Let's not overlook dental care for RI's most vulnerable children | Opinion
Dr. John Kiang is a diplomate of the American Board of Pediatric Dentistry and past president of the Rhode Island Dental Association.
On the eve of National Children’s Dental Health Month, we find ourselves failing our state’s most vulnerable children. Dental decay remains the most prevalent infectious disease of childhood. Poor and minority children, as well as children with special health care needs are disproportionately affected.
Children between the ages of 3 and 5, and those with special health care needs are simply unable to tolerate treatment in the traditional dental office. Their age, inability to understand and significant disease progression necessitates treatment in a surgical setting under general anesthesia.
More: Finding a primary care doctor in Rhode Island is getting more difficult. Here's why
Denial of operating room access for dental procedures has increased as hospitals prioritize more lucrative avenues of revenue. Elective medical procedures are given priority in lieu of dental, as they are more profitable and reimbursed at a higher rates. In addition to the financial pressures, hurdles such as insurance preauthorization, variations in insurance coverage and justification of medical necessity inhibit adequate and timely treatment for children.
The state’s Medicaid programs for medical and dental, Neighborhood Health Plan and RIte Smiles are at a further disadvantage than their counterparts with commercial insurances. The reason for this inequity is that families with the ability to pay have more options for services. These families have the resources to bring their child to neighboring states to seek services unavailable in Rhode Island, while poor children are left waiting months for a surgical date.
Delayed treatment of caries increases the likelihood of missed school days, emergency room visits, and creates additional medical complications. Chronic dental pain has a significant impact on a child’s mental and overall physical health. Without increased access, Rhode Island will continue to grow a population of children suffering from chronic oral pain.
To combat this problem, it has been suggested to utilize existing resources within our state. Outpatient surgery centers are a great alternative to full-service hospitals, as they provide same-day pediatric surgeries and can be brought into service for dental procedures. This would increase access while decreasing cost, as historically there is less overhead at these facilities. If a child on Medicaid can receive a tympanostomy (ear tubes) or tonsillectomy at an outpatient center, then it would make sense a child with severe decay could be treated in the same setting.
A group of prominent pediatricians, pediatric dentists and oral surgeons has met with representatives from the state Department of Health, Office of The Health Insurance Commissioner, RIte Smiles and Neighborhood Health Plan of Rhode Island, as well as leaders from commercial insurances, to propose that outpatient surgery centers be utilized to alleviate the backlog of children waiting for treatment under general anesthesia. This solution has many benefits — including, but not limited to, reducing unnecessary pain and suffering, reduction in emergency room visits, reduction in antibiotic usage, reduction in health costs and treatment — while alleviating hospital operating room constraints and providing the best care possible.
More: RI's low Medicaid reimbursements endanger dental care and other services for needy
Unfortunately, dental procedures are not recognized in outpatient surgery centers and will not be reimbursed because of bureaucratic red tape surrounding proprietary contracts. Instead of altering or amending existing contracts that would recognize outpatient centers as a location for treatment, the major insurance players are prioritizing revenue.
I am advocating that insurance companies negotiate contracts with outpatient surgery centers to improve access and reduce time to treatment. If these contracts are not negotiated, the extra costs would fall upon Rhode Island taxpayers as there is a proposal to include the additional cost into the state’s budget.
Why should taxpayers be responsible when insurance companies have already collected premiums and are charged with providing coverage for the children under their plans? We can do better — our children deserve it.
This article originally appeared on The Providence Journal: Insurance companies must negotiate contracts with outpatient surgery centers to improve access and reduce time to treatment.
