I have practiced dentistry in the Kenai-Soldotna area for the past 25 years. In that time I have watched the slow erosion of the Medicaid system. One by one, medical and dental providers have thrown up their hands in frustration and quit the "system." Why?
Well, it's simple if you read the study the state commissioned Dr. Vernon K. Smith to do in April of 2001. The study, "Access to Health Care and Provider Participation in the Alaska Medicaid Program," clearly outlines why every provider of dentistry in our area and many private physicians have simply dropped out and are no longer taking new Medicaid patients. I will concentrate on the dental issues but the medical issues are very similar.
The provider agreement:
1. Medicaid/Denali Kid Care requires a contract to be signed by the provider. This contract stipulates the provider will "hold harmless" the state should there be any litigation involving a Medicaid patient. As a dentist, I am unable to obtain malpractice insurance to cover me as a Medicaid provider. So, to indemnify the state for a program they administer, I must risk everything I have worked for throughout my career.
2. The contract that states I must agree to give Medicaid the "most favored nation" status. The means that I must charge the Medicaid patient the lowest fee I charge any patients in my practice. I cannot give a lower discount to senior citizens or low-income families or provide donated dental services without the risk of being charged with insurance fraud. One physician from our area and a few dentists from around the state have been prosecuted or threatened with prosecution and levied fines over this issue.
3. Medicaid/Denali Kid Care reimbursement levels averaged about 67 percent for physicians and 74 percent for dentists in 1999, and have not been adjusted since that time. In 1999 a nationwide study found dental office overhead averaged 72 percent.
4. Medicaid/Denali Kid Care patients have a much higher "no show" rate for their appointments. Appointment time in a dental office is specifically reserved for patient treatment and if the patient does not show up, that time is wasted and the office overhead goes on.
Folks, the Medicaid system has failed not only in Alaska, but nationwide. I commend the work being done by Healthy Commun-ities/Healthy People. They have worked long and hard to help fix the system, but I only see their solution as compounding the problems. To spend $750,000 on a facility and relying on grants to fund operations and overhead does not make fiscal sense. The money they have been granted would best be used for direct patient care.
1. Help providers fix the Medicaid/Denali Kid Care. Throw out the "hold harmless" and "most favored nation" clauses.
2. Raise the reimbursement rate to providers for the work they do. Use the $1.2 million in grant money to supplement the low Medicaid/Denali Kid Care reimbursement rate. In other words, put the money into direct patient care. The board of Healthy Commun-ities/Healthy People could serve to administer and oversee this process.
3. Hold Medicaid/Denali Kid Care patients accountable for showing up for their appointment. If they want free service, they should be responsible enough to make their appointments and on time.
The solution is almost too easy. If these changes were made, I foresee that instead of one clinic providing care for Medicaid/Denali Kid Care, there would be ten clinics in our area competing to provide dental services. The most significant result of these changes would be that Medicaid/Denali Kid Care patients retain the freedom to choose their own dentist.
Dan Pitts is a Soldotna dentist.
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