Sunday, March 8, 2009

Overspending and a broken system

I had officially marked this space with a specific train of thought forming to fill it, but that thought has grown much too big to be contained in one post. In the pondering of such subjects, I came to another point at which to begin making a case for changes in the health care system. (yes, yet another case for this necessary change. I know that the need is not at all disputed, but my hope is to add yet another face to the crisis)

As an employee of a community health care system, one of the benefits in place to make the lower than average pay and overwhelming working conditions more palatable is free health care for my family. Well, it is free to see a provider in our clinic, as they do not bill the difference between what our insurance reimburses and what the clinic charges. We also are able to use one of the dental clinics in our system at a very large discount.

Our youngest family member seems to have some very unique characteristics, one of which is an extra "tooth" that is coming in between his two front teeth. This small tooth piece (I think it is smaller than a baby tooth) is causing his two front adult teeth (on the top) to come in turned 90 degrees from the normal position, which has obvious ramifications.

The dental clinic associated with my employer does not do extractions on children of this sort. I think that they may not do any extractions on un-erupted teeth.

Because most/all of the children who are seen in this clinic are covered under Medicaid or CHP+ (the option for families who make too much for Medicaid coverage but are not able to provide insurance for their children) the standard to to refer them to the dental clinic at The Children's Hospital. It is also ideal to have a child undergoing sedation for a procedure to be cared for by someone who specializes in the care of children.

We think very highly of this clinic(and the hospital) and were eager to return and let them take care of our "funny tooth" problem. I called TCH to make an appointment for a consultation, and was told that because we do not have Medicaid or CHP+, I had to speak to a financial counselor and make arrangements ahead of time.

When I was transferred to the financial "counselor", I was told that they have created a special "Dental Package" for families who will be paying out of pocket for the sedated dental procedure. The Anesthesiologist, the hospital fee and costs of using the surgical facilities is conveniently lumped into a discount package, and then the cost of the actual dental work will be in addition.

The cost of that dental package is $2500, with a down payment of $1000 required on the day of the procedure, and the balance payable over a 24 month period interest free.
Shockingly, I almost had a nervous breakdown, knowing that it would be all but impossible for us to pull together $1000 dollars in a timely manner. This procedure needs to be done as soon as possible in order for the remaining teeth to have a chance to straighten out at all on their own.

As I fought a panic attack and feelings of total inadequacy at taking care of my son, I rationally thought of calling another dentist to see if they would be able to do the procedure in office, or at least in town instead of in the Denver area.

We had a very good experience with a pediatric dentist in town (Dr VanTassell) so I scheduled a consultation appointment for the following week.

Much to our relief, he can not only take care of the procedure in his office, he suspects it will only take approximately 15 minutes under local anesthesia! Oh, and the cost? Somewhere between $125 and $350, depending on how easily the funny tooth is removed.

Which leads to the next shocking question: why should Medicaid or CHP+ pay significantly higher costs for the same procedure? Families who are helped by these programs are not in a position to look for a cheaper price, nor would they need to. All costs are covered. I know that in the past when our children were on CHP+, it never occurred to me to find out what the cost would be up front. Of course it would be discounted or at least a fair price. Isn't that part of being a participating provider?

So, start thinking in numbers. The minimum price for 10 children to have dental procedures done under sedation would be $25,000. 10 procedures that could potentially only cost $3000 dollars if done in a non-hospital setting.

Or to break down differently, the 25,000 used to care for the 10 children in a hospital based dental clinic could provide the same care to 83 children outside of a hospital.

So, start pondering numbers on an even larger scale. Millions of individuals covered under our current system, having millions of procedures, millions of care choices. What if we were to revamp the system so that the dollars we spend are used in a more frugal way? What if providers were required to bid for procedures, provide the most comprehensive yet penny saving services in order to become a qualified provider?

I know that what we hear of most (what I live with day to day) is the low reimbursement rates for primary care providers and specialists who care for the low income Americans. Many clinics are forced to limit or eliminate the number of patients they include in their practice due to the very slow or unfairly low rates of reimbursement.

What would a national health care plan look like in which providers who offer preventive care are reimbursed at a competitive rate, and procedures must be bid for like a contractor working for a government agency. How many more people could we provide basic health care to if the fat was trimmed, and there was adequate reimbursement for the key providers who keep patients healthy?

One thought: If the average hospital vaginal birth with no complications costs $7000-10,000 (this does not include the cost of prenatal care, it is only the hospital bill for the birth), and the average cost of a homebirth (in Colorado) is $3000-$5000 (including all prenatal and post partum care, and newborn care for baby), wouldn't it make sense for Medicaid to support it as an alternative for healthy women who have no risks, and wish to have a homebirth?

I know that the jump from dental care to homebirth seems sudden, but you will learn that for me, everything can be related back to birth. The suggestion of homebirth likely evokes emotions in the reader ranging from "wow, are there still homebirthing hippies around?" to "who would be insane enough to have a baby at home, what if something goes wrong?"

Each of those questions will be addressed in a later posting. I just encourage you to think about the dollar amount related to covering those currently included in national health care dollars, and how those dollars can be better economized to make sure all American's are able to count on basic health care. It is just not something we can afford to go without.

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