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Massachusetts health care — wonky, with a healthy dose of reality

Health Policy Commission report: 35,000 avoidable dental ED visits cost us millions

Health Policy Commission report: 35,000 avoidable dental ED visits cost us millions

August 17, 2016

HPC: Preventable Oral Health ED Visits Report

Reducing the number of preventable emergency department (ED) visits has been an important measure of health care quality. According to the U.S. Agency for Healthcare Research and Quality, avoidable ED visits are not only costly, but may indicate poor care management and/or inadequate access to care, among other system failures in inefficient health care delivery and prevention.

Thus ED visits for avoidable oral health conditions are a marker of serious deficiencies in our health care. The Health Policy Commission released a policy brief Monday describing the extent and significance of preventable dental visits in hospital emergency departments across the Commonwealth, following their initial findings back in April. The stark findings: In 2014, there were over 36,000 preventable oral health ED visits in Massachusetts, which cost the health care system between $14.8 million and $36 million. Around half of all preventable dental ED visits were paid for by MassHealth.

HPC Chart: Preventable Oral Health ED visits by age - 2014

When regular dental care is inaccessible and/or unaffordable, people tend to delay needed care, often exacerbating a problem until it becomes an acute issue. Aside from being significantly more expensive, emergency departments are also ill-equipped to adequately address underlying dental concerns. Along with establishing dedicated ED diversion programs for oral health conditions, the HPC suggested that access to care could be improved by authorizing mid-level dental providers to provide routine care. These providers, known as dental hygiene practitioners or dental therapists in other states, are akin to nurse practitioners in medicine and have been shown to be a safe and economically viable option to reduce ED utilization and improve access. The HPC also suggested that the state consider supporting teledentistry initiatives to expand the “geographical reach of existing dental providers.” Complementary to establishing mid-level dental providers, teledentistry uses portable equipment and remote telecommunication technologies to reach those who live in remote or dental provider shortage areas and deliver care directly in community settings and has been found to be effective in other states.

The report also focused on cuts to MassHealth dental care:

Policy shifts may have affected oral health access. On July 1, 2010, MassHealth reduced dental benefits for its members age 21 and over, eliminating coverage for endodontics (root canals), periodontics (care for gums, such as plaque removal from below gums), crowns, and denture coverage for roughly 700,000 adults. Some of these benefits have since been restored, including fillings (March 2014) and dentures (May 2015). One retrospective study found that dental-related ED visits and costs at Boston Medical Center increased following MassHealth dental cuts. Of particular note, these dental visits increased 2 percent in 2011 and 14 percent in 2012, suggesting that higher ED use may be due in part to the cumulative effects of forgone prevention.

The general lack of integration of oral health into the rest of health care is also a root cause of preventable ED visits and overall poor oral health outcomes. Health Care For All believes that access to affordable, quality dental care is an important part of overall primary care, and enthusiastically supports the HPC’s policy recommendations as important steps to improved oral health in the state.

                                                                                                                            -- Kelly Vitzthum