13:41 PM

Why This Matters to Me Part 2: Reducing ER for Non-Emergency Dental Care

By Steve Pollock, Chief Operating Officer, DentaQuest

We have long known that patients showing up in the emergency room (ER) for non-emergency purposes is a significant cost driver. A recent article in Covering Health reported that between 2008 and 2010, more than 4 million patients turned to hospital ERs for help with dental conditions at a cost of $2.7 billion.

What many don’t realize is that patients often rely on ERs for dental problems that can be treated in a far less costly dentist office environment - or avoided completely through consistent, preventive dental care. Often ER care is focused on controlling infections and pain management. Neither treat the root cause of the dental problem, leading to new flare-ups and return visits to the ER for more medication for pain and infection.

As the Affordable Care Act (ACA) continues to encourage more informed use of healthcare resources and forces us to look at ways to reduce costs, reducing ER utilization for non-emergency services should be a top priority. Dental is a logical place to start.

The healthcare system is beginning to see the significant correlation between medical and dental health. ER care is an important place to make those connections, thus avoiding costly and unnecessary emergency treatment. For example, ICD-10 includes numerous dental codes; come October 1, 2015, doctors will be able to allocate time during appointments for a patient’s dental concerns. However, from a patient, clinical and cost perspective, much more needs to be done to keep children and adults out of the ER, and prevent the painful, life threatening and costly diseases that can result from poor dental care. We believe the first step is effective education. As an enterprise, we’ve begun to tackle this issue from multiple angles, focusing on case management and education in an effort to mitigate the number of adults and children visiting the ER for non-traumatic incidents as a result of neglected oral health:

  • Emergency Room Diversion Program. Using medical claims from ER visits identified as non-traumatic dental, we develop a list of patients to reach out to via phone on a biweekly or monthly basis for education on the importance of dental care. Our outreach is working. As a result of this approach, one of our health plan clients is experiencing a 31 percent average reduction in ER visits for non-traumatic dental.
  • Early Childhood Caries (ECC) Collaborative. For more than five years, the DentaQuest Institute has been collaborating with dental care providers at hospitals, safety net programs and private practices on the best ways to keep children out of hospital operating rooms for surgeries that treat Early Childhood Caries, an aggressive form of dental disease in young children. Cavities are a chronic and transmissible infection and one of the most common and avoidable diseases in children. The ECC Collaborative is focused on identifying best practice models of care that would reduce pain experienced by the children, reduce operating room utilization to repair damage caused by the disease, and prevent recurrence of the disease. As a result of this work, operating room utilization for ECC in the participating organizations has declined by a third, and the number of children who developed new decay declined by 30 percent.
Research shows that many costly visits to the ER could have been easily avoided with education, diversion programs, and proper care. As margins continue to tighten and health insurers are looking for new ways to reduce costs and improve services, diverting dental patients from ER care through education and prevention should be a top priority.