News

Open Wide - The Official Blog of The Chicago Dental Society

Permanent link  What do you know about IME?

05/15/2013

The following editorial regarding Incurred Medical Expense (IME) appeared in the Jan/Feb 2013 issue of the CDS Review.

 

Penny wise, pound foolish

By Walter F. Lamacki, DDS

Editor, CDS Review

 

In June, Gov. Pat Quinn signed legislation extracting $2.7 billion from the state’s $14 billion Medicaid program, ostensibly to save the program. One of the changes is the elimination of coverage for adult dental care, a bankrupt idea that former Gov. Jim Edgar tried in the 1990s and had to abandon when emergency room costs skyrocketed, thus eliminating any phantom savings. The $51 million adult dental program represents about 2 percent of the cuts. A 2005 study by the Kaiser Foundation concluded that any savings from the elimination of adult care are miniscule.

While one door slammed shut another opened a crack for those, I believe, to be the most underserved population of patients: those 100,000 residents living in nursing homes in Illinois. Up until now, those who received care under Medicaid were treated by volunteers and a few Medicaid providers on a hit or miss basis — miss being the operative word. But a quirk in the maze of federal regulations can increase access to care for this neglected patient pool.

Incurred Medical Expense (IME), until now an obscure provision of the Medicare/Medicaid regulations, can help many residents of nursing homes receive necessary dental care. The resident must be enrolled in Medicaid and have some income, usually Social Security. Typically residents assign their Social Security payments to the facility to pay for their monthly fees. However, they do not relinquish total control of their Social Security checks. When a resident with Medicaid receives a bill for services not offered by the facility, they may qualify for IME. They can elect to apply their Social Security checks to pay their dental bills. In most cases, the dentists will be paid their usual and customary fees. Medicare then will reimburse the nursing home for the lost income. Most states do not require pre-treatment authorization.

Please visit www.ada.org for a more detailed explanation of IME and the steps dentists must take to receive payment for their services. We don’t know — at this time — what changes, if any, the Affordable Care Act will bring, but my guess is some similar program will be in place.

If you chose to take care of nursing home residents (and I hope you will), your treatment presents a whole new perspective. Patients can have diabetes, chronic heart failure and other chronic conditions. The most difficult condition you will face is varying degrees of dementia and its big brother, Alzheimer’s disease. As Shakespeare’s Hamlet tells us, “Old men are twice children;” compassion and patience will be valuable tools in your armamentarium. 

You won’t have pretty pictures of your patient’s mouth, with a dozen pearly white porcelain veneers made possible by your persuasive skills. Many of the residents have outlived their closest relatives and seem to be warehoused out of sight and mostly forgotten. Improving the quality of their lives and giving them back their dignity will enrich you immeasurably. 

Post your response below, or email the editor at review@cds.org

Categories

access to care , cds review , dental care , health care reform , medicaid ,


Permanent link  Help keep adult dental services in the Medicaid program

05/11/2012

Did you receive an email from the Bridge to Healthy Smiles campaign today?  It reminded local voters that Illinois Governor Pat Quinn and the State Legislature are conducting a review of all Medicaid services to find $2.7 billion in budget cuts. Adult dental services are on the chopping block for possible elimination due to their classification as “optional services” under federal reimbursement guidelines.

The Bridge to Healthy Smiles campaign urged voters to help the governor and their elected officials understand that elimination of the adult services is not the answer; it will instead shift the burden to emergency rooms that can not treat the underlying dental condition.

You can read the full message from the Bridge to Health Smiles campaign here.

If you agree and want to help, the Bridge to Healthy Smiles campaign encourages you to call Gov. Quinn and your legislators and explain why they must not cut the adult dental funding and what the impact will be on the underserved population. 

Governor Quinn’s office can be reached at 217.782.0244 during business hours.

The Illinois State Dental Society has provided on its website links to help you identify your elected representative, and an outline of talking points for when you call that person’s legislative office:

  • The adult dental program is a state-optional program and only accounts for about 20 percent ($51 million) of the entire dental appropriation in the FY-12 budget, which is projected to be $300 million. Since the federal government pays half of the Medicaid costs, the State of Illinois’ savings would only be $25.5 million.
  • If the adult dental program is eliminated, much or all of the savings in the dental appropriation would be offset due to increased State spending for those patients who present to hospital emergency rooms seeking pain relief.
  • In most cases, emergency rooms are only able to provide pain medication and antibiotics, which temporarily address the clinical concerns.
  • The Pew Center issued a report on February 28, 2012, that documented a 15.8 percent increase in emergency room visits from 2006-2009 in states that reduced or eliminated adult dental care programs.

 

 

 

Categories

access to care , dental benefits , dental news , legislation , medicaid , public health , state of illinois ,


Permanent link  Help keep adult dental services in the Medicaid program

05/11/2012

Did you receive an email from the Bridge to Healthy Smiles campaign today?  It reminded local voters that Illinois Governor Pat Quinn and the State Legislature are conducting a review of all Medicaid services to find $2.7 billion in budget cuts. Adult dental services are on the chopping block for possible elimination due to their classification as “optional services” under federal reimbursement guidelines.

The Bridge to Healthy Smiles campaign urged voters to help the governor and their elected officials understand that elimination of the adult services is not the answer; it will instead shift the burden to emergency rooms that can not treat the underlying dental condition.

You can read the full message from the Bridge to Health Smiles campaign here.

If you agree and want to help, the Bridge to Healthy Smiles campaign encourages you to call Gov. Quinn and your legislators and explain why they must not cut the adult dental funding and what the impact will be on the underserved population. 

Governor Quinn’s office can be reached at 217.782.0244 during business hours.

The Illinois State Dental Society has provided on its website links to help you identify your elected representative, and an outline of talking points for when you call that person’s legislative office:

  • The adult dental program is a state-optional program and only accounts for about 20 percent ($51 million) of the entire dental appropriation in the FY-12 budget, which is projected to be $300 million. Since the federal government pays half of the Medicaid costs, the State of Illinois’ savings would only be $25.5 million.
  • If the adult dental program is eliminated, much or all of the savings in the dental appropriation would be offset due to increased State spending for those patients who present to hospital emergency rooms seeking pain relief.
  • In most cases, emergency rooms are only able to provide pain medication and antibiotics, which temporarily address the clinical concerns.
  • The Pew Center issued a report on February 28, 2012, that documented a 15.8 percent increase in emergency room visits from 2006-2009 in states that reduced or eliminated adult dental care programs.

 

 

 

Categories

access to care , dental benefits , dental news , legislation , medicaid , public health , state of illinois ,


Permanent link  CDS and its foundation provide testimony to Illinois Division of Oral Health

04/24/2012

In March, Chicago Dental Society provided testimony to the Illinois Division of Oral Health, which was conducting a statewide listening tour of oral health advocates. The information provided during the listening tour will become part of the state's oral health plan.

Chicago Dental Society and its foundation have three chief concerns regarding access to dental care in Illinois.

The first is the state of the government-funded clinics. Statistics CDS has available for the metro Chicago area include these facts: 

  • The dental safety net in Chicago includes 66 dental clinics that provide care for 753,281 Medicaid enrollees. That is one clinic for every 11,400 patients.
  • The Cook County Department of Public Health served close to 11,900 dental patients in 2000; in 2009, it treated fewer than 5,000.
  • In 2007, Cook County closed half of its county-run dental clinics, which now number four instead of eight. The City of Chicago, meanwhile, has closed all of its city-run dental clinics since 2004 and now has zero dental-clinic capacity.
  • Stroger Hospital has cut its dental operatories by 50 percent and now offers only emergency oral surgery; it fields approximately 400 requests a day for just 35 daily appointments that fill up in approximately 15 minutes every morning.
  • The dental safety net in Chicago and Cook County is equally undersized. And it’s only getting smaller.
  • As a public service, CDS compiled a list of safety-net dental clinics in Chicago and Cook, Lake and DuPage counties in 2006. That list included 44 clinics of various types, 24 of which were located in the city of Chicago. Five years later, in 2011, just 32 of those clinics — 18 of them in Chicago — were still open, and several lacked a dentist.
  • Although longitudinal data are not available, the Chicago Community Oral Health Forum (CCOHF) conducted a more comprehensive analysis of Chicago’s dental clinic supply in 2011. It found 66 safety-net dental clinics in Chicago that provided care for the city’s 753,281 Medicaid enrollees, or one clinic for every 11,400 enrollees.
  • At the county level, the Illinois State Dental Society (ISDS) reports through its Bridge to Healthy Smiles initiative that:
  • More than 1.4 million Cook County residents are registered for government health care (i.e., Medicaid), which is equal to nearly half of the state’s public aid population — making access to care “among the worst in Illinois.”
  • There is just one dental clinic in Cook County for every 15,700 uninsured children.
  • The Cook County Department of Public Health served close to 11,900 dental patients in 2000; in 2009, it treated fewer than 5,000.
  • Local public health agencies: In 2006, just eight of the 24 community health clinics run by the Cook County Department of Public Health offered dental care. In 2007, the county closed half of those clinics — in Markham, Robbins, Skokie and South Holland, Ill. — leaving only four surviving dental clinics — in Ford Heights, Maywood, Bridgeview and Rolling Meadows, Ill.,11 none of which accepts public aid patients — in addition to the county’s main dental office at John H. Stroger Jr. Hospital.

Our second concern is Medicaid reimbursement levels for dental care. The state of Illinois made strides in recent years to increase levels for children’s preventative care, and we have seen an attendant increase in the numbers of dentists treating Medicaid-enrolled children.

However, Gov. Pat Quinn has signaled that he plans to cut Medicaid spending, and we are very concerned that we preserve current levels or risk devastating access to dental care for children.

Our third concern is the lack of dental leadership within government agencies. We are heartened to have Dr. David Miller as the state’s dental director, but want to see similar positions filled in metro and county governments with a dentist at the helm. In particular, the Chicago Dental Society’s Government Affairs Committee has been advocating that a dentist be hired as the Cook County Dental Director so that there is an advocate for dentistry within the county health system.

In terms of what the society would like to see Illinois Department of Public Health’s Division of Oral Health take the lead on oral health literacy. Messages such as, “You can’t be healthy without a healthy mouth” need to be reinforced across a variety of media, as dental services are too often considered inessential.

We would also like to see the Division of Oral Health facilitate corporate-not-for-profit partnerships to provide greater access to dental care. As an example, the Chicago Dental Society Foundation is in the planning stages to open a dental clinic DuPage County. Having a forum for pursuing greater financial support for this project would be incredibly helpful.

Categories

access to care , medicaid , state of illinois ,