July 2007 Improving Medicaid patients' access to dental care


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July 2007 Improving Medicaid patients' access to dental care

  1. 1. Improving Medicaid patients’ access to dental care
  2. 2. Vast majority of dental diseases are infectious, irreversible and destructive. <ul><li>40-year-old male (patient has dental insurance) seen by Dr. Mick McCormick (Mauston). </li></ul>
  3. 3. Dental diseases can only be diagnosed and successfully treated with proper intervention by a licensed dentist and qualified dental staff. <ul><li>In Wisconsin, state and federal governments spend less than one percent , or just $38 million of $4.4 billion annual Medicaid (MA) budget, on oral health programs for children and adults. </li></ul><ul><li>Four out of five states spend higher percentage of MA dollars on dental care for children and adults than Wisconsin, according to the American Dental Association (ADA). </li></ul>
  4. 4. The American Academy of Pediatrics (physicians) says 20 percent of all health care funds spent on children should be directed at improving and maintaining oral health. <ul><li>Four-year-old female; Green Bay resident treated at First Impressions in Wausau due to lack of MA providers in her community. Disease so advanced pediatric dentist had to treat at Wausau Surgery Center under general anesthesia. </li></ul>
  5. 5. First Impressions has been committed to seeing children on MA despite the financial losses this imposes on the practice. <ul><li>Four-year-old female from Green Bay. </li></ul><ul><li>First Impressions is a multi-practitioner pediatric dental practice that gets only 40 percent return on MA billings. (Break-even point for most dental offices, not including dentist’s salary, is about 65 cents on the dollar.) </li></ul>
  6. 6. Maintaining one’s oral health improves overall health and can help keep health care costs lower. <ul><li>23-year-old female MA patient treated by Dr. McCormick early in 2007. </li></ul><ul><li>Paying reasonable rates improves a person’s access to a “dental home” where he/she can receive comprehensive dental care. </li></ul>
  7. 7. Death of 12-year-old, low-income boy in Maryland from a severe brain infection that spread from an abscessed tooth illustrates that neglecting dental health can be serious and costly. <ul><li>It was reported a dental extraction costing $80 accessed early on would have solved the 12-year-old’s problem; follow-up medical treatment, which unfortunately did not save the child’s life, cost $250,000. Stories such as this are heartbreaking and unacceptable in a society such as ours. </li></ul>
  8. 8. 95 percent of Wisconsin’s practicing dentists are small business owners. <ul><li>23-year-old female MA patient treated by Dr. McCormick early in 2007. </li></ul><ul><li>Small-business owner dentists do not impose a “hidden tax” on private-pay patients by cost-shifting losses incurred through participation in an inadequately-funded state dental MA program. </li></ul>
  9. 9. Dr. McCormick billed the state’s MA program for one comprehensive oral exam, PAN X-rays, a three-surface resin filling and surgical removal of two teeth for a total cost of $919 . <ul><li>He received a state MA reimbursement check for $283.65 or just 30.8 percent of the real cost . </li></ul>
  10. 10. <ul><li>… of the state’s lack of commitment to this program dentists either limit their MA participation or drop their certification. </li></ul>MA patients experience insufficient access, because…
  11. 11. Dental access improves when fair-market rates are implemented. 25.95% 20.83% ADA 25th percentile or below Virginia 57.33% 484.30% 85% of submitted charges Delaware 300.00% 144.44% Based on Delta Dental's &quot;Preferred Option&quot; network Michigan 93.38% 47.51% Private sector 75th percentile South Carolina 90.01% 122.22% ADA 75th percentile Indiana 111.66% 43.30% ADA 75th percentile Tennessee Percent Increase in Dentists Participating Percent Increase in Utilization Payment to Dentist After Increase State Dental Medicaid Rate Increases at a Glance
  12. 12. One out of every two WDA practicing dentists recently answered a questionnaire about dental MA participation. <ul><li>Nearly 80 percent of respondents said they would begin seeing or see new MA patients if rates were raised to the 75 th percentile of the most recent ADA fee survey for this region of the country . </li></ul><ul><li>The 50 percent of WDA member dentists who responded to the questionnaire alone would see approximately 111,400 new MA patients. </li></ul><ul><li>140,000 patients currently receive dental services annually under the fee-for-service MA program in Wisconsin. </li></ul>
  13. 13. The WDA asks the Legislature to prioritize dental funding within the state budget and increase dental MA reimbursements to the 75 th percentile. <ul><li>Four-year-old male MA patient treated by Dr. McCormick in 2007. </li></ul><ul><li>Increasing rates would cost the state an additional $20 - $30 million in General Purpose Revenue (GPR) per year. </li></ul><ul><li>If approved, the state would still spend less than two percent of its entire MA budget on dental services. </li></ul>
  14. 14. Legislators must decide if the state’s poorest citizens deserve to have two percent of the MA budget dedicated to improving their oral health. <ul><li>Teenage male patient of Dr. Michael Donohoo (Milwaukee) with dental problems caused by excessive soft drink consumption. </li></ul><ul><li>If legislators are unwilling to prioritize funding for dental access within the state budget, the WDA proposes fair reimbursement rates be provided by implementing a fee on distributors, manufacturers and wholesale dealers of soda. </li></ul><ul><li>An estimated two cents per 12-ounce can of soda – Two Cents for Tooth Sense™ – could generate approximately $70 million in additional revenue each year. </li></ul>
  15. 15. Charity is NOT an oral health care system. <ul><li>Volunteer data collection shows an individual WDA dentist appears to donate $10,000 - $12,000 worth of care each year in addition to the free services he or she may provide through MA, Donated Dental Services, Give Kids A Smile or other charitable programs. </li></ul>
  16. 16. True oral health prevention requires a comprehensive approach. <ul><li>Professional diagnosis by a dentist </li></ul><ul><li>Regular dental examinations with X-rays </li></ul><ul><li>Necessary restorative and periodontal treatment early in the development of dental disease </li></ul><ul><li>Regular personal oral hygiene practices </li></ul><ul><li>Observance of a healthy lifestyle and dietary habits </li></ul><ul><li>Consumption or application of appropriate fluoride supplements </li></ul><ul><li>Appropriate placement of dental sealants </li></ul><ul><li>Patient education </li></ul>
  17. 17. <ul><li>It is time for the state to prioritize funding so the promise of dental care to Medicaid patients can become reality. </li></ul>Access to oral health care is a promise Wisconsin has made to its Medicaid children and adults.