TDMR recently received the 2023 statistics of active and enrolled Medicaid dentists from a freedom of information request to Texas Health and Human Services. These statistics come from the THSteps Active and Enrolled Dental Provider Participation Report (downloadable PDF below), which is compiled annually and has been so since 1996 as part of the Frew settlement agreement. We published these last year.
Highest-ever number of inactive providers
It is a sad statement of fact that the number of dentists who are enrolled in the Medicaid program but didn’t participate in 2023 is the highest ever at 4,429 up 636 providers from 2022.
We mentioned this in a comment in a previous story and received the following response:
Make sure you report accurately on this TDMR so your readers know that the dentists who are dropping are the individually owned practices and not the DSO chains, hedge funds, corporate owned dentistry, etc., who are leaving Medicaid.
If you can get the numbers of dentist leaving Medicaid on an FOI then why not ask for the annual Medicaid reimbursement for these providers who dropped and let’s see how active they were in Medicaid?
And then let’s evaluate if it’s really higher fees that are needed or is there a something else driving this exodus?
All are low-volume providers
Oh, so we are going to report accurately. These non-participants are indeed all small Medicaid providers, considered low-volume, who would serve less than 30 patients a year. Historically, this has always been the case, but the numbers jumped considerably in 2023 and have been going steadily up since 2021.
Our response to the above comment was the following:
We have those figures, and you are correct that it is the low-volume providers, those treating less than 30 Medicaid patients a year as Texas HHS terms them, that are the vast majority inactive. Inactive means zero Medicaid billings during the calendar year.
Historically, this has always been the case though. There are definitely issues for such providers besides fees. TDMR would be happy to publish more about those issues and even present the information to the HHS dental director as well. If you wish to provide your views on this to us, please email info@tdmr.org and we’ll get it done.
Adding several thousand low volume providers back into the system would be a great reform.
The point of the fee issue is that the larger practices and chains that treat the vast majority of Medicaid clients in the state, several million children, and are the backbone of the program are going unviable due to the current economic climate.
The system is liable to crumble for all those children if this issue isn’t addressed this legislative session.
We did not receive a response to this.
High volume providers keep the system going
Whether it is popular or not with some, the high-volume providers, those treating over 100 patients annually, make the Medicaid system in Texas work.
And they are not leaving the system—not a single one, apparently.
This is praiseworthy, is it not?
The practitioners deserve support and the negative rabble-rouse that is apparently out there needs to tone down.
Praise is also warranted for the mid-volume providers, treating between 30 and 100 patients a year, some of which, based on the statistics, have probably moved up to high volume.
They aren’t leaving the system either because there are 0 inactive.
Let’s get everyone in the game
So, let’s get low-volume providers back in the game. TDMR would be happy to publish about the issues that prevent this.
But the Medicaid dental program would break down if high-volume providers left the field.
They need support in this trying economic climate.
Can we agree on this?
Getting Texas dentists back in the game of treating Medicaid patients is a goal that we all can support. As a former Medicaid provider, unfortunately that will not happen in my case. Listed below are a few reasons why – 1.Medicaid is a hotly political topic and MCO’s have immense political power and leverage, DSO’s and large providers have relative political power and individual providers have none. The individual providers and providers at large volume clinics hold all the risk. 2. Medicaid pays on quantity not quality. Providers are incentivized to work fast and do as much as possible instead of work to attain dental health with few billable dental codes. 3. The reimbursement for dental codes is ridiculously low. 4. The time involved in being a Medicaid provider, credentialing, billing, etc is significant.
And that is just a start. If dentists could treat Medicaid patients in a manner that it was not a disruption to their office and bill/credential similar to private insurance, there would be very little reason not to believe that there would be a wide adoption Medicaid as a part of the payer mix
Should be simple, shouldn’t it.
There is a bait and switch element to treating Medicaid patients. When you build an office in a low income area, you are committing to the program as you believe it will be a win/win. This commitment is long-term because of the current cost of building out a dental office.For a short time it always is a win/win. In time dental management org’s come in and take a piece of the treatment money. In time they limit certain procedures, reduce certain fee’s and even make credentialing take longer. They even introduce things like dental homes, and pre-authorizations, for some basic codes.They even offer higher payment for gold crowns, while quietly lowering payment for porcelain crowns. FYI: no one should be doing gold crowns on a premolar or even a molar in 2024 on a teenager. They do this so publicly there appears to be a reasonable fee, while punishing dentists for putting an aesthetic crown in the mouth. None of these approaches benefit access to care or quality of care to the child or the dentists administering the dental care. They simple slow access to care and dental treatment and create thousands of now unpaid dental claims for visits where technicalities enable dso’s not to have to pay claims. These approaches definitely increase the expense of delivering the care and do create more jobs because now a dentist needs two extra employees for pre-authorizations, and to call in dental home info and to resubmit rejected claims. All of this happens with no increase in fee’s over 16 years. The win/win is now a lose win. Medicaid wins because dentists are stuck, but dentists lose because rent, supplies, employee wages, utilities and dental equipment have all nearly doubled in the last ten years. The long term loss for Medicaid is new providers are no longer flooding in and a looming dentist shortage is coming. A current trend of diminishing returns is evident. .This is all easily prevented with a modest fee increase and sitting down with the state organization and honestly evaluating ffs fee schedules. Lose/wins always turn into losses. The loss is coming, but is easily avoided with some mutually beneficial negotiations.
Tremendous analysis. Thanks.