Dr. Vacharee Peterson came to Minnesota from Thailand as a high school exchange student and stayed for Bethel College and dental school, but she had trouble finding a job because the dentists told her she did not look like a proper dentist.
So with a bank loan and one dentist chair she struck out on her own mission: Healing the aching teeth of Minnesota’s most impoverished.
That was 33 years ago. Now, Community Dental Care has 54 chairs in four cities and last year served 42,000 patients, more than four out of five of them enrolled in a taxpayer supported health program like Medical Assistance or MinnesotaCare.
Peterson and her clinics are part of a contentious debate that has broken out at the Legislature over the state’s dental programs and — inevitably — money.
Over the years, Minnesota’s dental reimbursement rates have slipped to some of the lowest in the country, even after an increase for outstate providers that took effect this year. And there are new concerns about whether state dental money is distributed fairly.
Peterson said last year Community Dental treated 8 percent of all the public program dental patients, but received just 7 percent of program funding, which is big bucks she did not get to boost staff pay or help open new clinics in areas where need is strong.
This comes as state leaders are struggling to increase dental care around Minnesota, a closely watched barometer of the overall health of residents.
Although Minnesota boasts some of the best cared-for teeth and gums of nearly any state in the union, foes of dental disease say the care is uneven, with anecdotal evidence suggesting outstate Minnesotans traveling hundreds of miles to find a clinic that will accept Medical Assistance patients. About 60 percent of Minnesota counties are in what is known as a “dental health professional shortage area,” a dental desert, said Rep. Nick Zerwas, R-Elk River, who has been a champion of outstate dental care.
Just one-third of Medical Assistance eligible children and young adults received some kind of dental care in the previous year, according to a 2014 report by the Department of Human Services (DHS). Poor oral health can dim job prospects and can affect overall health in innumerable ways, especially in children, according to a growing body of research. Children may not be seeing dentists in part because too few clinics are willing to accept new patients because of the state’s low dental reimbursement rates.
“I get overwhelmed by calls because I’m one of the few in surrounding counties accepting state programs, but I can’t take on everyone,” said Dr. Michael Flynn, whose clinic is in Lewiston, Minn. “The only other option is to go to the emergency room.”
And they do find their way to emergency rooms. Sen. Julie Rosen, R-Vernon Center, said patients sought $130 million in dental care in Minnesota hospitals during a recent three-year stretch. (For comparison: The state’s total dental budget is about $181 million.)
With such a small pie, some legislators and dental advocates have begun to wonder who is getting the biggest slice and whether it’s deserved.
Rosen asked DHS for data on where the money is going, and ever since, she has turned her fire on HealthPartners, the prominent nonprofit health care provider and insurer.
Rosen’s data show that HealthPartners provided 6 percent of the total dental visits in a recent fiscal year, but received 14 percent of the payments.
Legislators are also skeptical of HealthPartners’ status managing care for public program participants — essentially acting like an insurer — while also providing the actual dental services. This means HealthPartners often takes money from the public programs and then pays its own providers, i.e., itself.
In some cases, it pays its own clinics $461 per dental visit, while paying other dental clinics an average of $235 per visit. In other words, HealthPartners pays its own clinics nearly twice what it pays other clinics.
Rosen has proposed legislation that seeks to create more equity and end what she says is an unfair deal for HealthPartners.
Donna Zimmerman, head of government affairs for HealthPartners said, “It’s unfortunate that our long-standing commitment to serving Medicaid patients, including our significant investments in improving access and care, are being mischaracterized.”
She said the data comparing payments to its own clinics vs. other clinics are being used incorrectly and unfairly. “HealthPartners dentists are paid based on time spent caring for patients instead of by traditional claims, so it’s hard to get an apples-to-apples comparison,” she said.
On the other hand, HealthPartners says the state money has been wisely spent: “We’ve used those dollars to invest in access, creating more sites, hiring more dentists, so people can get in quicker,” Zimmerman said. HealthPartners, with 17 clinics, had 61,000 dental visits from Medical Assistance patients in 2015 and has never limited the patients it is willing to see, Zimmerman said.
“We are providing superior care and access, and that costs more,” she said.
Peterson, whose clinics use interpreters to help with patients who speak 21 different languages, agrees that more money would help improve access and care. She loses hard-to-replace dentists and staff to other clinics all the time and hopes the state will either increase funding or create a more equitable division so her clinics can focus on retention and training.
Community Dental hunted down foundation money to begin treating schoolchildren five years ago and is now in 21 schools, providing dental care, chairs and all. That fits the clinics’ mission — nearly half the patients are children, many born to immigrants and the working poor.
The latest research shows even infants need dental care, while young children need to be habituated to regular teeth cleaning as early as possible.
“It’s very important that you catch them that early,” Peterson said.