|
Kenny Van Deusen (left) discusses his care with the VCU dental team: Matt Chapman (second from left), Erika Crawford, Michelle Dunlevy and Dr. Stuart Martin.
Patients participating in the Dentistry With a Heart program wait their turns at the Fredericksburg Smile Center.
-
Van Deusen had three teeth extracted at VCU. Six others were pulled at the Northern Neck Free Health Clinic.
Virginia Commonwealth dental students Matt Chapman and Erika Crawford remove some of Kenny Van Deusen's teeth. Van Deusen has no dental-care insurance, so VCU's $25,529.13 bill will be picked up by taxpayers. |
BY FRANK DELANO
Kenneth Van Deusen of Westmoreland County received rapid, effective care in September for his life-threatening tooth infection. He was lucky.
In 2007, 12-year-old Deamonte Driver of Maryland died of an infection that spread to his brain from an abscessed tooth. Driver was covered by Medicaid, but was unable to get either a filling or a tooth extraction that might have saved his life.
Van Deusen, a 32-year-old laborer who lacks medical and dental insurance, is rightly worried about the effects on his credit rating of his $43,991.88 in medical bills. "I guess I'll have bad credit the rest of my life," he said.
But the expense of his ordeal will not be his alone. The journey that began with a toothache took him across a sea of red ink that increases taxes and medical costs for everyone.
Van Deusen, who figures he made about $2,000 last year, will not have to pay a dime of his $25,529.13 bill at VCU Medical Center. He qualified for the hospital's indigent-care program. The cost of his lifesaving treatment at VCU will be paid by state and federal tax dollars.
This year, Virginia taxpayers will pay $193 million for indigent care at two state-run teaching hospitals. VCU Medical Center will receive $118 million and the University of Virginia Medical Center will get $75 million.
But most of the rest of Van Deusen's bills may end up being written off as uncollectible debts.
Bad debts in the nation's health care system are "a huge, invisible, undeclared tax" on people who can afford health insurance and health care, said Craig Yale, a vice president of Air Methods Corp.
Air Methods, which flew Van Deusen to Richmond, is the largest air ambulance company in the United States. According to its 2008 annual report, the company reduced its revenues from $630 million to $500 million to account for uncompensated care.
In 2007, Riverside Tappahannock Hospital reported $4.4 million in bad debts, almost 13 percent of the $35 million in patient revenues it reported to the IRS. Virginia hospitals wrote off $356 million in bad debts in 2006, according to the Virginia Hospital and Healthcare Association.
Fourteen percent of his company's bills go unpaid, said Kevin Dillard of LifeCare Medical Transports Inc., the ambulance company that helped Van Deusen in Tappahannock. The Richmond Ambulance Authority that took Van Deusen to VCU wrote off as uncollectible $8 million of its $17.4 million in revenues in 2008.
Low Medicaid and Medicare reimbursement rates also drive up costs for other health care consumers, the providers said.
If Van Deusen had been covered by Medicaid, they said, the payments would have been far below their costs of service. Each ground ambulance company would have received $75, and the hospital $241.68, from Medicaid.
Under Medicaid in Virginia, the air ambulance company would have received $1,119 for Van Deusen's flight, "barely more than the fuel costs," said the Air Methods vice president.
The shortfall of Medicaid and Medicare payments at Virginia hospitals totaled $565 million in 2007, according to the hospital association.
Add the $296 million in charity care provided by Virginia hospitals, and the Medical Society of Virginia estimates that the shifting of health care costs from worse-off to better-off patients added $1,107 to each family's health insurance premium and $368 to each individual premium in 2008.
"If the majority of the people we transport had insurance that paid reasonable reimbursements, the cost of service would actually go down," Yale said.
"The fear of everybody in the health care industry is that more people will be covered by programs like Medicare and Medicaid that don't cover the cost of services. If that happens, health care reform could cause things to be worse," he said.
PUBLIC AID LACKING
Back home in Montross, Van Deusen applied at the Westmoreland Department of Social Services for Medicaid and other forms of public assistance to help pay the bills piling up on his desk.
The county informed him that his application for state/local hospitalization assistance was denied.
"There are no funds available for the program," said his eligibility worker.
In 2008, Westmoreland received nearly $48,000 of $12.8 million appropriated by Virginia to help poor people pay hospital bills. The program was eliminated this year to reduce the state's budget deficit.
The odds are not good that Van Deusen will become one of Virginia's nearly 900,000 Medicaid recipients, who received about $5 billion in health services in 2007.
Medicaid programs vary from state to state, and Virginia's eligibility requirements are among the strictest in the nation. Only low-income children, parents, pregnant women, and elderly and disabled people receive Medicaid in Virginia, which ranks near the bottom of all states in its percentage of Medicaid recipients.
Federal regulations require all states to provide Medicaid coverage of comprehensive dental care for children. This year, more than 600,000 children were enrolled in Virginia's "Smiles for Children" program. Nearly half of them received dental services.
But for adults, Medicaid in Virginia covers only dental emergencies, such as tooth extractions. In 2006, the state's Medicaid program covered dental services for just 107 adults.
Health care reforms now under consideration in Washington call for increasing the number of people covered by health insurance and Medicaid.
But "dentistry gets the short end of the stick" in many of the proposals, said Dr. Ronald L. Tankersley, a Newport News oral surgeon who became president of the American Dental Association in October.
"Most people in policymaking positions don't have teeth like Kenny Van Deusen," Tankersley said. "Most policymakers don't even know people like Kenny exist."
Neither of the separate health care reform bills passed by the House of Representatives and the Senate addresses what the ADA calls "grossly inadequate funding in state dental Medicaid programs."
For example, the health care bill passed by the House contains a provision to expand Medicaid coverage, but contains no requirement for states to offer dental services for poor adults.
"We can't let this happen," said Tankersley. "We have to carve out funding to help these people. Charity is not a health care system."
Tankersley and the ADA support a provision in the Senate bill passed Thursday that would allow stand-alone dental plans in an insurance exchange. The ADA and other dental groups also support measures that would increase preventive care by adding dentists, facilities and programs to the public-health dental safety net.
A MISSION OF MERCY
By chance, that safety net caught Van Deusen in November. In researching this story, The Free Lance-Star contacted many health care experts, including Dr. Terry D. Dickinson, president of the Virginia Dental Association.
Dickinson is a prominent advocate of dental care for the poor through the VDA's Virginia Dental Health Foundation. In 2008, the foundation spent $254,000 on its Missions of Mercy and donated dental services.
Dickinson contacted the closest dental clinic available to help Van Deusen, the Northern Neck Free Health Clinic. The clinic was where his $44,000 trip through the complexities of the health care system began in September, when he was unable to pay a $25 fee.
"We were going to [pay Van Deusen's fees] under our Donated Dental Services program, but the clinic offered to take care of it. If he needs dentures or something, we offered to pay the lab costs so the clinic won't be out those dollars," said Dickinson.
In four recent trips to the Kilmarnock clinic, six more of Van Deusen's teeth have been pulled, in addition to the three extracted in September in Richmond.
Van Deusen said he's grateful for finally getting the dental care he needed.
"But what about all the other people out there who can't get it at all?" he asked.
Frank Delano: 804/761-4300
Email: fpdelano@gmail.com
Here are some dental-care providers for low-income adults in the Fredericksburg region.
FREDERICKSBURG AREALloyd F. Moss Free Clinic 1301 Sam Perry Blvd., Suite 100 (on campus of Mary Washington Hospital), Fredericksburg 22402; 540/741-1061; moss freeclinic.org. Service Summary: Offers free, limited dental services for uninsured residents of Fredericksburg and Caroline, King George, Spotsylvania and Stafford counties with household incomes of less than 125 percent of the federal poverty guidelines ($13,538 annually for single people). Volunteer dentists and dental hygienists provide fillings, extractions and cleanings Tuesday and Thursday evenings by appointment. Initial medical screenings required. Number of dental patients seen in 2008: 397. Current estimated wait time for dental appointments: six weeks.
Community Health Center of the Rappahannock Region, 2217 Princess Anne St., Fredericksburg 22401; 540/735-0560; cvhsinc.org/chcrr.html. Service Summary: One dentist and two assistants provide comprehensive dental services except orthodontics and wisdom-tooth extractions. Sliding-scale fees based on family income. First visit costs $50 for evaluation and treatment plan. Current estimated wait time for dental appointments: five months. Emergency care, such as antibiotics for abscesses, available at walk-in clinic.
Germanna Community College Dental Clinic, Spotsylvania Career and Technical Center, 6713 Smith Station Road, Spotsylvania 22553; appointments: 540/423-9823; info: 423-9823;
Dentistry With a Heart, Fredericksburg Smile Center, 2330 Plank Road, Fredericksburg;
Northern Neck Free Health Clinic, 51 William B. Graham Court, Kilmarnock 22482; 804/435-0575; nnfhc.com. Service Summary: Low-income, uninsured residents of Lancaster, Middlesex, Northumberland, Richmond and Westmoreland counties are eligible to receive comprehensive dental care at a cost of $25 per visit, payable in advance. Care provided by staff dentists, volunteer dentists and hygienists, and dental students. Medicaid, low-income Medicare and uninsured patients eligible for dental services with proper documentation. Current estimated wait time for appointments: two weeks.
Guadalupe Free Health Clinic of Colonial Beach, 5 S. Irving Ave., Colonial Beach 22443; 804/224-0571; guadalupefreeclinic.org. Service Summary: This church-affiliated clinic offers free, once-a-year dental care to uninsured residents of Colonial Beach and Westmoreland County whose incomes are below 200 percent of the federal poverty guidelines. A three-day clinic in November provided 106 patients with extractions, cleanings and fillings. The next dental clinic will be held in about a year.
PIEDMONT AREA
Fauquier Free Clinic, 210 West Shirley Ave. (Dental clinic located at 330 Hospital Drive), Warrenton 20186; 540/347-0394; fauquierfreeclinic.org. Service Summary: Volunteers provide dental services to uninsured, low-income residents of Fauquier and Rappahannock counties. Procedures include fillings, extractions and cleanings. Dental clinic opens at 5 p.m. every Thursday. Call 540/347-0394 on Tuesday mornings from 9 a.m. to noon to make an appointment. Current estimated wait time: two months.
Orange County Free Clinic, Orange County Health Department, 450 N. Madison Road, Orange 22960; 540/672-0793. Service Summary: Free extractions are provided to uninsured Orange County residents at 150 percent of federal poverty guidelines. Dental patients must register for appointments on Tuesdays from 5 to 7 p.m. Current estimated wait time for extractions: six weeks.
Health and Wellness Center of Louisa County, 115 Jefferson Highway, Louisa; 540/967-9401; cvhsinc.org/hwcl.html. Service Summary: Comprehensive dental care, excluding orthodontics and dentures, available to people with and without dental insurance. Hours: 8:30 a.m. to 5 p.m. Monday, Tuesday, Wednesday and Friday; 10:30 a.m. to 7 p.m. Thursday. Sliding-scale fees based on family income. First visit costs $45 for evaluation and treatment plan. Current estimated wait times: a few days for extractions; one month for fillings; four months for cleanings.
VIRGINIA RESOURCES
Missions of Mercy, Virginia Dental Association, 7525 Staples Mill Road, Richmond 23228; 804/261-1610, 800/552-3886 (in-state); vadental.org. Service Summary: Any individual who is able to show up on site is considered eligible for free dental services at these weekend dental clinics, where volunteers use portable dental equipment for cleanings, X-rays, oral surgery and fillings. Sponsored by the Virginia Dental Health Foundation and supported by a host of other organizations, three MOM projects will be held within driving distance of Fredericksburg in 2010. Patients arrive on site and register for services. Treatment is on a first-come, first-served basis. Upcoming MOM clinics include:
Feb. 13, Gloucester High School, 6680 Short Lane, Gloucester
March 12-13, Northern Virginia Community College, Medical Education Campus, 6699 Springfield Center Drive, Springfield
May 1, Barboursville Volunteer Fire Company, 5251 Spotswood Trail, Barboursville.
Virginia Dental Association, 7525 Staples Mill Road, Richmond 23228; 804/261-1610, 800/552-3886 (in-state); vadental.org. Service Summary: Volunteer general dentists, specialists and dental laboratories provide free, comprehensive dental treatment to those who cannot afford treatment due to financial limitations associated with advanced age, disability and/or mental disabilities. Details of and applications for the program are available at vadental .org. For additional information, call Barbara Rollins at 804/264-9010.
VCU School of Dentistry, 520 North 12th St., Richmond; 804/828-9190; dentistry.vcu.edu. Service Summary: Dental and oral-hygiene students provide comprehensive treatment under supervision of faculty. Initial $65 screening required. Treatment fees, requested at time of service, are approximately half the cost of private dentists. Interest-free loans available with approval of loan application. Clinics for specialized treatment, such as root canals and periodontics, also available. Estimated wait time for initial screening: six weeks.
