangements

The dental arrangements funded by the Department of Veterans' Affairs (DVA) are not affected by the discontinuation of the Medicare items. Eligible members of the veteran community will continue to receive dental treatment from dentists, dental specialists and dental prosthetists under the DVA dental scheme.

Dental prosthetists who use the one provider number to provide both Medicare and DVA services can call DVA to seek advice on its continued use for DVA services. The numbers to call are:

• non-metropolitan callers 1800 550 457
• metropolitan callers 1300 550 457

Further information

Information about the discontinuation of the Medicare dental items is being sent to GPs, dental prosthetists, dentists, dental specialists, and patients who have commenced treatment under the Medicare dental items.

Some additional questions and answers are attached.

For further questions about the discontinuation arrangements, please contact Medicare Australia on 132 150 (providers) or 132 011 (patients).

Questions and Answers for Dental Prosthetists
Discontinuation of Medicare Dental Items 85011-87777

Q: If a patient has commenced dental treatment under Medicare on or before 30 March 2008, but the claim is submitted to Medicare Australia after 30 March 2008, can the patient continue to receive further services under Medicare up to and including 30 June 2008?

Yes. To receive Medicare benefits up to 30 June 2008, the patient must have commenced dental treatment on or before 30 March 2008 (ie the patient must have received one or more services under Medicare dental items 85011-87777 between 1 November 2007 and 30 March 2008). However, the claim for these services may be submitted to Medicare Australia at a later date.

Q: Must all claims be submitted to Medicare Australia before the items are removed from the Medicare Benefits Schedule on 30 June 2008?

No. All valid claims under items 85011-87777 will be paid as long as the dental service was provided on or before 30 June 2008 and all the requirements of the service are met (up to the patient’s Medicare benefit limit of $4,250). The claim can still be submitted to Medicare Australia after 30 June 2008.

Q: What if a patient needs treatment beyond 30 June 2008?

Patients will need to meet the costs of all dental services provided after 30 June 2008. Dental prosthetists should advise patients requiring treatment beyond 30 June 2008 that Medicare benefits will not be payable for services after this date.

Some patients may be eligible for services under the new Commonwealth Dental Health Program which will commence on 1 July 2008. Further information about this program will be available over the coming months.

Q: Does the dental prosthetist need to review current treatment plans that continue beyond 30 June 2008?

This is a clinical decision for the dental prosthetist. Dental prosthetists are encouraged to review the written quote which was provided prior to commencing the course of treatment. If there are services to be provided after 30 June 2008, the cost of these services (which will not be covered by Medicare) should be explained to the patient.

Q: What if the dental practitioner needs to refer a patient onto another dental practitioner?

A patient who has commenced dental treatment on or before 30 March 2008 can still be referred by a dental practitioner to another dental practitioner after 30 March 2008. However, Medicare benefits will only be provided for services provided by dental practitioners up to and including 30 June 2008.