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.