Shifting dental care to the ER

Budget cuts to state dental care programs proposed by Gov. Tim Pawlenty will be an expensive shift that will end up costing state taxpayers more, say Minnesota dentists.

The governor has proposed eliminating dental care for adults receiving General Assistance, Medical Assistance, MinnesotaCare, and the Critical Access Provider Payment Program, and replacing it with an ER care program on Jan. 1, 2010.

“Non-pregnant adults would continue to receive emergency dental care through hospital emergency departments for emergencies such as severe pain, trauma or infections,” states the budget proposal on page 102.

There’s just one problem.

Hospital emergency rooms aren’t set up as dentist’s offices. They can supply patients with pain medications for tooth aches and antibiotics for dental infections but they don’t extract teeth. “They can’t actually perform dental procedures so there will be repeated visits,” says Tom Day, director of legislative affairs for the Minnesota Dental Association (MDA).

“It’s a short-term cut to make the budget work but it will significantly increase visits to the ER,” Day said. “We are absolutely opposed to the cuts.”

About 20,000 uninsured people visited emergency rooms for dental care in 2008, according to the MDA. About 7,400 of those dental-related ER visits were to Hennepin County Medical Center and at $450 to $550 per visit, the ER dental visits cost the state millions of dollars, according to Dr. Anthony DiAngelis, chief of dentistry at HCMC and a professor at the University of Minnesota School of Dentistry. “Things can get pretty bad pretty quickly for people with dental infections,” DiAngelis added.

Instead of following other states that have cut or never supported dental care, Minnesota should support its current set of programs, said Day. Other states pay much more in emergency room visits for dental care than Minnesota, he added.

Those visits are expected to climb along with the numbers of troubled industries and continuing lay-offs. The state lost nearly 75,000 jobs last year. In just the first two months of this year, 32,000 Minnesotans have been laid off from their jobs, according to the Minnesota Department of Employment and Economic Development (DEED). With job loss, access to affordable health care is also lost.

“Governor Pawlenty’s proposed budget cuts will further restrict access to oral health care at a time families need it the most,” said MDA President Dr. Lee Jess in a statement.

MDA has expressed its strong reservations about the proposed cuts to the governor and legislators. House and Senate health committees are listening and agree that the cuts go too far, Day said. Some legislators have proposed maintaining coverage for certain procedures to be used in the most serious health situations.

While medical specialists have traditionally fought to prevent legislators from prioritizing treatments, the future prospects for dental health in the state are looking so dire that mandating specific procedures into state law could be a necessary compromise in order to preserve critical services. Mandating coverage for the most critical care procedures “still doesn’t go far enough, but it’s a move in the right direction,” said Day.

Several bills that address dental care are still being hammered out in committees, and then they will be negotiated in conference committees before they are sent to the governor – where they are subject to a veto.

MDA proposes some solutions for saving on dental care costs. It advocates a single ”dental home” that would administer payments for services, rather than the dozen different companies now administering payments.

The present system adds costly overhead and is “a nightmare for the dentist,” said Day, because it forces dentists to deal with 10 to 13 different programs and types of paperwork.

Another solution for the health care crisis would be to direct the “provider” taxes levied on dentists and other health care professionals back into health care programs. “Provider taxes are not going to health care but to the general fund where they can be spent on any exigencies,” explained DiAngelis.

MDA has more than 3,000 members across the state, representing about 81 percent of licensed dentists in Minnesota.

Kathlyn Stone is an independent journalist in St. Paul. She maintains a health and science news site at fleshandstone.net.