Dental Trade Alliance -- 4350 North Fairfax Dr. Suite 220, Arlington, VA 22203 -- (703) 379-7755

Dental Trade Alliance Advocacy Packet During the April 2018 Washington Conference, DTA members focused primarily on thanking legislators for suspending the medical device tax and urging them to fully repeal the tax. They informed members of Congress about the importance of good oral health and the potential for significant financial savings because of oral health care’s positive effect on overall health. DTA members also requested the exclusion of dentists from the Sunshine Act reporting. Member participation in DTA’s advocacy efforts is critical, thank you for requesting this advocacy packet and taking steps to be a strong voice for the dental industry. DTA Advocacy Packet Contents:

• Legislative Issues Bundle Detailed information about DTA’s legislative priorities

o Oral health in the U.S. o Sunshine Act reform o Medical Device Tax repeal

• Member of Congress Letter

Pre-written message with instructions for contacting members of Congress

• Business Case for Oral Health White Paper Detailed summary of strategies for reducing health care costs

• Oral Healthcare Can’t Wait Infographic (PDF) Oral Healthcare Can’t Wait Infographic (JPG) Graphical high-level overview of the data presented in the Business Case for Oral Health white paper

Click on the links above to download separate copies of each item. You can also scroll down to view them all within this PDF file. Please contact Patrick Cooney, DTA Legislative Representative, at 202-347-0034 x101 or via email at Patrick@federalgrp.com if you have questions about DTA’s legislative priorities or if you need assistance contacting your elected Senators and Representatives. You are welcome and encouraged to provide feedback to DTA regarding your advocacy efforts. Please contact Amy Moorman, Vice President of Operations, at (703) 379-7755 or via email at amymoorman@dentaltradealliance.org.

If every American had a dental appointment every year, the overall health of the nation would improve.

DTA is working to increase awareness that proper oral health care will save dollars that would be spent on medical care; especially for those with chronic diseases:

» In 2014, more than one in every six U.S. dollars went to health care ($3 trillion total).

» The U.S. Healthcare System could save more than $29 billion if 60% of all diabeticadults received periodontal treatment.

» Diabetes patients who received periodontal treatment had better health outcomes.Additionally, the improved outcomes saved medical costs.

There is real potential for billions in savings for the system (and thousands for individuals) by promoting dental care. This would save taxpayer $ while providing a dental benefit to those who need it most.

Oral Health is an integral part of overall health. Facts about oral health: About 1 in 5 children and 1 in 4 nonelderly adults have untreated tooth decay. Students lose more than 51 million school hours and employed adults lose over 164 million work hours annually because of dental problems. Tooth decay is the most common chronic illness among school-age children. One of the top ten reasons for emergency room visits is dental pain.

Consequences of poor oral health include complications of major chronic conditions, pain, impact on children’s growth and development, nutrition problems, late detection of oral cancers, loss of teeth, missed school days and work, and expensive emergency room use. Research shows that diabetes increases your risk of oral disease and infection and poor oral health can make diabetes more difficult to control. Several types of cardiovascular disease may be linked to oral health, such as clogged arteries, stroke, and bacterial endocarditis. Gum disease has been linked to premature birth.

Government programs: Dental benefits are mandatory for children in Medicaid, but optional for adults. Medicare does not provide coverage for routine dental care.

»Oral Health in the U.S.»Sunshine Act Reform»Medical Device Tax Repeal»

Position The Dental Trade Alliance (DTA) believes the burden of reporting costs for dental manufacturers far exceeds any intended benefit of transparency in relationships with providers. DTA urges Congress to consider exempting small volume health professionals, including dentists, from coverage under the Sunshine Act as a way to reduce unnecessary burden. Under the Merit-based Incentive Payment System (MIPs) for Medicare Part B, clinicians who bill less than or equal to $30,000 in Medicare Part B allowed charges OR provide care for 100 or fewer Part B-enrolled Medicare beneficiaries in a designated period are exempt from MIPS. DTA feels this too would be a reasonable threshold for exemption from the Sunshine Act. The vast majority of dental consumable products and equipment are low cost items and the choice of product will not influence patient care. The potential programs savings anticipated by the reporting requirements likely would be minimal at best given dental benefits are not a standard benefit covered by the Medicare program.

Background The Physician Payments Sunshine Act (PPSA)--also known as section 6002 of the Affordable Care Act (ACA) of 2010--requires medical product manufacturers to disclose to the Centers for Medicare and Medicaid Services (CMS) any payments or other transfers of value made to physicians or teaching hospitals. It also requires certain manufacturers and group purchasing organizations (GPOs) to disclose any physician ownership or investment interests held in those companies. The data is published annually in a publicly searchable database. This provision requires device manufacturers to report payments or transfers of value to dentists that exceed $10. While dentists are covered under the definition of physician, dentists represent an insignificant portion of health care expenditures in federal programs. According to CMS, in it’s National Health Expenditures report, total expenditures for dental services in Medicare and Medicaid programs covered by this provision totaled $7.98 billion in 2013. That amounts to less than one percent of total expenditures for these programs. Equipment and supply costs in dental practices (which translates into the dental industry share) amount to less than 8 percent of the total practice income according to the American Dental Association.

Position

The Dental Trade Alliance opposes the medical device excise tax and believes it disproportionately affects dental companies. DTA is thankful Congress recently suspended this burdensome tax for a second two-year period, but respectfully urges Congress to fully repeal the tax.

Background

The Dental Trade Alliance is a trade association representing distributors, manufacturers and laboratories that manufacture and supply products and services to oral health professionals. The total number of employees in our industry is over 39,000. While we are a small portion of the total expenditure for health care, the importance of good oral health is increasing as more and more studies show a link between oral health and health in the rest of the body. Diabetes and cardiovascular disease are linked to oral disease. In fact, many studies have shown that providing oral health care for people with these chronic diseases would actually lower related medical costs.

The 2.3% medical device tax imposed by the Affordable Care Act (ACA; P.L. 111-148) in 2010 was one of a number of additional revenue-raising provisions to finance health reform. This tax, which took effect in January 2013, could amount to over $100 million a year for the dental industry.

We are concerned that the excise tax on medical devices disproportionately affects dental companies. In fact, the tax equals 40 times the potential benefit from additional profits because additional dental coverage under the ACA was very limited. The initial claims that there would be ‘windfall’ profits resulting from increased health care coverage is not the case for dental companies. Because of this we are concerned that any increase in the cost of dental care resulting from the added tax will affect access to oral care.

The Dental Trade Alliance (DTA) is an association of companies that provid e dental equipment, supplies, materials and services to dentists and other oral care professionals. Our member companies are distributors, dental laboratories and manufacturers, located in the United States, Cana-da and Mexico. By providing the best equipment, materials and services to dentists and oral care professionals, we are partners in improving the oral health of everyone.

Please contact Patrick Cooney at 202-347-0034 x101 or via email at Patrick@federalgrp.com if you have questions about this brief or other health policy matters.

Dental Trade Alliance—4350 North Fairfax Dr., Suite 220, Arlington, VA 22203—(703) 379-7755

Dental Trade Alliance -- 4350 North Fairfax Dr. Suite 220, Arlington, VA 22203 -- (703) 379-7755

Member of Congress Letter

1. Find your Senators 2. Find your Representatives 3. Fill out their contact forms 4. Copy the message below (personalize if desired)

------------------------------------------------------------------------------- I am a constituent of yours and work for a business in your district. My company is a member of the Dental Trade Alliance (DTA) which is an association of companies that provide dental equipment, supplies, materials and services to dentists and other oral care professionals. By providing the best equipment, materials and services to dentists and oral care professionals, we are partners in improving the oral health of everyone. I am writing to make you aware of these very important issues:

• DTA Seeks Reform of the Sunshine Act: The Dental Trade Alliance believes the burden of reporting costs for dental manufacturers far exceeds any intended benefit of transparency in relationships with providers. DTA urges Congress to consider exempting small volume health professionals, including dentists, from coverage under the Sunshine Act to reduce unnecessary burden.

• DTA Urges Repeal of Medical Device Tax: The Dental Trade Alliance opposes the

medical device excise tax and believes it disproportionately affects dental companies. DTA is thankful Congress recently suspended this burdensome tax for a second two-year period, but respectfully urges Congress to fully repeal the tax.

Detailed information regarding these positions can be found in our 2018 DTA Issues Briefing: https://www.dentaltradealliance.org/sites/default/files/DTA%20Files/Legislative/Advocacy%20Packet/2DTALegislativeIssuesBundle.pdf Please contact Patrick Cooney at 202-347-0034 x101 or via email at Patrick@federalgrp.com if you have questions about these or other health policy matters. Thank you for your time and interest in issues that affect my company and the dental industry in general. -------------------------------------------------------------------------------------------------------------------------------

An Unexpected Strategy for Reducing Health Care Costs

Health Care Needs a Cure

A M E R I C A I S T H E most expensive country in the world in which to get sick—or, if you’re healthy, to

protect against the financial risk of getting sick.

This news is familiar, yet the basic facts are still staggering:

In 2014, more than one in every six U.S. dollars went to health care (or $3 trillion total). 1 To bring that to a more

human scale, in 2015 average health care costs for a family of four with preferred-provider coverage exceeded

$24,000. Employers covered more than 57 percent of that total—an astounding $14,000 per employee. 2

Under the weight of this hefty expense, business executives face intense pressure to use benefits to help

satisfy employees and attract top talent, comply with government mandates, and monitor the bottom

line. When budgets are tight, many resort to curbing coverage or deferring costs to employees.

The ROI of Oral CareA G A I N S T T H E B A C K D R O P of this health care crisis, a recent study shares some refreshingly pos-

itive news: There’s real potential for billions in savings for the system (and thousands for individuals)

by promoting dental care.

These findings, resulting from an analysis o f medical, economics and epidemiology research, are

based on a simple biological truth: The health of our mouths affects the health of our bodies. A healthy

mouth often mirrors internal health; a diseased mouth can reveal, and complicate, internal illness.

When oral health worsens, medical health worsens and costs escalate. By improving oral health,

overall medical savings can be realized:

— If 60 percent of diabetes patients better managed their gum disease, savings could

equal about $29 billion per year.

— If 40 percent of pregnant women better managed their gum disease: about $7 billion.

— If 50 percent of dental-related emergency visits were handled in a community setting:

around $826 million.3

Figures are based on the 2014 population/2014 dollar.

The health care system, like the body, is in fact a system: When you strengthen one part, the burden

on the whole lightens. When patients with systemic illnesses treat their gum disease, their medical

outlook improves and treatment costs go down. When people receive regular dental care, they avoid

expensive interventions during late stages of oral disease.

Savings Related to Systemic Disease

T H E VA L U E O F more widespread oral care can’t be overstated. Consider these dental and nondental cases:

In a 2014 oral health study by United Concordia, Dr. Marjorie Jeffcoat found an impressive connection

between dental care and medical savings while studying cases of people with systemic

diseases: type 2 diabetes, heart disease, stroke or coronary artery disease (CAD).

W E N T T O H E A LT H C A R E

I N 2 0 1 4

in every1 6U S U S

more than

T H E R E ’ S R E A L

P O T E N T I A L

F O R B I L L I O N S

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1 “National Health Expenditure Data,” Centers for Medicare & Medicaid Services, www.cms.gov.

2 Christopher S. Girod, Scott A. Weltz and Susan K. Hart, “2015 Milliman Medical Index,” May 19, 2015, www.milliman.com/mmi.

3 Uma Kelekar, Ph.D., “Economic Costs of Oral Care in the United States in 2014,” 2015.

SS

Analyzing more than 330,000 insurance records, Jeffcoat and her team discovered that when individu-

als living with one of these chronic conditions received treatment for their gum disease, their medical

costs and hospital visits generally decreased overall. (The same was true for pregnant women.)

The calculated annual savings were as high as $5,681 per individual, with hospitalization decreasing

as much as 39.4 percent. 4 This amasses to approximately $74 billion across the population of those

with diabetes, stroke and CAD, if 60 percent of these individuals realized the benefits of oral care.

The most greatly reduced hospitalizations came for individuals with diabetes, a condition that nega-

tively interacts with gum disease. If a patient’s diabetes is poorly controlled, they are three times more

likely to develop severe gum disease. On the other hand, a patient’s diabetic symptoms can worsen

in the presence of gum disease (as bacteria in the mouth activates a type of white blood cell that is

thought to create insulin resistance). 5

Not surprisingly, research shows a connection between regular dental care and diabetes-

specific medical care—with savings amounting to $29 billion if 60 percent of the diabetic population

received oral care.6 These figures, translating to about $1,845 per diabetic individual, promise a

trickle-down effect for households and businesses.

A similar scenario is true for lung disease, given that the oral cavity serves as a chamber for respirato-

ry pathogens.7 Economically speaking, oral hygiene among Ventilator-Associated Pneumonia (VAP)

patients is highly cost-effective. When doctors in one ICU unit administered an oral care treatment

costing less than $3 per case, they saw VAP cases (which can cost between $10,000 and $40,000 indi-

vidually) decrease by 46 percent.8

Lastly, oral care has a bearing on pregnant women, given the evidence that poor oral health among

expectant mothers is associated with low birth weight, preterm birth, preeclampsia and gestational

diabetes.9 These unwanted circumstances all rack up additional medical costs.

Jeffcoat’s study helps quantify these costs, finding a significant decrease in pregnancy costs when moth-

ers received periodontal treatment—$2,433 in average savings per pregnancy.10

These striking outcomes all underscore the far-reaching influence o f o ral c are. W hen t reated a s a n

essential part of medical care, oral care improves overall health—in turn promising savings for indi-

viduals, employers and taxpayers.

It Pays to Spend on Preventive CareI N T H E C O N V E R S A T I O N about dental-medical connections, another more universal theme

emerges: the “spend now, save later” strategy of basic dental care. When you invest a modest amount

in early, ongoing care, you’re paid back over time by avoiding drastic care.

Consider a 2004 study on oral care for infants and children conducted by researchers in North Carolina.

Drawing on Medicaid claims and other data sets, the team found that timely care during the first five

years of life was critical in determining someone’s oral health future.

Specifically, they found a positive l ink between early preventive care and the likelihood of later pre-

ventive care—as opposed to restorative or emergency care. This also amounted to lower dental costs

per child. Those who received initial care by 12 months of age incurred $262 (in 2004 dollars), as op-

posed to $546 for children who waited until age 4 to get dental care.11

W H E N P E O P L E

R E C E I V E

R E G U L A R

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T H E Y A V O I D

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O F T H E D I A B E T I C P O P U L A T I O N

R E C E I V E D O R A L C A R E

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savings could

amount to

S S

4 Marjorie K. Jeffcoat, Robert L. Jeffcoat, Patricia A. Gladowski, James B. Bramson, Jerome J. Blum, “Impact of Periodontal Therapy on General Health: Evidence From Insurance Data for Five Systemic Conditions,”

American Journal of Preventive Medicine, Vol. 47, No. 2, August 2014, 166-174.5 Douglas B. Berkey and Frank A. Scannapieco, “Medical Considerations Relating to the Oral Health of Older Adults,” Special Care in Dentistry, Vol. 33, No. 4, August 2013, 164-176.6 Uma Kelekar, Ph.D., “Economic Costs of Oral Care.”7 Catherine Hayes, David Sparrow, Michel Cohen, Pantel S. Vokonas, Raul I. Garcia, “The Association Between Alveolar Bone Loss and Pulmonary Function: The VA Dental Longitudinal Study,” Annals of

Periodontology, Vol. 3, No. 1, August 1998, 257-261.

The connection is clear: Kids who see the dentist early and often avoid more extensive treatment down the line.

Without this regular care, children are more likely to end up in the operating room, seeking treatment

for cavities under general anesthesia—treatment that’s far costlier than care in a dentist’s chair. Case

in point: For children with cavities registered for Iowa’s Medicaid program, the cost was almost 20

times higher ($2,009 for operating-room care over $105 for clinical care).12

Another instance of prevention-driven savings occurs later in life when people wait until dental pain

becomes severe and end up in the emergency room. According to the latest annual data from the

Nationwide Emergency Department Sample, 2012 brought more than 2.1 million of these visits, worth

a total of $1.6 billion (or $750 per visit).13 In 2014 dollars, this could potentially amount to $826 million

in system-wide savings for 50-percent fewer dental-related ER visits.14

And that’s not to mention the benefits that routine oral care brings via early detection of oral cancer and

other diseases, leading to less-aggressive treatments, lower costs and higher survival rates.

The Path Forward

T H I S P O W E R F U L A S S O C I A T I O N —that oral care has the power to drive down medical costs and

promote overall health—provides a foundation for change.

Policymakers, practitioners and insurance providers can begin to take targeted steps to realize the

cost-effective benefits of more widely adopted dental care:

— Health care organizations can better integrate oral care into primary care, offering it as

part of their core services.

— Policymakers can mandate dental coverage, either as stand-alone insurance or as part

of medical insurance, to encourage regular care. They can redesign government pro-

grams to extend broader care to women and children.

— Businesses can ensure their employees are covered for oral health and design wellness

programs to encourage use of this coverage.

—Physicians can more actively refer patients to dentists.

— Dentists can expand their office hours to make services more easily accessible to those

who would otherwise seek emergency treatment.

— Pediatricians and primary care physicians can incorporate basic dental treatments, such

as the application of fluoride varnishes and dental sealants, into routine annual checkups.

Underlying all of this is the positive, proven link between oral wellness and overall health. As individu-

als receive better dental care, their medical health promises to improve. As the nation’s medical health

improves, valuable health care dollars return to the government, businesses and the American people.

8 Carrie Sona, Jeanne Zack, Marilyn E. Schallom, Maryellen McSweeney, Kathleen M. McMullen, James Thomas, “The Impact of a Simple, Low-Cost Oral Care Protocol on Ventilator-Associated Pneumonia Rates in

a Surgical Intensive Care Unit,” Journal of Intensive Care Medicine, Vol. 24, No. 1, Jan-Feb 2009, 54-62.9 The American College of Obstetricians and Gynecologists, 2013.10 Jeffcoat, et al., “Impact of Periodontal Therapy on General Health,” 166-174.11 Matthew F. Savage, Jessica Y. Lee, Jonathan B. Kotch, William F. Vann, Jr., “Early Preventive Dental Visits: Effects on Subsequent Utilization and Costs,” Pediatrics, Vol. 114, No. 4, October 2004.12 Michael J. Kanellis, Peter C. Damiano, Elizabeth T. Momany, “Medicaid Costs Associated with the Hospitalization of Young Children for Restorative Dental Treatment Under General Anesthesia,” Journal of Public

Health Dentistry, Vol. 60, No. 1, March 2000, 28-32.13 Thomas Wall and Marko Vujicic, “Emergency Department Use for Dental Conditions Continues to Increase,” Health Policy Institute Research Brief, American Dental Association, April 2015.14 Uma Kelekar, Ph.D., “Economic Costs of Oral Care.”

W H E N Y O U

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This report is based on research prepared for the Dental Trade Alliance by Uma Kelekar, Ph.D.,

Assistant Professor of Healthcare Management, Marymount University, Arlington, Virginia.

%%

S S

$ 7 BILLION

29 BILLION $

826 MILLION $

went to health care.

As individuals receive regular dental care, their medical health improves—creating

vast savings for the American health caresystem, government and businesses.

If 60% of diabetes patientsbetter managed their gum

disease, savings could equalabout $29 billion per year.

BILLIONS

We have found a way to save

in health care.

of Oral Care

in every 6 1 USDUSD

$ $

In 2014, more than

When oral healthworsens, medical

health worsens andcosts escalate. By

improving oral health,savings can be

realized:

If 40% of pregnant womenbetter managed their gum

disease, savings could equalabout $7 billion.

If 50% of dental-relatedemergency visits were handledin a community setting, savingscould equal around $826 million.

 ROI

How can policymakers help?

Considermandatory

dental coverageto encourageregular care.

www.oralhealthcarecantwait.org

Redesigngovernment

programs to extendbroader care toadults & kids.

This information is extrapolated from a report based on research prepared for the Dental Trade Alliance by Uma Kelekar,Ph.D., Assistant Professor of Healthcare Management, Marymount University, Arlington, VA.