I’m so sick of people like Paul Casamassimo, DDS spewing his bullshit. He has a vested monetary incentive to mouth off this crap and people just keep right on publishing it. Amazing! I’m sick of him and the elites like him saying people on public assistance are no show losers. And I’m sick of him trying to say the American taxpayer should pick up the bill for doctors who have missed appointments, or empty chairs as he puts it. Empty chairs may be a problem. Shit, don’t have 14 chairs you need to fill, Dr. Cass-ass! Think about it, you fool! BTW, are you still on the “advisory board” of that child abusing, scumbag company Small Smiles Dental?? If Cassamassimo would stop helping corporations steal Medicaid dollars to line their pockets there might be more money for us to pay for empty chairs and those missed appointments. Of course, that’s just how I see it… and I’m an idiot…so who cares what I think, right?
Dentists, Medicaid don't mix
Dental care for poor faces challenges of culture, funding
Marionstar.com
You're at a job interview, so smile. But if you're missing teeth, you're less likely to get hired.
Ohio's Medicaid-eligible population largely ignores dental health, dental professionals say. This means minor problems turn into big problems, which frequently end up with the dentist yanking out the problematic tooth.
A big part of the problem is access. Just 28 percent of dentists in the state accept Medicaid or one of its managed care plans, according to the Universal Health Care Action Network of Ohio. Dentists say they lose money on Medicaid patients since the reimbursement rate is too low and the paperwork is burdensome.
But a clinic in Marion has its doors wide open. Make an appointment, and get seen that day. But Dr. Brandon Washington of Center Street Community Health Clinic on West Center Street says low-income people just aren't interested in taking care of their teeth. They wait until it's too late and the tooth gets yanked.
Dr. Paul Casamassimo, a dentist at Nationwide Children's Hospital in Columbus, said a major flaw with Medicaid is that reimbursement rates are not indexed, so they don't grow with inflation or increased costs to physicians.
"There needs to be some kind of legislative or administrative action to raise fees," Casamassimo said. "The last fee increase was in 1999 or 2000... that's now 12 to 13 years old, they never raised it to come close to what it costs to render those services."
Casamassimo said dentists get about 40 percent of what they'd normally charge for a Medicaid patient. It costs a dental office about $50 to do a cleaning. Medicaid may give them $20. To fill a cavity it costs the office close to $100. Medicaid will reimburse them $35.
"Dental Medicaid, as a percentage, is not even two percent of the total Medicaid budget," Casamassimo said. "There is still some room to grow that portion of Medicaid and have a significant improvement."
This doesn't account for the paperwork that needs to be filled out, and the hoops the providers must jump through if a form is submitted incorrectly.
To boot, Medicaid patients aren't the best about showing up for appointments.
"Dentists often end up with an empty chair," Casamassimo said.
The state has considered ditching dental care for adult Medicaid in the past. Federal Medicaid laws require the state to provide dental care for children, but not adults.
However, the Ohio Dental Association has successfully fought removing adult dental care.
"If parents don't go to the dentist, they're less likely to bring their children to the dentist," said David Owsiany, executive director of the association. "If we can get patients to see the dentist on a regular basis, it's much more cost effective in the long run."
Patrick Beatty, chief of policy for Medicaid with the Ohio Department of Job and Family Services, said the state is divided into seven regions, and there must be dental care providers in each region.
Beatty said adult dental care is optional, and many states don't offer it at all.
He doesn't see Medicaid reimbursement rates rising during these troubled budgetary times for the state.
"They're not going to cut the Medicaid budget, but our costs grow even though our budget doesn't get cut," he said.
Since the U.S. Supreme Court upheld the Affordable Care Act, President Barack Obama's national health care overhaul, it will mean even more Medicaid patients, Beatty said.
"It will create an access problem," Beatty said. "The Affordable Care Act does not expand the workforce or the number of practices out in the field. It doesn't increase the rate paid for this vast number of new enrollees, it's just the existing structure made larger, and it just makes the line longer."
David Maywhoor, project director for Dental Access Now!, a division of the Universal Health Care Action Network of Ohio, said this problem could be helped by changing certain Ohio laws. Dental cleanings are usually done by a dental hygienist, who must work under the immediate supervision of a dentist.
Dentists recommend that people see the dentist for a cleaning twice a year.
If instead hygienists could work at a satellite office of a dental practice, they could serve many more people, he said.
Cathy Levine, executive director of the Universal Health Care Action Network of Ohio, said providers are not located in poorer neighborhoods, something else that restricts access.
"Oral disease is a progressive disease, it doesn't happen overnight, it happens from a long time of neglect," Levine said.
It becomes a jobs issue, Levine said.
"We live in a service economy," Levine said. "People who don't have teeth are not hired in service jobs - people with bad teeth are not hired in many jobs. If we want to have an employed work force we need to provide oral healthcare. We can't have high numbers of the adult population with bad teeth."
But they don't show
There is at least one indication that this population doesn't make dental care a priority.
Last year, Marion's federally-funded Center Street Community Health Care Center in Marion hired Washington to provide primary care dental services to the community.
The clinic charges patients on a sliding scale based on income.
His doors are wide open to Medicaid patients. If someone calls, he can probably see them that day.
While the number of dental patients seen at the clinic has seen steady growth, time slots on his schedule remain empty.
"A lot of times with dental, people are more reactive instead of proactive," Washington said. "Here we get a lot of people that want to come to the dentist, but they've let things go so long they're afraid of what they'll have to do to get out of pain."
People are also reluctant to miss work to come see him, Washington said. This is why 60 to 70 percent of what he does are extractions - pulling teeth that are beyond repair.
"The public has not made dentistry as important as their overall health, and that's prevented a lot of people from showing up to their dental appointments," Washington said.
However, Dr. David Bullard, an oral surgeon for Oral and Maxillofacial Surgery Centers in Chillicothe, tells a different story.
Since he only does oral surgeries and not routine care, his business is able to survive on a patient base that's 70 percent Medicaid.
And he's very busy. Patients often have to wait months to get in.
Since the volume is so high, "It's certainly possible to make a profit off it, at least for an oral surgeon," Bullard said.
Emergency rooms
Washington said about 25 percent of his patients come to him after going to the emergency room.
At MedCentral Health System in Mansfield, emergency room visits for dental care got so frequent that the hospital considered installing a dental chair, but realized it would be hard to find a dentist to have on staff, said spokeswoman Cindy Jakubick. Instead, Jakubick said, they're given medicine for the pain and referred to a dentist.
"We see a handful a day," Jakubick said. "People who end up with some kind of infection so they're in pain or uncomfortable. They've waited too long. A lot of them misunderstand and think we can take care of their dental issue."
AND another thing:
If these damn mills would not harass the hell out of people and stop calling them 100 times a month to get them to make an appointment, they wouldn’t get so many people making appointments they have not intention of making, just to keep their asses from calling! Grow a brain, ya’ll!
