Hospital finance executives spend a lot of time trying to figure out how to treat the uninsured patients who stream into their emergency rooms as inexpensively as possible. Those costs are almost always written off entirely, a boost only to the uncompensated care section of their community benefits report.
There is a way to head off some of those costs relatively cheaply, and not with the infrastructure required to keep community clinics up and running. It's by keeping a dentist on call.
Dentistry is a prosperous profession where clinicians make a lot of money on cosmetic procedures patients must pay for out-of-pocket. Meanwhile, insurers have rigorously capped benefits at $2,000 a year or less, keeping their products cheap enough to remain attractive as an employer benefit. The extra cash has led to a lot of research, most of it linking poor oral care to a lot of chronic and pricey health issues, including diabetes, cancer, heart disease, and other problems that inevitably lead to an emergency room visit.
Yet, there are persistent issues regarding access to dental care. A new report by the Institute of Medicine and the National Research Council estimates that more than 10 percent of Americans live in areas with a shortage of dentists. Nearly 40 percent of Medicare enrollees have no dental insurance. And state Medicaid programs have regularly cut oral care in order to reduce costs. Most dentists do so well in their private practice that they don't or won't treat Medicaid enrollees.
If you think this doesn't affect your institution, consider Deamonte Driver. He was a 12-year-old kid in Maryland who died in 2007 from a massive infection that began with an abscessed tooth. Even though he was in Medicaid, his mother couldn't find a dentist willing to treat him. Extracting the tooth would have cost less than $100. Instead, he was hospitalized for more than six weeks before he died, running up a hospital bill of more than $250,000. There are a lot more kids--and adults--like Driver who don't die, but are hospitalized because of poor oral health.
Some hospitals take a fairly proactive approach to the oral care issue. For example, Children's Hospital of Los Angeles began a telehealth program a few years ago that monitors the oral health of kids in rural areas of California via dental hygienists who visit the schools and a dentist at the hospital. If an issue is spotted, the child can be brought to Los Angeles for treatment, or a local dentist is found to provide care.
However, that's mostly the exception to the rule. Many hospitals that had affiliations with dentists have cut them in recent years to curb costs. Or they have never worked with dentists at all.
Given the new scrutiny the Internal Revenue Service is giving to the community benefits provided by hospitals and the need to focus more on preventative care to cut costs as part of the Patient Protection and Affordable Care Act, it may make a lot of sense for hospitals to spend $60,000 a year or so to have a local dentist on the premises once a week. They could either offer clinics to walk-ins or screen urgent care or ER patients with relatively minor ailments. It could keep those ERs less congested down the line, save an enormous amount of money, and make for loyal--and eventually insured--patients once Medicaid expands dramatically in 2014. - Ron