Walker: Dental Care Model Serves Low-Income Communities

Posted June 13, 2012 at 4:43pm

As the practice and delivery of health care in the United States evolves, we hear a great deal of discussion about keeping Medicare solvent for future generations and ensuring the oldest and most vulnerable among us receive quality, cost-effective and patient-centered care.

As important as this dialogue is, policymakers and other stakeholders fail to fully address an equally important population with significant access-to-care issues — the youngest and most vulnerable among us. It’s an unfortunate fact that while our nation strives to ensure comprehensive care for aging baby boomers, many American children still lack even the most basic health care services.

Case in point: A widely reported story in the media told the tragedy of Deamonte Driver, a 12-year-old Maryland boy who died when an infected tooth spread bacteria to his brain. Deamonte’s mother had tried in vain to find a dentist who would accept Medicaid patients and treat the abscessed tooth — an $80 treatment that could have prevented a tragic death. But like about 16 million other underserved children across the country, Deamonte went without dental care because the vast majority of dentists choose not to accept Medicaid-enrolled patients, citing, among other reasons, low reimbursement rates.

According to the Pew Center’s 2011 Report on the State of Children’s Dental Health, tooth decay is one of the most common diseases of childhood — five times more common than asthma.

Alarmingly, for every child without medical insurance, there are nearly three children without dental coverage. And while many of us take for granted our twice-yearly dental visits, going without this care can have a significant effect on the health of the entire body and not just oral health.

The Pew Center’s report cites research showing children who do not receive dental care miss a significant number of school days, use costly emergency room services more often and encounter less desirable job prospects as adults, compared with their peers who have access to care.

As bleak as the picture might look for underserved children, there is a bit of good news concerning dental care for this group. Many states, including Maryland, are improving oral care for Medicaid enrollees. Spurred by the Deamonte Driver tragedy, Maryland lawmakers have pushed forward with multiple initiatives to ensure the state’s children see dentists regularly. The evidence for improvement is strong with Maryland achieving an “A” grade in the recent Pew Center report, something that only six other states achieved and a vast improvement from their prior assessment.

Important partners in the nationwide effort to improve pediatric dental care are group dental practices that fill the significant void in pediatric dental care by focusing on serving underserved communities.

Practices like these bring trained, licensed dentists into communities that have historically lacked sufficient dental providers for the Medicaid population. The model allows dentists to focus on dental care without the distraction of business operations, allowing dentists to be dentists and not attempt to run the business functions for which they might have insufficient knowledge or experience. The dentists contract with business experts to ensure smooth operations and the availability of state-of-the-art electronic health records, digital X-ray systems, preventive care processes and quality controls. These practice models are new to dentistry but are widespread among other health care models including medical, urgent care, ophthalmology, medical imaging and more.

Business models like this are working. Kool Smiles dental practices in underserved communities across 16 states and the District of Columbia mainly serve Medicaid patients — in fact 80 percent to 90 percent are Medicaid enrollees. By providing quality dental care backed by efficient business systems and practices, Kool Smiles clinics continue to successfully operate and maintain exemplary patient satisfaction rates.

The Deamonte Driver story, while tragic, has clearly illustrated the urgent need to change the business-as-usual attitude regarding pediatric dental care. It’s simply not acceptable for innocent children to go without care because public policy and providers are at odds. With innovative business practice, and leadership by lawmakers, we can ensure good health and happy smiles for all American children.

Paul O. Walker is a board-certified pediatric dentist and has served as president and director/examiner for the American Board of Pediatric Dentistry and as a member of the board of trustees for the American Academy of Pediatric Dentistry.