1. Reimbursement rates are too low (especially for adult coverage). And in some cases, reimbursement doesn’t even cover the cost of doing business. So in essence, the dentist is being asked to reach into his or her own pocket to pay the patient’s bill. That’s ridiculous.
2. The no show rate is crazy high. In the clinic that I work in the show rate is ~50%, so we double and sometimes triple book. Whenever more than 50% do show up, which happens almost daily at some point in the day, it creates a chaotic environment for everyone. Would doubling our capacity (e.g. staff, operatories, etc.) or not double booking “fix” this problem (e.g. long, unpredictable waits) from the patients’ perspective? Sure, but it wouldn’t solve it from the dentists’ perspective because on average the show rate would still be 50%. You can’t stay in business doing that.
3. The threat of an audit, fines and/or prison time is real when the feds are involved (Medicaid, Tricare, etc.). Some of you might be thinking, “But I’m not violating any laws or regulations, so I should have nothing to really worry about”. Well, I say think again my friend. I would highly encourage you to read the book, Three Felonies a Day: How the Feds target the innocent by Harvey Silverglate. The following excerpt from Chapter 2 of the book summaries the gist of the problem. “That risk [federal indictment] is particularly acute for certain medical practitioners, such as those who treat chronic pain. It also extends to those physicians, hospitals, and clinics [including dental] which collect fees from federal government medical programs, as well as many others. The list of physicians subject to all-too-easy indictment for violations of federal laws is long because the governing statutes and regulations are deceptively easy to violate. These laws are not readily understood by medical practitioners operating in good faith because they are vague, complex, and often self-contradictory. If one adds up the number of physicians who are threatened by this state of affairs, it constitutes nearly every physician practicing medicine today.”
Until these factors change, which the chance of that happening is slim to none, you will never have the majority of dentists accepting Medicaid. And who can blame them for making that choice in the current environment? I wouldn’t and neither should you.
Mark Frias, RDH
Mark, The reliance on Medicaid for addressing Access issues is fraught with problems. I think highlighting these 3 issues is spot on.
I see these problems as “hidden” factors that diminish the logic that says states need dental therapists to address Access to Care issues for those relying on Medicaid. What do you think?
Hey Spencer,
I support dental therapists (for other reasons), but I think they will do very little to increase “access to care”. That’s a whole other issue and future blog post : ).