Minnesota dentists want higher reimbursement for public patients

by T.W. Budig
ECM Capitol reporter

Dr. Michael Flynn, a dentist for 34-years, smiled at the idea that anxiety is holding down dental reimbursement rates.

“Maybe that is a factor,” Flynn, president of the Minnesota Dental Association , said in response to a question about  bias against those with the hooked probes and high-pitched drills.

“But it’s not an excuse for not doing the right thing,” he said.

Dr. Susan Block, of Prior Lake,  and Dr. Michael Flynn, of Lewiston, representing the Minnesota Dental Association, were recently at the State Capitol arguing for higher reimbursement rates for dentists. (Photo by T.W. Budig)
Dr. Susan Block, of Prior Lake, and Dr. Michael Flynn, of Lewiston, representing the Minnesota Dental Association, were recently at the State Capitol arguing for higher reimbursement rates for dentists. (Photo by T.W. Budig)

Dental Association officials are active at the State Capitol this session, arguing they’ve been unfairly forced to subsidize dental treatment for patients on state health care programs.

“I’m paid based on a 1989 fee scale,” Flynn said. “That was the year my daughter was born. Now she works in a hospital in the metro area.”

In a March report, the Office of the Legislative Auditor noted the state’s fee-for-service base rates for most dental procedures were based on 1989 dental rates. These rates rank in the lower one-third of all states, and are lower today than a decade ago.

“I didn’t go into dentistry to get rich,” Dr. Susan Block, a dentist for nearly 30 years, said.

But you have to stay in business, said Block, who practices dentistry in Prior Lake.

The state supplements its fee-for-service rates with other payments, the auditor notes, such as a “critical access” payments.

But managed care organizations (MCOs) are not required to make similar payments, the report notes.

And it’s difficult to determine whether the additional payments supplant rates negotiated between dentists and MCO.

On average, dental payments by MCOs exceed the state’s fee-for-service rates, but the differences were sometime small, the auditors note.

In its findings, the auditor’s report concludes that Medical Assistance dental payments are poorly coordinated, inconsistent, and recommends that the reimbursement rates be increased.

Rates were given a three percent across-the-board increase in 2000, but were  cut three percent by the Legislature in 2011.

Low-income people, especially those with special needs or those living in Greater Minnesota, face challenges in finding dental care, the report notes.

Block agrees.

“We have a son with special needs. And you discover a whole world when it comes to special needs that you’re not aware of,” she said.

When special needs parents find a dentist for their child, they’re thrilled.

“It’s a challenge to take care of these people, but you do it out of the heart,” Block said.

“And every time I sit down and do fillings, it’s 30 cents on the dollar,” she said.

Flynn, whose dental practice is in Lewiston, tells of a patient from Calendonia being driven at state expensive for treatment in Savage because of lack of local dental care.

Because of a lack of access, people suffering from tooth aches or other dental ailments end up in hospital emergency rooms, the association maintains.

From 2007 to 2010, dental-related emergency room visits cost $148 million, according to the association.

Cost-avoidance should be part of the discussion on formulating reimbursement rates, Flynn said.

Low reimbursement rates are causing dentists to refuse MA cases, or limit the number, he said.

The auditor’s report indicates that’s exactly the case.

Almost a quarter of dentists responding to a survey indicated they had stopped serving MA patients after 2010.

Some reimbursement relief may be on the horizon.

House Health and Human Services Finance Committee Chairman Thomas Huntley, DFL-Duluth, said dentists have a legitimate complaint.

“The rates are way too low,” he said.

MA patients can be difficult patients, Huntley said,

Many dentist work alone, and MA patients are more apt than other patients to miss an appointment, he said.

“That’s almost a double loss (for dentists),” Huntley said.

Like Flynn and Block, Huntley stresses the importance of dental care.

He cites the testimony of a Hennepin County Medical Center official concerning a diabetic who suffered from tooth infections.

“They had to remove half of his face and half of his chest,” Huntley said.

It cost more than $1 million.

“If he had had his teeth cleaned, it would have been taken care of,” Huntley said.

The Dayton Administration is proposing a five percent increase to dental reimbursement rates, Human Services Department Assistant Commissioner Scott Leitz said.

Current rates reflect the struggles of budgeting during recessionary times, he said.

Both the House and Senate in their human service finance bills are also looking at five percent dental reimbursement rate increases.

Dental Association official say the proposed increase is a step in the right direction but insufficient.

Huntley, for one, doesn’t believe dentists get the same level of respect afforded physicians.

“Except with me,” Huntley said.

Rep. Jim Abeler, R-Anoka, doesn’t see any bias working against dentists but rather pure mathematics.

That is, there’s a lot of competition for a limited pool of dollars.

“They’re (dentists) in good company,” said Abeler, the lead Republican on the House Health and Human Services Finance Committee.

Reimbursement rates for many health care providers are low.

“It’s easier to cut reimbursement rates than to cut people from programs,” Abeler said.

But Flynn and Block argue lawmakers need to put their money where their mouths are.

“Whether you like it or not, the mouth is part of the body,” Block said.

“And it needs to be taken care of,” she said.

Minnesota’s Medicaid (MA) program provided health and dental services to 910,000 people in 2011.

Dental services represent just three percent of program expenditures, according to the auditor.

The Minnesota Dental Association represents more than 3,000 Minnesota-licensed dentists and dental students.

Tim Budig can be reached at [email protected]