Pignatelli has plan to increase dental care access by creating mid-tier provider

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PITTSFIELD >> Berkshire County residents end up at the emergency room for preventable dental treatments at the second-highest rate in the state, according to a recent report by the Health Policy Commission.

And many of those treatments, which are far more expensive than a typical dental visit, end up being billed to the state because the patients can't afford the cost.

"We have a real dental access problem in the Berkshires," said state Rep. William "Smitty" Pignatelli, D-Lenox, who has introduced legislation designed to make dental care more accessible by bolstering the number of dental providers. "This is especially troubling because taxpayers end up on the hook covering the costs of emergency care when we could have prevented the issue at a routine checkup."

According to data reported by the commission, between eight and 10 people per 1,000 of population end up in the ER for dental emergencies. Most of them are lower income, and most of them were children.

A visit to an emergency room for dental treatment can range from $400 to $1,500 per visit, which is four to seven times more than a dental office visit, which averages between $90 and $200.

The bill (S.2076 or H.2076), introduced by Pignatelli and state Sen. Harriette Chandler, D-Worcester, aims to address the problem by introducing a new level of dental practitioner. The House version was favorably reported out of the Joint Committee on Public Health and is currently in the Joint Committee on Health Care Finance.

Modeled after a Minnesota program, the bill calls for the addition of dental hygiene practitioners, who would be authorized to perform some of the more routine dental procedures currently only handled by dentists.

In order to become a dental hygiene practitioner, a dental hygienist would be required to earn the certification with two years of college courses and training. This would be a mid-level practitioner with more training and certifications than a dental hygienist, and would work under the guidance of a dentist.

"We need dental hygiene practitioners so that dentists can expand their capacity and treat families before they end up in the emergency room," Pignatelli said.

But some dentists say the plan doesn't address the real problem: reimbursement under MassHealth.

The state health care insurance plan is only reimbursing dentists for only 40 to 50 percent of the cost of treatment. Some dentists won't even see MassHealth patients because of low reimbursement rate. Others limit the number of MassHealth patients they'll see to minimize the financial sacrifice.

As a result, some MassHealth patients either can't find a dentist to treat them, or don't even try until an acute condition forces them to visit the emergency room.

Many dentists don't accept MassHealth dental patients because of the low reimbursement rate. Others limit the number of MassHealth patients they see. In 2014, 35 percent of dentists treated MassHealth patients and only 26 percent billed at least $10,000 to the program.

Pignatelli said it's not the fault of the dentists: "It is very difficult for a dentist to book patients when they're getting a reimbursement of only 40 cents on the dollar. That's the struggle we're in."

And while the political climate makes it an uphill battle to increase the reimbursement rates, in the meantime, giving dentists a tool to increase their revenue and see more MassHealth patients could buy some more time, Pignatelli said.

"What we've got is a perfect storm of people not getting care," he said.

But Dr. Louis Yarmosky, co-owner of Yarmosky Pediatric Dentistry, said adding another level of practitioner wouldn't help at his practice, which has locations in Pittsfield and Great Barrington.

It's a matter of space, he said. Both offices already operate at capacity and couldn't see a higher volume of patients if they wanted to.

"It's not about having more people to provide care; it's about being able to afford to provide the care." he said. "And for the patients, for most of them they don't have access to care because they can't afford it. So adding another level of dental care provider is not necessarily going to help the problem."

Yarmosky agrees that lack of access to dental care is a serious problem in the Berkshires that needs to be addressed. But a simpler and faster way to do what this legislation tries to do would be to expand the duties of a dental assistant to include some of the other routine dental procedures currently limited to full dentists.

And that wouldn't take two years in college, saving time and money.

"We applaud Smitty's efforts, but you have to deal with the reimbursements," Yarmosky said. "All kids deserve dental care. But access is not good because somebody has to pay for it. You can't work for nothing. If we were seeing 100 percent MassHealth patients, we would have to close our doors."

According to Michael Supranowicz, director of business development at Hillcrest Educational Centers, the dental hygiene practitioner would not only free up time for the dentist, but it would allow some practices to bring dental services to retirement homes or schools, bringing to services to those who can't get to a dentist office.

At Hillcrest Dental, part of the Hillcrest umbrella of services, approximately 75 percent of its patients in Pittsfield and North Adams are covered through MassHealth.

"Here at Hillcrest, we serve a large number of MassHealth patients, but there's a limit to how many people we can see in a given day," Supranowicz said. "Reimbursement rates, combined with provider shortages, can lead to more people going to the emergency room for care. Allowing for dental hygiene practitioners, combined with an increased MassHealth reimbursement rate, could potentially allow more MassHealth patients in the Berkshires to access care."


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