Thursday, January 18, 2018
Health

Dental care in the ER is costing us millions — and not helping patients

Dental problems are driving a growing number of Floridians to the emergency room — and costing taxpayers millions of dollars, according to a new study published in the Journal of Public Health Dentistry.

The study found the number of dental-related visits to Florida emergency departments surged from 104,642 in 2005 to 163,900 in 2014, an increase of about 57 percent.

The total charges over that period increased more than threefold, reaching $193.4 million in 2014. Roughly half was billed to Medicaid or Medicare.

That's a sizable expense — especially considering most emergency rooms aren't equipped to treat the underlying problem.

"The emergency department is about the least appropriate, most expensive place you can go for dental care," said Dr. Scott Tomar, a professor of dentistry at the University of Florida and a co-author of the study. "In most cases, they give the patient a painkiller and antibiotics, and tell them they really need to get to a dentist."

Dr. Dina Howell, the chief dental officer for the Tampa Family Health Centers, called the trend "a major problem across the state."

"It's not cost-effective at all," she said.

So why are more people with tooth pain filling Florida's emergency rooms?

Some experts blame the state Medicaid program.

In Florida, Medicaid plans are required to cover only emergency dental services — namely denture-related procedures, extractions and the draining of any abscesses. Since 2014, the plans have offered some expanded benefits, from oral exams to X-rays.

Finding a provider can be difficult. Studies show only about 860 dentists, or about 8 percent of professionally active dentists statewide, participate in the Medicaid program.

"Very few private-practice dentists will see Medicaid patients, and that's a fact statewide," said Kim Herremans, executive director of the Greater Tampa Bay Oral Health Coalition. "The reimbursement rates are very low."

Herremans said many adults in the Medicaid program aren't getting fillings and root canals when they need them — and wind up in serious pain.

The numbers bear that out. Nearly 40 percent of Florida patients who sought dental-related care in an emergency room in 2014 were covered under Medicaid, the study found.

It wasn't only Medicaid enrollees.

Another 38 percent of visits were by people who did not have medical insurance and paid out of pocket. Eleven percent went through commercial insurance.

Those people may have put off preventive care and routine visits because of rising costs, said Tomar, the professor involved in the study.

"The cost of dental care has far exceeded the rate of price increase for pretty much any other goods or services," he said. "Even for middle-class folks, dentistry is becoming increasingly expensive."

On average, the charges for patients who visited the ER with tooth troubles were $1,430.35 — less than the $4,545.68 average charge for all other visits, the study found, but no small burden on Medicaid.

Tomar said that money would be better spent on preventive services and early treatment.

"We could have prevented a lot of this by providing access to routine dental care and simple fillings," he said. "Instead we wait until patients wind up in pain or with an acute infection — and the person still walks out with the underlying cause untreated."

Floridians have options for dental care outside of private providers. The federally subsidized Tampa Family Health Centers, for example, operate 10 dental clinics with 80 dental chairs across Hillsborough County. The centers accept Medicaid, Medicare and private health insurance, and also offer "self-pay" prices based on income.

Last year, the centers served more than 26,000 dental patients, said Howell, the chief dental officer. Three-quarters were at or below the federal poverty level, she added.

The patients on Thursday afternoon included 30-year-old Diana Chavez, who paid $20 out-of-pocket for a routine cleaning.

Chavez said she considers oral health an important part of overall health. She had serious tooth pain and swelling last year, and is taking steps to prevent it.

"I want to avoid the emergency room," she said.

Contact Kathleen McGrory at [email protected]m or (727) 893-8330. Follow @kmcgrory.

   
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