The Morning Drill: November 14, 2011

Good morning!

A collection of dentistry and health related links/comments for your day.

Supreme Court will hear health care case this term

The Supreme Court said Monday it will hear arguments next March over President Barack Obama's health care overhaul, accepting a case that could rival the historic Bush v. Gore ruling in shaking the political landscape.

The decision to hear arguments in the spring allows plenty of time for a decision in late June, just over four months before Election Day. This sets up an election-year showdown over the White House's main domestic policy achievement.

The justices announced they will hear more than five hours of arguments from lawyers on the constitutionality of a provision at the heart of the law, the requirement that individuals buy health insurance starting in 2014 or pay a penalty, and other related questions about the act.

The White House said "we are pleased that the court has agreed to hear this case."

"We know the Affordable Care Act is constitutional and are confident the Supreme Court will agree," communications director Dan Pfeiffer said in a statement.

Republicans have called the Patient Protection and Affordable Care Act unconstitutional since before Obama signed it into law in March 2010. But federal appeals courts have been split on their assessment.

The high court's 5-4 decision in the Bush v. Gore case nearly 11 years ago effectively sealed George W. Bush's 2000 presidential election victory.

Professional Dental Cleanings May Reduce Risk of Heart Attack, Stroke

Professional tooth scaling was associated with fewer heart attacks and strokes in a study (Abstract 17704) from Taiwan presented at the American Heart Association's Scientific Sessions 2011.

Among more than 100,000 people, those who had their teeth scraped and cleaned (tooth scaling) by a dentist or dental hygienist had a 24 percent lower risk of heart attack and 13 percent lower risk of stroke compared to those who had never had a dental cleaning. The participants were followed for an average of seven years.

Scientists considered tooth scaling frequent if it occurred at least twice or more in two years; occasional tooth scaling was once or less in two years.

The study included more than 51,000 adults who had received at least one full or partial tooth scaling and a similar number of people matched with gender and health conditions who had no tooth scaling. None of the participants had a history of heart attack or stroke at the beginning of the study.

The study didn't adjust for heart attack and stroke risk factors -- such as weight, smoking and race -- that weren't included in the Taiwan National Health insurance data base, the source of the information used in the analysis.

"Protection from heart disease and stroke was more pronounced in participants who got tooth scaling at least once a year," said Emily (Zu-Yin) Chen, M.D., cardiology fellow at the Veterans General Hospital in Taipei, Taiwan.

Professional tooth scaling appears to reduce inflammation-causing bacterial growth that can lead to heart disease or stroke, she said.

Texas Medicaid problems may apply nationwide

Claims procedures discovered in a News 8 investigation of the Texas Medicaid Dental program may apply to the whole country, because of the payment process employed by a major government contractor.

In a series of investigative reports over the last several months, News 8 discovered hundreds of millions of dollars in Medicaid billing for orthodontics. Now it appears the problems, which have triggered a federal audit, may be linked as much to the way the claims are approved, as they are to the individual dentists involved.

It turns out that the claims examiners are paid by quantity, and not necessarily quality, under a program called Activity Based Compensation, or ABC. The more claims they process, the more money they make, creating a strong incentive not to take too much time with each one.

"Your tax dollars aren't working," said a former claims specialist, one of several News 8 has interviewed. "You're paying for [dental] services that shouldn't be paid for."

Texas paid out $184 million in Medicaid dental claims last year, as much as the rest of the nation combined.

New California Medicaid cuts may affect kids' dental services

In 2009, some 3 million adults in California lost their Medicaid dental benefits as the state struggled to close a severe budget gap.

Now many of the state's poorest children are facing potential cutbacks in Medicaid dental services as well.

On October 27, the U.S. Centers for Medicare and Medicaid Services (CMS) approved a state proposal to reduce Medi-Cal provider reimbursements by 10% in the 2012 fiscal year, retroactive to June 1, 2011.

The rate reductions were authorized by California Assembly Bill 97, which was signed by Gov. Jerry Brown in June and required federal approval of all Medi-Cal budget reductions prior to implementation.

The cuts, which will save the state $623 million, would impact outpatient services for physicians, dentists, clinics, optometrists, medical equipment, laboratories, and pharmacies. California spends $14 billion annually on the Medi-Cal program.

Medi-Cal currently provides dental benefits to 6.9 million people through a contract with Delta Dental of California. In 2009, the state eliminated most adult Denti-Cal services except for pregnant women and some emergency situations.

While children's services are exempt from the Medi-Cal cuts, the exemption applies to medical services, not dental, according to the California Dental Association (CDA).

"After the loss of the adult dental program, we are now talking about cuts almost exclusively on the care provided to children," said Daniel G. Davidson, DMD, the president-elect of the CDA. "Access to care should be the main goal here, and because these cuts are counter to that goal, CDA is analyzing its options to determine the most appropriate next steps to take to reverse it."

Under the federal Medicaid Act, the state is required to demonstrate that Medicaid patients and privately insured patients have equal access to healthcare and that access will remain intact if the cuts are implemented. In a statement issued October 27, CMS said that, based on "extensive data" submitted by the state, it believes access to care won't be jeopardized for Californians as a result of the cuts.

But many healthcare groups remain unconvinced, and the California Medical Association (CMA) is threatening to file a lawsuit to stop the cuts from being implemented.

"The primary concern on our part is access to dental services for children because adult dental was virtually eliminated two years ago," said Joel Diringer, JD, MPH, the interim executive director of the Center for Oral Health. "And we are talking primarily about private dentists because the FQHCs [federally qualified health centers] won't be affected by the cuts. Private providers and community clinics are the ones that will be affected by this."

As of 2007, Denti-Cal served some 8 million people in California, although only 25% of beneficiaries reported a dental visit in 2007, according to the California Health Care Foundation (CHCF). In fact, the service is significantly underutilized, Diringer noted -- even with the elimination of most adult Denti-Cal services in 2009.

"Only about one-third of children on Denti-Cal have a dental visit annually," he said.

Enjoy your morning!