March 24, 2023
The Honorable Benjamin Cardin
Chair, Subcommittee on Health Care
Committee on Finance
United States Senate
Washington, DC 20510

The Honorable Steve Daines
Ranking Member, Subcommittee onHealth Care
Committee on Finance
United States Senate
Washington, DC 20510

Re: March 29, 2023 hearing, “An Oral Health Crisis: Identifying and Addressing Health
Disparities”
Dear Chairman Cardin and Ranking Member Daines:

On behalf of the American Association of Oral and Maxillofacial Surgeons (AAOMS), which
represents more 9,000 oral and maxillofacial surgeons (OMSs) in the United States, thankyou for the opportunity to comment on your request for information on the scope and roleof OMSs in providing oral healthcare to patients. We offer the following comments inresponse to your request for information prior to your upcoming hearing on oral
healthcare access.

OMSs are surgically and medically trained dental specialists who treat conditions, defects,injuries and esthetic aspects of the mouth, teeth, jaws, neck and face. After earning a dental
degree from an accredited four-year dental school, OMSs complete a minimum of fouryears of hospital-based oral and maxillofacial surgery residency training that includes
rotations in such areas as general surgery, anesthesia, and clinical research. Nearly 40
percent also earn a medical degree or complete a fellowship training program.

Based upon the available practice data, the most common procedures performed by OMSs
are extractions of infected, impacted or diseased teeth; dental implant placement;
corrective jaw surgery to reconstruct inadequate structures; facial trauma treatment,
including lacerations and other facial injuries; as well as head, neck and mouth cancer
diagnosis and surgical treatment. Many OMSs also perform cleft lip/palate surgery, serve as
members of the sleep team to help treat obstructive sleep apnea, treat TMJ disorders andfacial pain, and perform facial cosmetic procedures. The majority of OMS patients are aged
19 and older with the primary demographic being between the ages of 19 and 59.

Past survey data of AAOMS members show that approximately two-thirds of AAOMS
members practice in large metro areas and cities comprised of more than 100,000 people,
while approximately one-third practice in small cities comprised of less than 100,000
people, and a very small percentage practice in rural areas. Unfortunately, availability ofmore comprehensive data is currently limited regarding disparity in practice and patient
populations. To address the paucity of data, AAOMS engaged in efforts to create acomprehensive registry to track patient data and outcomes several years ago but use waslimited without engagement from electronic health records companies. We welcome
additional conversation with the Committee with regard to making data more readily
available to the oral health community.
As the Committee discusses issues related to oral health access, AAOMS would like tohighlight a few efforts the association has been engaged in at the federal level.
•AAOMS has worked with a coalition of more than 70 patient and provider groups forseveral years to advocate for enactment of the bipartisan Ensuring Lasting Smiles
Act (ELSA). The bipartisan bill - introduced by Sens. Tammy Baldwin (D-Wis.) andJoni Ernst (R-Iowa) and Reps. Drew Ferguson (R-Ga.) and Anna Eshoo (D-Calif.) –passed the House last year and would require health insurers to cover dental
treatment for patients with congenital craniofacial anomalies. ELSA would benefit asubset of the approximately four percent of Americans born with a congenital
anomaly. 1 With regard to oral health, that subset includes cleft lip and cleft palate –which impacts 6.4 in every 10,000 babies born in the U.S. 2 – and ectodermal
dysplasias – which includes 3.5 to 7 out of every 10,000 children worldwide. 3 ELSA
would ensure coverage for necessary care throughout the lifetime of the patient –not just when they are children. ELSA will be reintroduced this spring, and thecoalition looks forward to working with the bill sponsors to enact it in the118th Congress.

•AAOMS recently partnered with the American Dental Association and the American
Academy of Pediatric Dentistry to successfully lobby CMS to increase the Medicare
facility payment for dental procedures performed on children, adults withdisabilities and the frail elderly in hospital outpatient settings. As a result, CMS

1 National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control andPrevention. Birth defects. Available at: https://www.cdc.gov/ncbddd/birthdefects/index.html. Accessed
March 21, 2023.
2 Mai CT, Isenburg JL, Canfield MA, Meyer RE, Correa A, Alverson CJ, Lupo PJ, Riehle‐Colarusso T, Cho SJ,Aggarwal D, Kirby RS. National population‐based estimates for major birth defects, 2010–2014. BirthDefects Research. 2019; 111(18): 1420-1435. https://pubmed.ncbi.nlm.nih.gov/31580536/. Accessed March21, 2023.
3 Majmundar VD, Baxi K. Ectodermal Dysplasia. [Updated 2022 Jul 25]. In: StatPearls [Internet]. Treasure
Island (FL): StatPearls Publishing; 2023 Jan-. https://www.ncbi.nlm.nih.gov/books/NBK563130. Accessed
March 21, 2023.

established a new HCPCS code as part of the 2023 Hospital Outpatient Prospective
Payment System and Ambulatory Surgical Center Payment Final Rule. Effective Jan.
1, G0330 may be used by hospitals to report facility costs associated with Medicarecovered dental procedures requiring monitored anesthesia or OR time. The newcode is assigned a payment rate of $1,722.43. Previously, facilities billed an unlisted
code which resulted in a payment rate of $216.07. Advocacy efforts will continuethis year with a focus on making the new code payable in the ASC setting aswell as ensure state Medicaid plans adopt the code and CMS payment rate.
••AAOMS supports the expansion of Medicare coverage for medically necessary dental
treatment related to acute medical conditions. Specifically, during the 117thCongress, AAOMS advocated in support of the Medicare Medically Necessary Dental
Care Act by Congressman Steve Cohen (D-Tenn.) that would expand and codify thetypes of medically necessary procedures for which Medicare would cover dentalrelated treatment. Similarly, AAOMS has supported CMS’ efforts to use its regulatory
authority to expand access to medically necessary dental procedures essential forthe successful treatment of certain medical conditions. AAOMS recently provided
comments for consideration for the 2024 proposed physician fee schedulethat support Medicare coverage for medically necessary dental treatment
related to certain additional medical procedures/ conditions, specifically,
before and after head and neck cancer treatment, regardless of whether thediagnosis is primary or secondary; for patients with osteonecrosis of the jaw; as wellas prior to or contemporaneously for patients undergoing total joint arthroplasty
and cardiovascular procedures.

AAOMS also strongly supports student loan relief as one of many possible solutions
to physician and dental workforce shortages, specifically in underserved areas.
AAOMS and more than 40 other physician and dentist organizations support
the Resident Education Deferred Interest (REDI) Act (S 704/HR 1202) –bipartisan legislation introduced by Sens. Jacky Rosen (D-Nev.) and John
Boozman (R-Ark.) as well as Reps. Brian Babin (R-Texas) and Chrissy
Houlahan (D-Pa.) – which would allow borrowers to qualify for interest-freedeferment on their student loans while serving in a medical or dental
internship or residency program. Physicians and dentists who undertake several
years of residency with very low pay are often unable to begin repaying theirsubstantial student debt immediately. As a result, they qualify to have theirpayments halted during residency through deferment or forbearance processes, butthey continue to accrue interest that can add tens of thousands of dollars to theirloan balance over the life of the loan. Deferment or forbearance can be very costly toa resident and further compound their debt load due to accumulating interest. For
example, a student with the average debt of $300,000 entering their four-year
residency program could accrue more than $80,000 in accumulated interest(assuming a 6 percent interest rate) which will be added to their $300,000 principal.
Supporters of the REDI Act believe this current loan structure unfairly punishes
medical and dental residents during one of the most critical times in their education

and serves as a deterrent to those interested in practicing in underserved areas orentering faculty or research.

Finally, oral and maxillofacial surgery is one of the few dental specialties whose members
accept and bill Medicare. According to a 2020 survey of AAOMS members, approximately
40 percent of OMSs report being Medicare providers. As Congress looks to address accessto care disparities, we encourage you and your colleagues to address the longstanding
challenges with the Medicare reimbursement system that deter providers fromparticipation. More specifically, the Medicare Physician Fee Schedule MPFS is the only
payment system within Medicare without an annual inflationary update and that requires
any updates to be budget neutral. The situation pits specialty providers against primarycare providers and forces all to lobby Congress each year to avoid costly payment cuts.
According to an American Medical Association analysis of Medicare Trustees data,
Medicare physician payments have declined by 22 percent from 2001to 2021, when
adjusted for inflation. 4 Many providers, including OMSs, are small business owners anddeal with a wide range of shifting economic factors when determining their ability toprovide care to Medicare beneficiaries. We urge Congress to address these reimbursement
challenges to ensure a sustainable provider network for the nation’s seniors.

Again, thank you for your leadership on oral healthcare issues. AAOMS would be pleased towork with the Committee on this important initiative. Please contact Jeanne Tuerk, AAOMS
Director of Government Affairs, at 800- 822-6637, ext. 4321, or jtuerk@aaoms.org.

Sincerely,Paul J. Schwartz, DMD
AAOMS President

4 American Medical Association. Medicare updates compared to inflation (2001-2021). Available at:https://www.ama-assn.org/system/files/ama-medicare-gaps-chart-grassroots-insert.pdf. Accessed March
21, 2023.