More Fla. residents going to ER for dental care

More than 115,000 hospital emergency room (ER) visits in Florida in 2010 were for treatment of conditions considered avoidable with proper preventive and restorative dental care, according to a report released December 15 by the Florida Public Health Institute (FPHI).

Reviewing the Florida Agency for Healthcare Administration's Emergency Department Database for 2008 to 2010, the institute found that the number of patients seeking ER dental care reached 115,696, up from 105,892 in 2008, while costs grew to $88.8 million from $66.8 million in 2008.

The number of children receiving ER dental care has climbed to 15,528 in 2010 from 14,603 in 2008, the report noted.

Although spending increased across all categories of payors, the most dramatic increases were to Medicaid, for which the number of patients grew to 40,430 in 2010 from 28,875 in 2008. Medicaid charges climbed to $29.7 million in 2010 from $16.2 million in 2008.

FPHI will continue to analyze the data, but its initial review suggests lack of access to preventive and restorative dental services is responsible for the high rates of ER patients, according to FPHI Executive Director Claude Earl Fox, MD, MPH. Medicaid does not cover such dental services for adults, and many private dental practices will not accept Medicaid patients due to low reimbursement rates.

"We can see from the data that most visits are occurring during regular business hours," Dr. Fox said. "This means patients either have no way to pay, parents cannot find a dentist who will accept the Medicaid reimbursement rate or don't have the transportation necessary to reach one, or patients have no access to a public clinic."

The largest category is those patients who pay out of pocket for their ER visit. The number of such patients reached 49,435 in 2010, from 48,515 in 2008, after a 2009 peak of 50,014 at the height of the recession. Hospital charges in this category reached $35.3 million in 2010.

FPHI and Oral Health Florida have endorsed a set of policy solutions to stem the increasing use of hospital ERs for dental care, including the following:

• Expanding preventive services by dental hygienists
• Supporting and expanding county health department dental services
• Working toward 100% community water fluoridation
• Expanding preschool and school-based preventive dental services in high-risk communities
• Increasing Medicaid reimbursement rates for preventive and restorative dental care
• Cover routine dental services for adults under Medicaid

"The report released today by FPHI indicates an alarming rate of emergency room usage for oral-health-related conditions," said Cesar Sabates, DDS, president of the Florida Dental Association (FDA), in a press release. "This report identifies a significant problem that has exacerbated around the state as access to routine dental care remains unresolved."

Each year, the FDA advocates for effective legislative changes to reduce the costly and inefficient usage of ER services for dental care, and encourages the establishment of a dental home, Dr. Sabates noted.

"Given that dental-related issues are, at their very core, preventable, and that an ER visit is most likely only able to treat the symptom of the condition, rather than the cause, the FDA supports a number of efforts to provide greater access to care and preventative services for Florida's citizens," he said.

The FDA supports attacking the core of the oral health problem by focusing state resources on education and prevention, combined with a meaningful increase in Medicaid funding for preventive services for both adults and children, dental student loan forgiveness or assistance for new graduates, and continued support for community water fluoridation.

"The FDA has been working in partnership with the Legislature on access to care," Dr. Sabates stated. "Our joint efforts in tandem with legislative support resulted in an increase in Medicaid funds and a change in statute allowing hygienists to initiate certain services in health access settings. Much more still needs to be done to ensure that Florida citizens have access to routine dental care. It is our hope that data such as this will be used to continue increasing access to care to the underserved population."