Tuesday, February 28, 2012

More Americans Seeking Dental Treatment at Hospital Emergency Rooms

(USA Today) While government-managed health care programs such as Medicaid pay for emergency room visits for adult enrollees seeking temporary relief from toothaches, tooth abscesses and other dental emergencies, coverage of outpatient dentist office treatment for those problems varies greatly from state to state, according to a 2011 federal Medicaid report. Federally mandated preventive and other dental care usually ends when Medicaid recipients enter early adulthood. That leaves states to determine whether they will provide dental benefits to adult Medicaid patients and if so, what type and how much. Ten states — Alabama, Arizona, California, Colorado, Delaware, Missouri, Texas, Utah, Virginia and Washington — offer no Medicaid dental benefits to adults, the report shows.

This has been a problem for some years now.

More Americans are turning to the emergency room for routine dental problems - a choice that often costs 10 times more than preventive care and offers far fewer treatment options than a dentist's office, according to an analysis of government data and dental research.

Most of those emergency visits involve trouble such as toothaches that could have been avoided with regular checkups but went untreated, in many cases because of a shortage of dentists, particularly those willing to treat Medicaid patients, the analysis said.

The number of ER visits nationwide for dental problems increased 16 percent from 2006 to 2009, and the report released Tuesday by the Pew Center on the States suggests the trend is continuing.

In Florida, for example, there were more than 115,000 ER dental visits in 2010, resulting in more than $88 million in charges. That included more than 40,000 Medicaid patients, a 40 percent increase from 2008.

Many ER dental visits involve the same patients seeking additional care. In Minnesota, nearly 20 percent of all dental-related ER visits are return trips, the analysis said.

That's because emergency rooms generally are not staffed by dentists. They can offer pain relief and medicine for infected gums but not much more for dental patients. And many patients are unable to find or afford follow-up treatment, so they end up back in the emergency room.

"Emergency rooms are really the canary in the coal mine. If people are showing up in the ER for dental care, then we've got big holes in the delivery of care," said Shelly Gehshan, director of Pew's children's dental campaign. "It's just like pouring money down a hole.

"It's the wrong service, in the wrong setting, at the wrong time," she said.

The center in Washington, D.C., is a division of the nonprofit Pew Charitable Trusts.

The fact is there needs to be a frank discussion as to who will pay for American's dental care.

There is no doubt that providing emergency treatment at a hospital for a bad tooth or a gum infection is not cost efficient. However, with many states facing insolvency and the federal government running massive deficits, how can the Medicaid system be changed to facilitate better care practices.

The Pew Charitable Trusts want to license mid-level dental practitioners to provide routine care. I hate to tell them but the costs to providing care to these folks will not be that marginally different than that provided by a licensed dentist. A new type of practitioner will not be the answer either short or long term.

Perhaps, the states could build and staff their own emergency dental centers?

But, as I said, many states face extreme budget challenges and who will decide if care is an emergency or not? Where will these centers be located, who will run them and what will eligibility for patients be?

There are many questions and no easy answers to this problem.

Then, there is the issue of personal responsibility for one's own dental condition.

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