This is a lengthy PBS video report on the state of dentistry in the US.  I have had my share of dental work and when it hurts, you can’t get away from yourself as it’s in your head.  Medicare doesn’t cover dental care. image Right at the very beginning you see RAM USA (Remote Area Medical) headed up by Stan Brock and the free clinics they sponsor all over the US.  I have done quite a few posts that promote their events for reader awareness and at almost every free clinic they put on, they are begging for more dentists as they can never get enough.  People looking for dental care at the free clinics usually have jobs too but can’t afford the dental work.  The free clinics were in Oakland in March of this year and they had plenty of empty dental chairs, due to a lack of dental volunteers.  When RAM had their clinics in the Los Angeles area the USC dentistry school kicked in big time.

“Remote Area Medical–California” Begins Four Day Free Medical Clinic in Oakland–Volunteers Needed



1200 children a year get their dental care under general anesthesia in Florida every year and it is due to one of the lowest compensation rates in the US.  Only around 10% of the dentists in Florida will accept Medicaid.  Doctors look into getting enrolled in the system but reimbursement is 20% of what the dentist would normally get.  Half the kids in the US rely on Medicaid for dental care.  Corporate dental chains are offering some relief in some areas that take children that are on Medicaid only.  Kool Smiles is one that is backed by private equity.  One office manager said she enjoyed working there at the start but then it turned into a dollar system and the company computer system tracks production to the absolute minute detail.  The company survives on Medicaid reimbursements.  Some dentists said the chain encourages the use of crowns as they pay better, whether or not the child needs it or not.
Part One

With children under 9 the chain used 50% more crowns than normal when compared to other dental providers.  Critics say the Kool Smiles business model is at the root of some of the care problems.  It’s better than the alternative which would be zero but it’s cattle mill dentistry as dentists get bonuses based on how much revenue they bring in. 
Part Two

Small Smiles was another chain that was also backed by private equity and in Connecticut they were threatened with “malpractice” and things cleaned up a bit.  There’s an interview in the video with Grassley looking into the care.  When you listen to one of the folks interviewed about quality it sounds rehearsed about “how we care about quality”.  Watch and make your own opinion. 

There’s a non profit group in Alabama that has 15 clinics who areimage trying to help out and there’s no bonus system and dentists get paid a salary on whether or not they see zero patients or a number of the every day and they rely on Medicaid.  The bonus here is that children get preventive care here.  They hope to move the model to other states.  Alabama Medicaid seems to be enough for this group with their model as they don’t have to make a profit. 

Similar to nurse practitioners the dental business in Minnesota is trying the same thing, they do fewer procedures than a full on dentist.  They go through training as does a dentist for the most part.  People are getting treated that would normally not get treatment and this is the only state with dental therapists. 
Part Three 

Adults are having to go to the ER room to get prescriptions for infected teeth.  Over a million patients a year end up in the emergency room.  Aspen dental is another corporate dental chain for adults.  They specialize in dentures and make them in the office and the office managers sell healthcare credit cards.  GE backs the credit cards and the dentist gets paid right away for the entire care once the patient signs the contract. 

The credit cards are very high interest and it begins even before the dental work begins.  We are back to the parameters of the “algorithms” on how this kicks in. 

29.9% is the interest rate if a payment was missed and they paid a 175k settlement and Andrew Cuomo was in the picture on this one as well.  Aspen has “pay for performance” on how much they convince patients to do with work and bonuses are paid monthly.  The question is are they doing the right things for care with big carrots hanging there?  Doctor’s get a percentage of the profit but the office manager bonuses are the ones doing the sales job and set up with credit cards.  Some offices have “quotas” and this sound like some hospitals who tried this with admitting quotas of sorts. 
Part Four

There’s really no regulation of corporate dental practices so this makes it difficult.  Other than charity there are many with no solutions.  BD


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