Financial hurdles remain for dental care


ORAL HEALTH: BY THE NUMBERS

84,325 Ohioans visited an emergency room for a dental problem in 2011

2,040 Butler County residents visited an ER for a dental problem, each year 2009-11

$188.5 million in emergency room costs for dental treatment, 2010-11

19 percent of Ohio's children have untreated cavities

12 percent of Butler County children under 18 have never visited a dentist

340,000 children statewide have never been to a dentist

71 percent of Ohioans visited a dentist in the past year

Source: Centers for Disease Control and Prevention, Ohio Department of Health, UHCAN Ohio

Millions more Americans are gaining dental coverage through the Affordable Care Act, but the health care law isn’t doing enough to improve reimbursement rates for the care, according to the dental community.

Approximately 8.7 million children — and only about 800,000 adults — could gain extensive dental coverage through the ACA by 2018, according to the American Dental Association.

The health care law requires dental coverage be an essential health benefit for children; but insurers don’t have to offer adult dental coverage, according to Healthcare.gov.

A barrier to access dental care is the lack of private dental offices that accept Medicaid or limit the number of Medicaid patients due to a low reimbursement rate of 37 percent of marketplace fees, officials said.

Dr. Steven Moore, a West Chester dentist, said his office does not accept Medicaid because the reimbursement rate doesn’t even cover his expenses.

“People providing the care need to make a living,” Moore said. “We’ll treat everyone, but we can’t lose money treating patients.”

Moore said he wouldn’t be able to accept Medicaid and still be able to provide his employees a competitive wage, benefits, paid vacation, and pay the utility and insurance bills for his business.

Shortage of care

Butler County has two areas — Middletown and East Hamilton — designated as dental Health Professional Shortage Areas (HPSAs) by the federal Health Resources and Services Administration.

Melanie Amato, spokeswoman for Ohio Department of Health, said Butler County’s two shortage areas have a low-income designation, meaning there aren’t enough dental providers serving the low-income population.

“Often, this segment of the population receives Medicaid or is uninsured and can’t afford to pay full fees for dental care,” Amato said. “Private practice dental offices very rarely offer sliding fee payments.”

The American Dental Association has said there’s “strong evidence” that reforming Medicaid and increasing reimbursement rates to market levels would increase access to dental care.

About 71 percent of Ohioans visited a dentist in the past year, according to the Centers for Disease Control and Prevention.

And in Butler County, 12 percent of children under age 18 have never visited a dentist, according to ODH.

“It’s an afterthought for a lot of people,” Moore said. “Oral health contributes greatly to overall health and total body health.”

Moore said his practice, Lakota Dental Group, most commonly treats periodontal (gum) disease, which causes loss of teeth and bad breath; tooth decay in the form of cavities; and in more severe cases abscesses from untreated cavities.

Moore said an abscess happens when the tooth decay gets into the nerve of the tooth and surrounding tissue. In the most serious cases, an abscess can cause death.

Emergency department visits

Emergency departments across Ohio treat patients daily for dental complaints, officials said. That dental care was at a cost of $188.5 million for 2010 and the first half of 2011, according to the latest figures from ODH.

“Pain is the biggest thing that brings people into the ER,” said Dr. Marcus Romanello, medical director of the emergency department at Fort Hamilton Hospital.

In 2011, over 84,000 Ohioans — those with public insurance or no insurance — visited an emergency room for a dental problem.

In Butler County, about 2,000 residents visit an emergency room for a dental problem each year, according to the nonprofit Universal Health Care Action Network Ohio.

Tina Gregory, director of emergency trauma services at Atrium Medical Center, said their emergency department treats people daily for dental problems, including jaw and tooth pain, broken teeth and abscesses that cause “very acute and intense” pain.

“Part of the reason is dental care is expensive and not a lot of people have dental insurance,” Gregory said. “Even if you do, you can’t always get in right away.”

Hospital officials said while they can treat a patient’s pain or give antibiotics for an infection, they are unable to treat the cause of the problem due to not staffing dentists.

Both the Hamilton and Middletown hospitals will refer patients, especially those low income, to an eight-bed dental clinic in Middletown, operated by Primary Health Solutions since 2011.

The clinic accepts Medicaid and is on track to hit 10,000 dental visits next year, said Ken Mitchell, director of operations at Primary Health.

Mitchell said the nonprofit agency last summer also introduced Mission Dental, a mobile dental clinic that travels around Butler County.

The mobile unit — complete with two treatment beds, X-ray and radiology technology, and electronic medical records — operates two days a week in Hamilton, and the remaining days are split between the Talawanda and Fairfield school districts.

Starting in January, the mobile clinic will also spend one day a week traveling to Hamilton’s public schools to screen and treat students in all grades Pre-K to 12, said Tracy Heinecke, head nurse for the district.

The mobile clinic — which bills all types of insurance and helps low-income families — has the capacity to see 20 students per day.

“Fifty to sixty percent of the kids we’ve seen in the schools need care,” Mitchell said. “Some have abscesses and we’ll work with the school to get care within 24 hours.”

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