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Report: Dentists underpaid by state for low-income patient care

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Dental work
Essense Ridley, 6, got her teeth cleaned Thursday, March 7, 2013 at a Children's Dental Services clinic in north Minneapolis. A report released Friday by Minnesota's Legislative Auditor says the state should pay dentists more for treating patients enrolled in Minnesota's Medical Assistance program.
MPR Photo/Lorna Benson

Minnesota doesn't pay dentists enough to treat patients enrolled in the state's Medical Assistance program, says a report issued Friday by the Minnesota Office of the Legislative Auditor.

The report says the state should increase the base rate for dentists treating MA patients and it should simplify the claims process, so dentists will be more willing to continue serving these low-income patients. 

Dentists have long complained that Medical Assistance, the state's program for the poor, doesn't cover their expenses.

"That needs to be addressed," says Legislative Auditor James Nobles. "If we want dentists to serve MA patients, I think we have to be more fair in our payments to them."

FORMULA OUTDATED

Minnesota's dental payment rate is based on how much dentists charged in 1989 and not the costs of current dental services. The rate ranks among the bottom third of states, according to the report.

The low payments have prevented patient access to dental care because many dentists have either dropped out of the program or restricted the number of MA patients they will treat, Nobles said. 

"Ultimately they are the provider network and we have to entice them to participate. We have to be fair with them," said Nobles. "And we have to have a system that is not as complicated as it currently is." 

Twenty-four percent of Minnesota dentists who responded to the Legislative Auditor's survey said they stopped serving MA patients after 2010. 

"It's heartbreaking that I can't see the patients that I desire to see because I don't have the financial ability to do it."

The report says among all MA recipients, people with special needs and those in sparsely populated areas have experienced the greatest challenges finding a dentist.

Dentist Michael Flynn, who has a part-time practice in Lewiston, closed his other practice located in Winona because he was losing too much money on his Medical Assistance patients.

"Unfortunately our clinic in a given year had to write off over $800,000 in unpaid claims just because of the difference in reimbursement," said Flynn.  "We just weren't affordably able to do it. So the entire staff from the Winona office is currently unemployed."

Flynn, who is president of the Minnesota Dental Association, said he has limited new MA patients since 2010 due to the reimbursement situation.

"I find it very hard to turn them down. To me it's heartbreaking that I can't see the patients that I desire to see because I don't have the financial ability to do it," said Flynn. 

COMMUNITY CLINICS FILL IN GAPS

Patients in urban areas have better access to dental care because there are more community dental clinics willing to serve MA patients.    Six-year-old Essense Ridley of north Minneapolis got her teeth cleaned this week at a Children's Dental Services clinic in her neighborhood. Last year, the private non-profit served just over 30,000 low-income children and pregnant women in Minnesota. 

Even at her young age, Essense has already had more dental work than many adults. She has four fillings and two crowns due to cavities. And her mother said she has another cavity that is scheduled to be filled soon.

"Essense has an issue with brushing her teeth for some reason," says Shanika Ridley. "She just says she don't want to do it. But we make her do it, though. And then they love candy. And that's a killer to teeth." 

Shanika Ridley said her daughter's tooth decay was a wakeup call for her family. She has since banned gummy fruit snacks and pop in her home. Ridley said her two younger children have healthier teeth — but they each have at least one cavity.

Sarah Wovcha, executive director of Children's Dental Services, said her organization sees a lot of children with extensive oral disease and the problem is getting worse.

"We have seen a tenfold increase in the need for general anesthesia, hospital cases," Wovcha said. "These are cases in which there's severe dental disease in all four quadrants of the mouth and really the only way that the child can be comfortably treated is in a general anesthesia setting."

Wovcha attributes some of the increase in emergency care to the challenges families face in getting access to care. She said her clinics have a four-month wait for patients who need hospital-based emergency care. 

Children's Dental Services raises money from many sources to cover the costs of treating its MA clients and other patients who have no insurance. But Wovcha said it's getting harder and harder to do that. Last year, for the first time in its 94-year history, Children's Dental Services posted a loss of around $100,000. 

Bills have been introduced in the Minnesota House and Senate this session that would raise the state's dental payment rates. The legislation would take the median fees dentists charged in 2011 and reimburse providers at 75 percent of that rate.

The Department of Human Services said in a letter that it supports the Legislative Auditor's key recommendations and has included a dental rate increase in the Gov. Mark Dayton's budget.