Helping needy people receive dental care is a goal that everyone can agree is honorable.
Such is the purpose of the dental clinic Central Peninsula Health Center Inc. plans to open in Kenai in March. While there has been no argument with CPHC's purpose, there has been some contention over its method of addressing the need for more local access to health care for under- and uninsured people.
Private practice dentists in the area have voiced some concerns regarding the clinic. The main one being that the clinic may compete with them for clients.
"Here's what's going to happen, and it's happened nationwide -- (the clinic) will be underfunded and their grants specify that they can see any patient they want," said Dan Pitts of the Soldotna Dental Clinic, who has been a practicing dentist in Soldotna for 26 years. "Eventually they're going to open their doors to take in fee-for-service patients. That will just be competing with all of us in town. It's not fair, that's using public money to compete with private enterprise. That's not what public money is meant for."
Pitts' fear of this competition stems from a complaint dentists have with the Alaska Medicaid Program. Medicaid reimburses providers at a rate that typically barely covers the provider's costs. According to Pitts, the clinic won't be making enough money through Medicaid reimbursements, so it may start treating more patients that have private insurance or the means to pay for treatment as a private practice.
"They're going to have a budget they're going to have to make," he said. "They're only funded for a year, as far as what I have heard, they will be underfunded. If a guy in practice who runs an efficient practice can't make it doing Medicaid work, how can they make it? Their overhead is not going to be any less than mine."
Pitts praised the efforts of CPHC in trying to provide more access to dental care for under- and uninsured residents in the central peninsula. However, he said that could be better achieved if the Medicaid program increased its reimbursement rates and made other efforts to encourage more private practice dentists to participate in the program.
"The folks with Healthy Communities (one of the organizations responsible for founding CPHC and the clinic), I commend them, they've worked very hard," Pitts said. "I've asked them myself to help fix the system instead of creating their own, but mostly their answer is, 'Well, we've got the money, we're going to spend it.' ...
"But they have worked very hard at (the clinic) and I commend them for that. It's been like two trains going uphill on two parallel train tracks, and we just can't get on the same track. It's sad."
Stan Steadman, executive director of CPHC, said he does not anticipate the clinic being in financial trouble.
"Community health centers have existed for a long time, they're found throughout the country," he said. "The oldest in Alaska is the Anchorage Neighbors Health Center. They've operated successfully over this period of time. We carefully looked at what it was going to take to operate this facility, and we have an accountant on board who looked at this over months of time.
"We feel certainly that we can be successful. ... We anticipate we will be able to be successful. Our success is not to make a profit, our success is to deliver services to the people."
Steadman confirmed the clinic will be obligated to serve anyone who comes through the door. However, the purpose of the clinic is to treat patients who currently do not receive care. The clinic will not seek out patients who have private insurance and the financial means to receive treatment elsewhere.
"We have our target people to serve," Steadman said. "If somebody can afford the service (of a private dentist), we encourage them to go where they feel like they can get the best service and best value. I think those people that have providers in the community and have the resources (to pay them), I think they'll keep going to those other providers. I'm not anticipating that there's a reason to come to us other than they're not getting care somewhere else."
Paul Engibous, a pediatric dentist from Anchorage who operates a biweekly dental clinic in Soldotna that accepts Medicaid and Denali KidCare patients, said he is in favor of the clinic as long as it targets people who are not currently getting treatment anywhere and doesn't get into a competitive situation with local dentists. He did not think that would be the case, however.
"I don't think (the clinic) is trying to take anything away from anybody," he said. "They provide a service that's not fully met, and I'm glad to see it from that perspective. I have great sympathy with the local (dentists) down there and I don't want to see them suffer, but I really don't think they will. I don't think someone has to win at another person's expense. It can serve people who can not be seen other places."
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