Princess Health and More dental patients using ERs, showing lack of dental coverage, shortage of dentists and the stepchild status of oral health.Princessiccia

Princess Health and More dental patients using ERs, showing lack of dental coverage, shortage of dentists and the stepchild status of oral health.Princessiccia

Affordable Care Act dental care dental health dentistry dentists emergency rooms health reform hospitals obamacare oral health

Gusty 19:26 Add Comment

More patients are going to hospital emergency rooms for dental care, illustrating how oral health remains the stepchild of the health system despite health-care reform.

"An analysis of the most recent federal data by the American Dental Association shows dental ER visits doubled from 1.1 million in 2000 to 2.2 million in 2012, or one visit every 15 seconds, Laura Ungar reports for The Courier-Journal and USA Today.

Christopher Smith of Jeffersonville, Ind., had a dental
infection that put him in a Louisville hospital for a
week. (Courier-Journal photo by Sam Upshaw Jr.)

"This is something I deal with daily," Dr. George Kushner, director of the oral and maxillofacial surgery program at the University of Louisville, told Ungar. "People still die from their teeth in the U.S."

A longstanding federal law requires ERs to treat patients regardless of their ability to pay. "Although they often provide little more than painkillers and antibiotics to dental patients, the visits cost more than three times as much as a routine dental visit, averaging $749 if the patient isn't hospitalized � and costing the U.S. health care system $1.6 billion a year," Ungar reports.

Private dental insurance is not common. "Just over a third of working-age adults nationally, and 64 percent of seniors, lacked dental coverage of any kind in 2012, meaning they had to pay for everything out of pocket," Ungar writes. The Patient Protection and Affordable Care Act "requires health plans to cover dental services for children but not adults," and "Medicare generally doesn't cover dental care at all," she notes.

In Kentucky, the expansion of Medicaid under Obamacare has increased dental visits in the program by 37 percent, but it offers "only a short list of dental services," such as extractions, which patients often choose instead of restorative work, for which they would have to pay.

Another big issue is that many dentists don't accept Medicaid, which pays them only 41 percent of private reimbursement, Ungar reports. Also, Kentucky has a shortage of dentists. "A 2013 workforce study by Deloitte Consulting found the state needs 612 more to meet demand," Ungar notes.

More dentists would encourage more preventive treatment, which dentists say would save a lot of money. "If we were going to the dentist more often, we could avoid a lot of this," Dr. Ruchi Sahota, a California dentist and consumer adviser for the ADA, told Ungar. "Prevention is priceless."

Fewer than 60 percent of Kentuckians saw a dentist in 2013, making their dental-visit frequency 43rd in the nation, according to the Kentucky Health Issues Poll.

Princess Health and Video streaming for consultation with doctors expands and becomes more popular; 2 Ky. insurers use it and another plans to.Princessiccia

Princess Health and Video streaming for consultation with doctors expands and becomes more popular; 2 Ky. insurers use it and another plans to.Princessiccia

doctor shortages doctors emergency rooms primary care telemedicine

Gusty 16:16 Add Comment

In the past, people had to go to the emergency room to receive medical attention if they required it outside the usual hours for doctors. Now telemedicine programs such as KentuckyOne Health's "Anywhere Care" and Anthem BlueCross BlueShield's "LiveHealth Online," Kentuckians can access a doctor 24/7 through a computer or mobile device.

Photo from The Lane Report

"Patients like telemedicine because it's fast and easy to use and cheaper because it's a low-overhead service," Esther Zunker writes for The Lane Report, a Lexington-based business magazine.

UnitedHealthCare, a Minnesota-based health benefits provider for many people in Kentucky, plans to cover Skype-based doctor visits through "NowClinic," "Doctor on Demand" and "American Well." Anywhere Care and Live Health Online give clients a list of certified doctors they can chat with through video on a computer or a mobile device. The doctors can provide diagnosis and treatment and even write a prescription. They can direct patients to an emergency department if necessary.

It's affordable, too. A LiveHealth Online appointment costs the same as an office visit for eligible members. LiveHealth doctors usually charge $49 per online "visit." Anywhere Care costs $35 per visit, even if patients don't have insurance.

"As we know, care can be limited and is based on being able to get someplace when [a doctor] has an opening," said John Jesser, Anthem's vice president of provider engagement strategy. "They only have certain hours, and that doesn't always work for when people don't feel well. [Telemedicine] expands access to care for the consumers, making it much more friendly to their schedule and lifestyles."

Telemedicine is also convenient for doctors. It saves money for hospitals and allows one doctor in one location to help patients in a variety of locations. Patients can receive help with chronic conditions over periods of time without having to travel to the doctor's office.

"We've had amazingly positive feedback from patients who have tried this service," said Kathy Love, director of strategy and business development for KentuckyOne Health's Central East Kentucky Market. "People have told me they've used it multiple times when they've needed it . . . either late at night or over the weekend."

She also said people who use telemedicine still need a primary-care physician: "It's something you can access 24 hours a day with a very minimal wait and very professional providers, but it shouldn't replace your very important relationship with your primary-care doctor." (Read more)

Princess Health and Princess Health andDoctors in emergency rooms say they are busier since Obamacare began; hospitals struggle to handle extra patients.Princessiccia

Princess Health and Princess Health andDoctors in emergency rooms say they are busier since Obamacare began; hospitals struggle to handle extra patients.Princessiccia

Affordable Care Act emergency rooms health insurance hospitals Medicaid obamacare Patient Protection and Affordable Care Act state governments

Gusty 12:38 Add Comment

Nearly half of emergency-room doctors say their ERs have seen an increase in patients since health reform went into effect, and 86 percent say they expect the increase to continue, according to a poll by the American College of Emergency Physicians. Of the 1,845 completed surveys, 9 percent said ER visits had increased greatly and 37 percent said they had increased slightly. When asked what they think will happen over the next three years, 41 percent said visits will increase greatly and 45 percent said they will increase slightly. (ACEP graphic)

"Dr. Jay Kaplan, a member of ACEP's board of directors, said he wasn't surprised by the findings given the large influx or Medicaid enrollees and the difficulty in locating primary-care doctors who will see those patients," Paul Demko reports for Modern Healthcare. Kaplan told him, �When people get insurance, they feel like they deserve healthcare. When they deserve health care, and there's nobody else they can see, they come to us.�

77 percent of respondents
said their ER is not prepared
for an increase in patients

But some hospitals say many patients are going to the ER for ailments that are not emergencies, Laura Ungar reports for The Courier-Journal. Lewis Perkins, vice president of patient care and chief nursing officer at Louisville's Norton Hospital, said the emergency room is seeing 100 more patients per month, an increase of 12 percent. "We're seeing patients who probably should be seen at our (immediate-care centers)," he told Ungar. "And we're seeing this across the system."

ER visits at the University of Louisville Hospital are up 18 percent, while Dr. Ryan Stanton of Lexington, president of the Kentucky chapter of the ER physicians' group, said ER services are up 7.5 percent in that city. He told Ungar, "It's a perfect storm here. We've given people an ATM card in a town with no ATMs." (Read more)

Phil Galewitz of Kaiser Health News reports that a study in Massachusetts following its Obamacare-like expansion showed an initial surge in ER use followed by a decline over several years. Hospital officials around the country told him that the biggest impact of the expansion of Medicaid is that patients can now go to a primary-care doctor instead of the emergency room for routine care.

Princess Health and Princess Health andPsychiatric patients' demand for emergency-room care presents a problem the Affordable Care Act won't solve.Princessiccia

Princess Health and Princess Health andPsychiatric patients' demand for emergency-room care presents a problem the Affordable Care Act won't solve.Princessiccia

emergency medical service emergency rooms hospitals Medicaid mental health Patient Protection and Affordable Care Act psychiatrists psychiatry

Gusty 11:23 Add Comment

Psychiatric patients' demand for emergency-room care has been a concern in hospitals, and it's going to get worse. Even though ERs are not properly equipped to help psychiatric patients, people still often go there with psychiatric concerns. Most ERs simply lack room to deal with such situations. According to a survey, 84 percent of emergency physicians say they have psychiatric patients "boarded" in their emergency departments awaiting transfer to a mental-health facility, Adrianna McIntyre writes for Vox.

"People having a mental-health crisis seek care in emergency departments because other parts of the health care system have failed them," said Alex Rosenau, president of the American College of Emergency Physicians.

A psychiatric patient who shows up to the emergency room may require immediate care at the hospital, and sometimes there isn't an open bed in the right department. Those shortages often necessitate psychiatric patients to wait in the emergency room, or board, until space elsewhere opens for them. Both the closure of psychiatric facilities and diminished state funding have contributed to the issue. "Between 1955 and 1997, total state spending on mental health fell 30 percent, a period during which most health spending grew rapidly," McIntyre writes.

If hospitals don't figure out how to deal with the problem, it's going to get worse. In fact, experts say the implementation of the Patient Protection and Affordable Care Act will only exacerbate the problem. Some studies reveal that insured patients are more inclined to go to the emergency room�even for non-urgent issues�because the cost usually isn't as high. Lower-income people are even more likely to do that, and this population will comprise many of the newly insured citizens.

Though hospitals want people to use the health system properly, they also want to make sure patients do visit the ER when it really is necessary. "We don't want to impose any barriers on people going to the emergency room," said Hans House, a clinical professor at the Iowa University Carver College of Medicine. "We don't want people to be afraid to go to the ER."

The Affordable Care Act has provided more funding for reimbursement of emergency psychiatric care in Medicaid, a service the public program doesn't generally cover. However, this doesn't address the lack of space in emergency departments. "We know that a lack of psychiatrists available and staffing patient beds is a barrier," House said. "That's a personnel issue." (Read more)