Footsteps

Dollars and Dentists


FRONTLINE recently had a program on how the cost and quality of dental work should be managed: 
http://www.pbs.org/wgbh/pages/frontline/dollars-and-dentists/

The program raises many interesting issues and in many ways these issues could be easily extended to general health care problems. Here are my two comments about some portions of the program:

1. We hear in the program that many dentists refuse to accept children on  Medicaid in Virginia and Maryland due to low reimbursements by Medicaid. However, a company named Cool Smiles run by a private equity firm has been able to strive in those states by just accepting these patients. The program suggests that Cool Smiles might be involved in malpractice. The program mentions the higher rate of stain-less crowns that children receive in Cool Smile offices as potential evidence for malpractice. Apparently, the profit margin for crown work is higher based on what Medicaid pays. Some interviewees in the program also suggests that a private equity firm is not a good choice for running a dental clinic. I have several problems with what I heard. First, why do we believe a private equity firm can be greedy and unethical but an individual who runs his/her own private practice could not be so? Is it not ultimately those who refused to accept children on Medicaid are also unethical? If we agree that the profit margin is higher for crown work, is it not  the responsibility of the state health officials to correct the rates? And finally, how can be sure that higher number of crown works in Cool Smiles is an indication of malpractice when most of these children who are likely in dire need of some serious oral treatment? I am not defending a private equity firm but we might have only found a scapegoat. 
2. In another part of the program, we clearly hear from the dental establishment in another state (Alabama) that they are afraid of a non-profitable clinic. This clinic accepts children on Medicaid and has been able to sustain while these dentists refuse to accept such patients. We clearly hear that these dentists are afraid of the success of this clinic. The president of the clinic is not a dentist and the dental establishment uses this point to undermine the value of the clinic. In fact, this is a common theme and we often hear from physicians and dentists that they do not accept anyone but one of their own to run a health care facility. Surely whoever runs a business should know a lot about it but is it really necessary that a dentist runs a dental clinic? In fact, the success of this dental clinic may suggest something else and that is what dentists charge in this country is much higher that what it should be.