ER Visits for Dental Issues
The USA Today recently discussed the cost issue of Medicaid patients going to the ER for their dental issues. This is because many states don’t offer dental care for these people or if they do then few dentists actually offer it. The article makes the point that the state is paying more in ER visits than if they just offered more dental services. Much of that makes sense. The bigger issue is how little Medicaid pays when the state does cover dental services. I know a dentist who states it actually costs him $12 for every Medicaid patient he sees (when he adjusts for staff, material, etc). That’s a problem. The article quotes one ER doctor who states by funneling patients to the ER for their dental pain all they really receive is pain pills and “these patients become addicted to the narcotic medicine”. Hmmm. Not so sure about that. What he fails to mention, and not mentioned anywhere else, is how many of these “dental pain” patients were narc seekers in the first place. It is a very common excuse to get their fix. Doctors can’t really see the pain and many of these patients have horrible caries to begin with. Ask any other ER doc who sees “tooth pain” on the sheet for the chief complaint and that is the first thing he or she is thinking.
So, there are a few issues going on here with some that no one wants to talk about:
- Some of these ER visits are about getting narcotics.
- Some of these ER visits are real but these patients don’t have what the paper estimates as between $70 to $107 to have their teeth pulled.
- Some of these patients have that money but it is cheaper (read: free) to go the ER then to go to the dentist. And would rather smoke and have a cellphone than get their teeth fixed.
- And lastly, and still not mentioned, maybe, just maybe, we can get these patients to take better care of their teeth. I cannot tell you the amount of twenty-something Medicaid patients I see who look they have been chewing rock candy all day.
If you start doing dental blocks and refuse narcs (you took care of the problem with local) the number of ER visits you get on your shift decreases exponentially.
This works and you can provide much needed relief for those that need it.
thats not fair statement some people dont have good dental ins and the problems might happen during weekend the amount of narcotics they give you anyways doesnt amount to much
If that dental patient in the ER is a Medicaid mangled care patient, the visit may get dinged against the doctor’s utilization.
I noticed that when I was contracted in a Medicaid mangled care plan. The Medicaid patients were in mangled care medicine, behavioral health, and dentistry. There were contact telephone numbers for each sub-plan, on the Medicaid patient’s card.
Now that patient presents in the ER with dental pain. The ER staff, some combination of ignorance of the rules………and I don’t blame them for not knowing the subtlety, they have better things to do…….not to mention force of habit, and the physician is the only person who would respond to the call anyway. So the ER enters the patient as a “medical” ER visit.
The patient has never presented to the dentist or the mental health people, they say “not my patient”. The patient has never been to my office either, but the physician is still considered “responsible” for that person’s care anyway. Present with dental pain in the ER, somehow it’s not the problem of the dentist “on-call” for that Medicaid plan.
Actually, I found out in my area, the dentist is supposed to be available under the Medicaid plan, and for years, no dentist was actually available. I had a dental patient, never seen in my office, who had a Medicaid dental procedure done two days prior, now with pain on weekend, two days after dental work.
Patient ran through the system……and I subsequently did it again myself to be sure…..and found out there had never been a dentist on-call for our area Medicaid, even established patients who had just had dental work.
These dental patients turned out to be one of the top ten reasons they presented to the local ER, and all that showed up against our utilization and witholds.
The dentists, meanwhile, sat back and enjoyed perfect utilization statistics for ER visits, because they offered no service, collected the money anyway, and the physicians did their work and we paid for the privilege.
I am a medical doc not a dentist. Have that crap of narcotics seekers in er all the time. The rock candy most chew is meth.
Absolutely right on all counts Doug. As someone who works full-time ER exclusively in small-town/rural hospitals, I can confirm every point you made. Sometimes there is some new pain and you use narcs, along with antibiotics. Sometimes it’s the fourth visit that month for the same problem the ER can’t fix, and you refuse further pain meds. And when I point out that it would be cheaper to go to the dentist to FIX the problem than to see me to NOT fix the problem, I get the same expected blank stare, that tells me the patient never intended to pay anyone anything to begin with. Then they storm out, pissed at the lack of Lortab dispensed, and light up another smoke on the way to the car.
I got the hell out of the ER because I got sick of patients like this. Got out of Urgent Care because I got sick of being told by the UC chain CEO that I had to treat patients like this so the company would get their $$.
I used to call Walgreens for every dental patient and if they had gotten narcs from 3 or more providers in the past 12 months, all they got was antibiotics and Naproxen.
I actually had a friend who worked in the ER at the local VA who had the moxy to extract the teeth in question after doing a block. He read how to inject the anesthetic and yanked the teeth.