Medicaid patients struggle with dental access

Access to dental care appears to be a struggle for Central Oregon’s Medicaid patients, according to a new report based on surveys from about 3,900 members.

The region’s coordinated care organization, the group that takes in state funding and uses it to administer care for the more than 50,000 members in Deschutes, Crook and Jefferson counties, ranked lowest in the state with respect to overall access to care in 2015, according to an annual report released in June by the Oregon Health Authority. At that time, the study exploring Central Oregon’s Medicaid patients’ access to doctors and dentists was already underway.

With respect to dental care, 67 percent of patients said they had to wait at least eight days for a routine appointment. For urgent dental needs, 61 percent had to wait at least two days.

Mike Shirtcliff, president and founder of Advantage Dental, which provides dental care for roughly 80 percent of the CCO’s members, said he wasn’t at all surprised by the results. In fact, the current wait time for a routine dental appointment at Advantage is probably six to eight weeks out — and could be up to 90 days, he said.

Advantage has worked hard, adding clinics and providers across the region, to keep up with being slammed with far more patients than was expected before the state expanded access to its Medicaid program, known as the Oregon Health Plan, Shirtcliff said.

“We put in a lot of capacity and a lot of infrastructure, but frankly it wasn’t enough,” he said. “We’re getting there, but it wasn’t enough.”

The state has laws around how long OHP patients should have to wait for care. For dentistry, people must be seen within an average of eight to 12 weeks or the community standard, whichever is less. Central Oregon does not have a community standard, so it’s unclear how this applies locally, said Leslie Neugebauer, the director of Central Oregon’s CCO, PacificSource Community Solutions.

“It’s pretty open ended,” she said.

Oregon’s laws give providers a lot of leeway for when they can see patients. Annual physicals can take place within 30 days of when they’re requested. Routine appointments must be within five days. Doctors have two days to see patients who need urgent care. Emergency issues must be addressed within 24 hours.

Neugebauer said the concern locally isn’t that providers aren’t meeting those rules, it’s that they’re not aware of them.

Morpace, the Detroit-based market research and consulting firm hired to perform the study, provided the interview results to the Central Oregon Health Council, a governing board of local officials and medical providers that oversees the CCO. The Health Council initially said it would pay Morpace up to $375,000 to perform the study. The preliminary data will be used to develop recommendations for improvement with Health Council members. A final report will be publicly released likely in January, Neugebauer said.

“We’re going to have to talk about what’s reasonable for our community, talk about short and long goals and what’s the low hanging fruit and tackle that first and then doing more quality initiatives throughout 2017,” she said.

For routine medical care, 83 percent of patients were able to see their primary care providers within seven days. When it came to urgent care, 60 percent of patients said their primary care providers saw them within one day of their request. (Urgent care in the study did not refer to urgent care clinics at Bend Memorial Clinic or St. Charles Health System.)

It’s important providers get patients in for primary care and urgent issues in order to avoid emergency room visits, Neugebauer said.

“If something can be taken care of in a lower level of care, it’s a win-win for everyone,” she said. “Less time, less cost and hopefully it’s better quality for the member as well.”

Plus, she said she’s seen evidence that the longer an OHP patient is made to wait for an appointment, the less likely they are to show up for that appointment.

Advantage Dental has been trying to figure out how to get more OHP patients willing to show up for appointments, Shirtcliff said.

“Why is it that people on Medicaid don’t comply?” he said. “Is it the system, or is it something behaviorally wrong with them?”

Members of the Health Council have emphasized using creative ways to improve patients’ access to care, such as phone calls or videoconferencing. In interviews, only one in 10 patients said they had received care over the phone. Of those who did, though, nine of 10 said their questions were answered and they got the care as soon as needed.

“If people are liking getting care over the phone and if they’re getting their needs met over the phone, I don’t see why we wouldn’t look at that more,” Neugebauer said.

Central Oregon Medicaid patients saw providers less in 2014. The number of primary care visits each OHP member received declined after Medicaid eligibility expanded to people with higher incomes that year, from an average of five visits per member per year in 2013 to 4.4 visits per member per year in 2014. After the expansion, the CCO’s membership increased by 59 percent.

“Community partners didn’t realize there was going to be so much demand and so much stretched capacity,” Neugebauer said.

— Reporter: 541-383-0304,

tbannow@bendbulletin.com