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.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  6 comments for “ER Visits for Dental Issues

  1. Jim
    January 25, 2012 at 11:23 pm

    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.

    • Ed
      May 22, 2012 at 6:49 pm

      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

  2. ninguem
    January 25, 2012 at 12:58 pm

    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.

  3. William Given MD
    January 25, 2012 at 12:41 pm

    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.

  4. Pat
    January 21, 2012 at 9:31 pm

    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.

    • Semi Retired
      January 25, 2012 at 9:11 am

      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.

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