Early Care Crucial in Limiting Dental Costs

WATERVILLE -- More Mainers are looking for dental care in hospital emergency rooms, due to lack of insurance.

Dr. Barbara Covey, an emergency-department physician at MaineGeneral Medical Center, says her department can treat as many as 10 dental-related emergencies a day. Covey is also the board president for the nonprofit Community Dental Center in Waterville, which has served low-income clients since 2000.

Many of those emergency-room visits for dental problems could be prevented, she says.

"I have drained abscesses on children as young as four years of age and had to admit patients to the hospital for life-threatening complications of dental infections because they were unable to get basic dental care," she said.

Covey and her staff are able only to provide antibiotics and symptom management. Because of this, these patients return repeatedly with recurring and worsening problems, she said. The financial numbers don't make sense, she explained, because emergency care is 10 times more expensive than preventive treatment.

Covey holds some hope for eventual additional funding at the state level. Dental providers and representatives from the Maine Dental Association and the Maine Dental Access Coalition testified at hearings recently to plead their case for one special bill.

Rep. Meredith Strang Burgess, R-Cumberland, serves on the Health and Human Services Committee and sponsored the bill. L.D. 624, "To Implement Certain Recommendations of the Report of the Governor's Task Force on Expanding Access to Oral Health Care for Maine People," proposed a modest increase in MaineCare rates for certain critical dental services.

"I do not think there are any voices who are against the bill in pure principle, other than there is no money," Strang Burgess said. "Clearly dentists and several other professionals, like speech and hearing, are not reimbursed at logical market rates."

Strang Burgess explained that the legislation has been recommitted back to the HHS committee, that will carry the bill over until the second session of the 124th session of the Legislature. The modified version, totaling $2.8 million, will be reconsidered in January 2010.

"This is being done to wait to see if there any new opportunities that may come forward to fund the increase in MaineCare reimbursement to dentists," she said.

The Waterville dental center has a full-time dentist, two hygienists and clinical and support staff, and Covey knows there's only a slim chance to turn things around. "At this point, our center is facing serious financial challenges," she said. "MaineCare payments for service are set so low they do not pay for the cost of giving the care, and we actually lose money on many procedures."

Because of state budget cuts, funding from the Maine Department of Oral Health, which helps pay for the care of uninsured patients, has been reduced severely.

The few other nonprofit 'safety net' dental centers in the state trying to service low-income, uninsured patients also are struggling, Covey said.

Increased MaineCare reimbursements for dental services would allow centers to cover their costs when treating patients.

"More realistic MaineCare payments could also attract more private dentists to deliver services," she said. "As more people have access to routine care, the rate of dental decay and more expensive repairs goes down."

This provides a much more economical way to spend health-care dollars, she said.

Covey said the center's success stories offer her inspiration.

"We've had young children with such serious decay that they required extractions of all their baby teeth," she said. "Now, many of them have a mouthful of healthy secondary teeth, after receiving regular preventive and maintenance care."

One patient needed a kidney transplant, but could not obtain it until her dental problems were treated. Most of the other stories are less exciting, but critical to Covey's single-minded vision.

"Think of the patients treated who never develop dental disease, because they are now able to obtain routine care," she said.

BY VALERIE TUCKER
Correspondent
KJ/MS
6/8/09