Every day, there is another heartbreaking story in the news that shouldn’t occur. Some of those stories are about people who face access to health care challenges — people in pain, not sure where to turn for care who in desperation go to the hospital emergency department. Yet, when it comes to dental conditions, hospitals are rarely equipped or staffed to meet patients’ needs. Often all that can be done is to provide prescriptions for antibiotics and pain medications, which doesn’t solve the underlying dental condition. Dentists and physicians have recognized this and are working together in communities across the country to help connect patients with the dental care they urgently need.
The American Dental Association’s Emergency Department (ED) Dental Referral Program is an innovative solution that takes a community-based and patient-centric approach. To understand how these models successfully connect patients to care, consider the challenge:
· 2.2 million people visit hospital EDs each year for dental pain, and according to the American Dental Association’s (ADA) Health Policy Institute, 41 percent of these visits are reimbursed through Medicaid.
· That’s one patient every 15 seconds — yet hospitals are rarely staffed or equipped to provide dental care.
· A staggering $2 billion was spent on hospital ED visits for dental conditions in 2015 alone.
· According to the DentaQuest Institute, 2014 was the first year Medicaid paid the largest portion of these costs.
· According to Health Policy Institute, 79 percent of these ED visits could be shifted to a dental office — saving the healthcare system millions of dollars and getting patients the care they need.
ED referral models are best practices for how emergency and primary care are working together to get patients into a dental home, a location where patients can go to receive regular oral care and treatment. There are multiple referral models that can be used, depending on the community setting. The Pay it Forward model, for example, refers patients from the ED to volunteer dentists who provide care and where patients “pay” for their treatment through community service to nonprofits. In Michigan, the usage of the ED for dental visits dropped by 72 percent over a six-year period in one county. Hospitals in Florida and Alaska are now piloting the Pay it Forward referral model.
The Voucher Emergency Department model enables a patient to be immediately referred for necessary dental care without a waiting period, and is currently in operation in Illinois, South Carolina, and Missouri. Pilot voucher programs are being considered in other states, including Alabama.
A Birmingham, Alabama, pilot program launched in 2016 referred 510 patients from emergency departments to local dentists, leading to a 14 percent reduction in ED visits for dental pain from the same months in the previous year.
Visits to the ED for dental pain can range from $400–$1,500 compared to $90–$200 for a visit to the dentist. Thus, ED referral programs have the potential to save millions of dollars in healthcare costs. Take the state of Maryland for example. According to DentaQuest, Maryland adult Medicaid enrollees are more likely to visit the hospital for the treatment of chronic dental conditions than any other subset of the adult population. Though these adults only comprise 15.3 percent of the state’s total adult population, they account for more than half (53 percent) of the total 42,327 ED adult dental visits statewide.
But ED referral models are working for these patients. To help connect people from the ED to the dentist, a Western Maryland program works with Community Dental Health Coordinators (CDHCs), trained members of the dental team with community health worker skills, to help triage patients coming in with dental pain. CDHCs help ensure appropriate and cost-effective care by helping low-income patients navigate their public health benefits and connect them to a local dentist that will provide treatment, reducing the likelihood of future ED visits for the same condition. Over a five-year period, this program led to a 26 percent reduction in ED visits for dental pain, and 2,400 patients received the dental care they needed, amounting to $2.1 million in dental services. The American Dental Association Health Policy Institute estimates that the Maryland Medicaid program could save up to $4 million per year by referring ED visits for dental pain to dental offices.
Dentists want to deliver the dental care patients need before it turns into a painful emergency. Dentists will continue collaborating within communities to implement emergency department referrals and help patients alleviate, as well as prevent, future suffering from untreated dental disease. Community-based initiatives like the ED referral models are just one way to help make a difference here and now, while at the same time saving millions of dollars in healthcare costs.