The Marin Board of Supervisors recently voted to take Health and Human Services department staff recommendations and integrate the medical specialty clinics and county dental clinic with Marin Community Clinics.
The prospects for a seamless transition and maintaining continuity of care are dim.
Maintaining the level of services provided by the county dental clinic during and after the transition present immense challenges. The county dental clinic staff has been largely eviscerated, before the fact, and is now operating with a skeleton crew; sometimes only one dentist is on duty, with more staff considering leaving.
Marin Community Clinics chief dental officer Connie Kadera stated during the Beilenson hearing that MCC provides adult care according to Denti-cal guidelines. Denti-cal approved benefits are so limited as to be far below the standard of care provided by Marin County Dental. Denti-cal ignores the standard of care by limiting access to many procedures.
Patients at the county dental clinic enjoy a more robust range of services, akin to those in a private dental office. They have the vast majority of oral surgery procedures in-house, without being referred. They are provided with a range of prosthetic solutions, including partial dentures of all types, and fixed bridgework.
They have most root canals performed by county staff at the clinic. The county clinic provides periodontal treatment and maintenance.
These services are beyond the scope of Denti-cal benefits and those currently provided by Marin Community Clinics.
According to its own data, in 2016 MCC referred 3,463 patients for services outside of their clinic, including 1,196 for oral surgery, 796 for root canals, and 327 for general dentistry.
The county adult dental clinic is more efficient in several ways. These include the use of dental auxiliaries with extended functions and the liberal use of interns who rotate in their third and fourth years at UCSF School of Dentistry.
Some county auxiliary staff are educated and licensed by the state to provide additional procedures that a dentist might otherwise perform. They complete certain fillings, take impressions, participate in root canal treatments, and more.
MCC does not employ or offer similar positions. These skills will be lost, along with the increased efficiency.
MCC currently employs no dental hygienists, which leaves their dentists to do oral hygiene and limits their availability to provide other services.
UCSF has suspended the intern program at Marin Community Clinics because students there were not allowed to provide enough treatment to satisfy their requirements.
Federally Qualified Health Center providers like Marin Community Clinics are required to provide considerable data and metrics to the federal government in order to obtain reimbursement levels above and beyond what the county gets from Denti-cal for the same procedures. Staff members have complained about the amount of time taken away from patient treatment to supply this data.
Due to public demand to maintain the Fourth Street clinic location, county HHS relented and is keeping the location open for now, but that will not eliminate the siloing of services as advocated by HHS director Dr. Grant Colfax. Its dental electronic records system does not interface with its medical records system.
With the loss of efficiencies, many staff changes, a need to upgrade services and the increased time necessary for data and metrics recording required by FQHC guidelines, MCC will need to have a plan going forward to meet the challenge of providing a seamless transition on Nov. 3.
No plan has been revealed, and it is the Board of Supervisors’ responsibility to hold HHS accountable to closely monitor the level of patient services — not just the number of visits — during and after the integration.
Michael Aaronson of Fairfax maintained a long-standing private dental practice in San Rafael and in recent years worked as a dentist at the county Dental Clinic. He retired from that position.