July 30, 2012|By Tim Darragh, The Morning Call
Medicaid cuts mean less dental care for poor
Allentown endodontist is driven to retirement as Pennsylvania eliminates root canal coverage through Medicaid.
Jerome Grossinger has closed his endodontistry practice (root canals)… (BEN MORRISON, THE MORNING…)
The phone is still ringing off the hook in Dr. Jerome Grossinger's quarters in an office building in Allentown's West End.
But his office isn't taking appointments.
The 77-year-old endodontist, a dentist who specializes in root canals, has relieved his patients' excruciating pain for the past 42 years, focusing in recent years on low-income and disabled people covered by Medicaid.
He is 77 for heavens sake!!! The way this story is presented you would think he was in his prime and had a wife and 4 little ones at home – two still in diapers.
But instead of treating the 15-20 new patients he'd typically see every week, Grossinger recently sat alone in his office and scanned years of patient records in bags, furniture stacked in the waiting room and the odds and ends of four decades of health care being readied for the Dumpster.
Grossinger is reluctantly calling it quits.
"I cannot believe this is happening to me," he said, recently. "I'm really in a daze about this."
Seriously!!!?? Look, Dr. Grossinger is probably a great guy and has had a thriving business for many many years, but to make him the example of Medicaid cuts??!!
Grossinger is retiring because the state, in a money-saving move, decided its Medicaid program will no longer cover root canal work on Medicaid recipients older than 21. Since few people under 21 need the procedure, Grossinger says he was effectively put out of business.
Well, Dr. Grossinger needs to move over to the “baby root canal” business. It’s been flourishing over the last decade!
This year, the state spent $5.1 billion on the joint state-federal Medicaid program, up from $3.5 billion in 2010-11. Officials estimate that the cuts, which affect root canals, treatment of gum disease and denture coverage, will save $42 million.
"A lot of states have eliminated dental care" from their Medicaid plans, said Donna Morgan, a spokeswoman for the state Department of Public Welfare. "We have limited dollars to work with."
People on Medicaid across the country are facing the same problems. A U.S. Centers for Disease Control and Prevention report this month showed that nearly half of Medicaid patients who had a mouth or tooth problem hadn't seen a dental health professional in six months or longer because they couldn't afford the cost.
Maybe the author should have included the $’s of Medicaid fraud in dentistry, that might explain some of those cuts! Yes, when the coffers are locked down and the raping and pillaging, slows, spending - which is really costs - will also decrease!
Pennsylvania's Medicaid rules still allow patients to get coverage for tooth extractions, which unlike root canals require only one visit. So Medicaid will cover the cost of pulling a tooth but not saving a tooth.
"They will allow you to take out as many teeth as you want, but I'm sitting here with my arms folded," Grossinger said.
Dr. Grossinger, is probably also drawing his ss while his arms are folded. Please, doc, donate your time and the rest of it, relax a bit!
Aside from pain issues, dental care is important for overall health. Healthy, clean teeth aid digestion, and gum problems are linked to heart disease. People with damaged or missing teeth also may be embarrassed or ashamed of their appearance.
Grossinger was able to care for Medicaid patients because he had an agreement with the welfare department that covered his costs. Standard reimbursements cover around 25 percent of a provider's costs, said Dr. Charles Incalcaterra, a dentist at Lehigh Valley Hospital's clinic in Allentown.
The latest Medicaid cut leaves Grossinger's former patients with the choice of pulling a tooth that otherwise could be saved or living with the pain until they can be seen in dental clinics run by LVH, Sacred Heart Hospital in Allentown and St. Luke's University Hospital's clinics in Bethlehem and Easton, he said.
Since the Medicaid cuts went into effect, the St. Luke's emergency rooms have seen "a big influx" of patients in severe pain with infected teeth, said Dr. Mohammed Qahash, medical director of St. Luke's Dental Services. Many of those patients will be referred to the clinics, he said.
If the patient needs a root canal, doctors at the clinic will do the procedure and appeal to the state for reimbursement as an exception, he said. But in many cases, the hospital either works out a reduced payment plan with the patient, depending on income, or it eats the entire cost.
"We try to work with them, whatever they can afford," Qahash said. "We take them out of pain and clean the infection out."
Medicaid still covers basic teeth cleaning and cavity filling, but because many patients have had poor dental care, the patients that come to the emergency room and clinics are often coming with advanced infections as well as other health issues. For instance, Qahash said, diabetics often develop gum disease and now will have little option but to have their teeth pulled.
That, in fact, is what a few patients have done to themselves, he said.
A dentist at the clinic at St. Luke's this week told Nicolas Ciprian of Allentown that he needs a root canal. But the Allentown man, who also is disabled, cannot afford to pay out-of-pocket. "This is a big problem for me," said Ciprian, who may qualify for charity care at the clinic.
Other patients locally and across the state are deciding to live with the pain. Kaiser Health News recently highlighted the case of Marcia Esters, who needs crowns and new dentures, but the Medicaid cutbacks also now will cover only one set of dentures per lifetime. The Pittsburgh woman said she has taken to eating pureed food and isolating herself.
