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Lack of preventive dental coverage ends up costing state: report

Many Floridians forgo routine dental care because they can't afford it, which runs up the costs of emergency care for conditions that could have been prevented, according to a report released today.

There were 115,000 emergency-room visits for preventable dental conditions in Florida in 2010, at a cost of $88 million, the report by Florida Public Health Institute said.

A third of those visits were charged to the state Medicaid program at a cost of almost $30 million, according to the report, raising the question of whether the same amount could have been used to prevent the emergencies from occurring.

But only 8 percent of dentists in the state accept Medicaid in their offices, said the report, which the Institute conducted on behalf of Oral Health Florida, a coalition of dentists, hygienists and other public-health advocates.

“We were surprised by some of the findings in the emergency room utilization analysis, such as the high number of visits during normal work hours when dental offices and clinics would typically be open, indicating that patients were choosing the emergency room over a dental office,” said Dr. Claude Earl Fox, executive director of the institute, through a press release.

“So this time we wanted to look at some of the factors behind these expensive ER visits,” said Fox, who also co-chairs the Oral Health Florida coalition.

The report listed several conclusions:

• Because Medicare and Florida Medicaid do not cover preventive or restorative services for adults, many adults put off dental care until an infection deteriorates to the point at which emergency treatment is required, as ERs are required by law to accept all patients regardless of their ability to pay.

• Preventive and restorative treatment of children is covered by Medicaid, but the amount Medicaid reimburses dentists for care is so low – one of the lowest in the nation – that only 8 percent of Florida dentists accept the coverage. Several Florida counties have no dentists who accept Medicaid.

• Many low-income Floridians whose earnings are too high to qualify for Medicaid skip dental care because they cannot afford to pay out-of-pocket costs for treatment, dental insurance premiums or insurance co-pays or transportation costs.

• Health access settings, such as public health clinics, are not authorized by the Florida Agency for Health Care Administration to bill Medicaid for some preventive services administered by dental hygienists without direct dentist supervision, as is done in many other states.

• State budget cuts to county health departments have severely limited the opening or expanding of dental clinics to meet demand for services.

The analysis was released on the eve of the airing of the Public Broadcasting Service’s presentation of Dollars and Dentists, on Tuesday at 10 p.m. (although some stations may carry it at other times). The program is a joint investigation by the show Frontline and the Center for Public Integrity.

Dr. Frank Catalanotto, professor and chair of the University of Florida’s Department of Community Dentistry and Behavioral Science and co-chair of Oral Health Florida, appears on the program, which features footage from Florida public dental clinics. He said that Florida is the nation’s “poster child” for the crisis in access to dental care.

“Florida is at or near the bottom in almost all, if not all, indicators of oral health for children and adults,” Catalanotto said. “It is time that we stop viewing oral health and dental care as some type of optional add-on to overall healthcare and recognize it for what it is: A preventive practice that is as important as an annual flu vaccine or physical.”

County-by-county results are available from Martha Kurth Harbin at (850) 251-2803 begin_of_the_skype_highlighting FREE (850) 251-2803 end_of_the_skype_highlighting or mharbin@policywisdom.

Carol Gentry, founder and special correspondent of Health News Florida, has four decades of experience covering health finance and policy, with an emphasis on consumer education and protection.