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Straight Teeth Talk: Obamacare, dentistry

By By Mac Lee
July 31, 2012 at 2:31 a.m.

Mac Lee

It is too soon to know what effect the Affordable Health Care Act, also known as Obamacare, will have on dental treatment or dentistry itself.

Since there is no such thing as dental insurance, I don't believe the government should or could force someone to have dental benefits. It is also hard to imagine the federal government paying massive sums to fix teeth in adults.

The state and federal government do have existing dental services for undeserved children.

The purpose of this column is to shed some light on how that works. It may give some insight in what is to come in medicine/dentistry.



Medicare

Medicare will not pay for dental work. If cataract surgery is needed, Medicare pays the bill. If dental surgery is needed, you are on your own.

Dentistry and medicine have historically always been two separate disciplines. It is neither right, nor wrong, it is just the way it is. Quite honestly, most dentists prefer it to be that way because it keeps us out of the control of the government.



Medicaid

Medicaid, on the other hand, does cover dentistry for children who are eligible.

Abuse of the Medicaid system of reimbursement is rampant, as reported in a recent PBS "Frontline" series. The title of the program was "Dollars and Dentists." The program showed what almost everyone in the dental community already knew: In order to make money serving Medicaid patients, a different business model is needed.

The pay scale is so low, a dentist must see more kids and work faster just to squeeze by, or they can manipulate the system by doing unnecessary, fraudulent dental procedures.

Here are some simple numbers just to illustrate the problem. The numbers are not real, they are just examples.

If a dentist's overhead is $100 an hour and Medicaid pays $20 for a filling, it would take five fillings just to break even. If there were 10 decayed teeth that could be filled in that same hour, then the dentist would profit by $100.

If those same five teeth needed crowns instead of fillings and Medicaid paid $100 for the upgrade and the crowns could be done in an hour, the dentist's profit would be $400.

If there were 10 teeth that needed crowns and all could be done in an hour, the profit would be $900.

How easy would it be to find decay that wasn't there, especially if there was a bonus tied to profit?

According to "Frontline," Medicaid fraud occurs mostly with big dental chains that have found a market in serving the government-funded programs. These chain stores are run by corporations that streamline services with upper management and ownership, sometimes being corporate people and not dentists.

The program made a point of saying Texas has one of the highest reimbursements for Medicaid. Because of this higher pay, the chains move to Texas. So, the big question PBS had was, are these large firms fulfilling a needed service or they there just to make money?



Federally Qualified Health Centers

Federally Qualified Health Centers have been around since 1991. According to the Department of Health and Human Services, they are "safety" net providers such as community health centers, public housing centers, outpatient health programs funded by the Indian Health Services and programs serving migrants and the homeless.

It appears that the Supreme Court ruling on Obamacare was an important one for the FQHC's, which are now implementing dental services. The center that PBS interviewed was a private, nonprofit center that obtained its money from private and public grants (Health and Human Services) and Medicaid.

These centers get federal money on two levels: hundreds of thousands of dollars as grant money, plus the money they charge Medicaid for the services they provide.



Dental volunteers

The program also showed the best of dentistry, i.e. dentists giving free work or taking Medicaid and losing money for a good cause.

Victoria-area dentists do a great job of donating their time. Dr. Chuck Rader said the local Guadalupe Valley Dental Society recently teamed with the Texas Smiles Foundation to provide a Texas Mission of Mercy, a free dental program that lasted for two days in late June at the VISD Conference Center. Dental care, valued at more than $393,000, was provided to 583 patients. More than 50 dentists, 25 dental hygienists, 10 registered nurses, and more than 200 lay volunteers, from as far away as Japan, came together to donate their time and talent and provide free dental care to just about anyone.



Prevention - The Only Answer

There is one thing dentists know: Clean teeth do not rot. Prevention works almost 100 percent of the time. There is no real interest in prevention from the government because, and this is my opinion, dental decay is a socially accepted disease. It is an accepted thought that children are going to have decay.

Decay is an infection that can go to the body and brain. Children can die from dental decay. It is the No. 1 reason they miss school. They can't eat, can't sleep and can't pay attention in school.

If a child has lice, the state requires the child to go home and mandates the parents get rid of the lice.

If a child has black, rotten teeth, parents are not held accountable. It is a real shame and right now, the accountability is on the government to take care of the kids. It is a good thing for the underprivileged kids, but there has to be a better way than spending billions on a totally preventable disease.

Wouldn't it make sense to direct that money toward prevention? If you are a parent or a teacher of young children, you can go to operationstopdecay.com and download a teacher's guide and children's activity book so you can start teaching good preventive techniques. It is non profit organization and the information is free.

As to Obamacare and dentistry, it appears your dental repair costs will not add to the deficit; you are going to have to take care of it on your own.

Dr. Mac Lee practices in Edna. He is a international speaker to dentists and is an advisor to Dr. Mehmet Oz. To learn more, visit drmaclee.com or call 361-782-7191.

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