The Rhode Island Health Care Association is lobbying the General Assembly to
move forward with a bill that would boost Medicaid reimbursements for dentists
serving the nursing home population.
“It’s very frustrating to us because we’re being held to a standard we can’t meet,” said Hugh Hall, chairman of the association and an administrator at the West View Nursing Home in West Warwick. “A system is in place, but no one is accepting it. We’re in a Catch-22 here.”
Hall said nursing home facilities in the state are required to have each of their residents receive an annual dental screening and then make sure that any problems – from cavities to dentures – are treated. That puts nursing homes in a tough spot, fewer and fewer dentists are willing to travel to be paid less than the going rate for their services through Medicaid.
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Hall said so far it’s been a matter of luck that there have been no emergencies within a growing backlog of Rhode Island’s 10,500 nursing home residents (about 80 percent of whom are dependent on Medicaid health assistance).
Hall said the problem has exploded in the past 18 months as the few dentists who relied on nursing home patients for a “good chunk” of their business and used to travel regularly throughout the state have stopped the practice entirely or curtailed their rounds dramatically.
Along with low Medicaid reimbursements, Hall said the dentists have cited a variety of reasons, among them an inability to find other dentists within their practices to cover patients at their offices, the rising costs of malpractice insurance and an inability to find and retain dental hygienists.
“It’s a problem that’s been building for a long time,” said Hall, of the shortage of dentists willing to come work with residents. “It’s a problem that has been sort of masked over the last 10 years by a few dentists.”
Hall said the woes have only been compounded as the dental profession as a whole has taken to asking patients to pay in full and then have the patients themselves be reimbursed by insurance companies. Businesses today can’t afford the lengthy delay in HMP and PPO payments and Hall said those delays are far worse when it comes to Medicaid, which only exacerbates the problem with its low reimbursement rates.
“Anyone who was still making exactly what they had been making 13 years ago, and losing money in the process, would realize that maybe this isn’t the right business to be in,” said Hall, who also noted that the elderly are not alone in facing the problem.
Children who rely on low-income medical assistance are also likely finding it hard to locate a willing provider.
In mid-February, identical bills were introduced in House and Senate to increase the reimbursement rates for dental care, as well as ask that appropriately licensed hygienists and dental assistants be granted an expansion of privileges to provide care to nursing home residents.
But perhaps more importantly, the bill would raise the rates to be paid each year by the state to dentists, dental hygienists and dental assistants who provide services to nursing home residents.
The reimbursement rate would be set either equal to, or at 125 percent, of the median of the rates paid to the professionals for similar services by Blue Cross & Blue Shield of Rhode Island, Delta Dental and the rates reported by the American Dental Association fee schedule survey for New England.
“The rates being paid right now are not even close,” Hall said. “It’s a tough budget year, but this is an issue that’s not going away.”
