Medicaid patients have been found to be about twice as likely to miss appointments.6 Due to a variety of barriers, adults who qualify for Medicaid also underutilize preventative services, and they consequently are more likely to require surgery, at greater expense to the payor than they would have had they received proper preventative care.7 The result is that the resources and systems required to successfully treat Medicaid patients vary from private pay patients. At the practice level, deeper discounts negotiated by private insurance leave less room in the bottom line to accommodate patients whose fees on a per-patient basis do not meet the practice’s expense to treat them. Practice expenses may exceed the average for a variety of reasons such as increased labor costs due to location, and lack of patient demand could depress gross billing. Table 1 on next page explores a hypothetical scenario of how low Medicaid billing rates impact a practice’s income (Table 1). Were a private practice to bill at only Georgia Medicaid rates, they would be unable to cover their expenses even if the dentist were to work for free. To see this in action, consider a simple thought experiment. Take the average gross billings for an owner dentist in a private practice and the average number of patient visits, including hygiene appointments, and divide the two numbers to estimate the average billing per visit. Make a few assumptions about discounts using insurance data estimates, and then estimate per-visit collections. From there, one can play with different insurance mix scenarios to see how the imaginary practice will fare. Using the Medicaid estimate alone yields losses of over $100,000 even after excluding the dentist’s net income from expenses. In the ideal world imagined above, where substituting patients by insurance type does not increase costs, the imaginary practice’s margin is already razor thin. Now consider that treating Medicaid patients involves treating a different patient profile altogether, and other practice characteristics may vary by setting. Differences between 1 Wehby GL, Lyu W, Shane DM. The Impact of the ACA Medicaid Expansions on Dental Visits by Dental Coverage Generosity and Dentist Supply. Med Care. 2019;57(10):781-787. doi:10.1097/MLR.0000000000001181 2 Singhal A, Damiano P, Sabik L. Medicaid adult dental benefits increase use of dental care, but impact of expansion on dental services use was mixed. Health Aff. 2017;36(4):723-732. doi:10.1377/hlthaff.2016.0877 3 Taylor HL, Holmes A, Schleyer T, Blackburn J. The Relationship Between Dental Provider Density and Receipt of Dental Care Among Medicaid-Enrolled Adults HHS Public Access. Vol 35.; 2024. 4 Borchgrevink A, Snyder A, Gehshan S. The Effects of Medicaid Reimbursement Rates on Access to Dental Care.; 2008. www.nashp.org 5 Medicaid Fee-For-Service Reimbursement as a Percentage of Dentist Charges for Child and Adult Dental Services, 2022.; 2023. Accessed June 13, 2024. https://www.ada.org/-/media/project/ada-organization/ada/ada-org/ files/resources/research/hpi/hpidata_medicaid_reimbursement_2022. xlsx?rev=17bbbff470fd41659f05dfdc04e091e0&hash=43DE07E85C3C1A466DB7DA47D2EF815A 6 Mathu-Muju KR, Li HF, Hicks J, Nash DA, Kaplan A, Bush HM. Identifying demographic variables related to failed dental appointments in a university hospital-based residency program. Pediatr Dent. 2014;36(4):296-301. 7 O kunev I, Tranby EP, Jacob M, et al. The impact of underutilization of preventive dental care by adult Medicaid participants. J Public Health Dent. 2022;82(1):88-98. doi:10.1111/jphd.12494 8 Income, Gross Billings, Expenses, Characteristics: Selected 2023 Results from the Survey of Dental Practice (Tables in Excel).; 2024. Accessed September 9, 2024. https://www.ada.org/-/media/project/ada-organization/ada/ada-org/files/ resources/research/hpi/hpidata_sdpi_2023.xlsx?rev=9308a6137e7b48eb8863e8ec16d07f98&hash=93709D6DBA038D03B8A9130F7A8409E9 9 ADA Health Policy Institute in Collaboration with American Dental Assistants Association, American Dental’ Association, Dental Assisting National Board, and IgniteDA. Dental Workforce Shortages: Data Navigate Today’s Labor Market.; 2022. Accessed September 9, 2024. https://www.ada.org/-/media/project/ada-organization/ada/ada-org/files/resources/research/hpi/dental_workforce_shortages_labor_market.pdf?rev=e6025d77df184e6c95dc7cefde4adee3&hash=225FCBBCCB67174AAFC760FE2287322D 10 Anderson O. States experience Medicaid wins. ADANews. July 3, 2024. Accessed September 8, 2024. https://adanews.ada.org/ada-news/2024/july/states-experience-medicaid-wins/ 11 Crowe J. Medicaid Fee Increase Having Positive Impact on Patients, Dentists. Ohio Dental Association. June 19, 2024. Accessed September 8, 2024. https:// www.oda.org/news/medicaid-fee-increase-having-positive-impact-on-patients-dentists/ Source: Medicaid fee schedule data was retrieved from official state websites. Schedules obtained were the most recent postings as of July 2024. The ADA fee survey estimate is based on the ADA’s 2022 Fee Survey adjusted for inflation using the Personal Health Care – Dental Services Index. Comparing Regional Reimbursement Rates for High Frequency CDT Codes Under $100 (State Medicaid and Private Fees) Figure 1 | 31 Nov 2024
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