ORAL HEALTH EMERGENCY ROOM SPENDING IN FLORIDA* HOSPITAL EMERGENCY ROOM DENTAL CARE VISITS DRAMATICALLY INCREASING More than 115, hospital emergency room visits in were for dental care with charges exceeding $88 million. Much of it may have been avoided with proper preventive care. An analysis of emergency room visits from to for dental conditions generally considered preventable found the number of patients seeking emergency-room dental care increased over the three years by about 1,, and charges have increased by more than $21 million. More than half of the increase $12.9 million was to Medicaid and Medicaid Managed Care. In contrast, charges to private insurance increased by only about $8,. The data is a conservative estimate of the true cost of care as it reflects only a subset of the most common billing codes used to charge for dental services. LACK OF ACCESS DRIVING EXPENSIVE EMERGENCY ROOM VISITS Hospital emergency rooms are among the most expensive sources of dental care yet typically provide only temporary relief of the problem. Peak times for emergency room visits are during business hours, an indication of lack of access to providers willing to take Medicaid patients. While dental practices may refuse to accept Medicaid patients due to low reimbursement rates, hospital emergency rooms must treat all patients regardless of their ability to pay. The average age of emergency-room dental patients is 32, when a lifetime of neglect may manifest as significant health issues. This may be exacerbated because routine dental services for adults are not covered under Medicaid. Better access for low-income patients to preventive and restorative services may be a cost-effective solution to reducing hospital and overall healthcare spending. Millions $1 $5 $66.8 15,992 TOTAL VISITS VS. CHARGES TO ALL PAYORS $78.2 $88.8 115,696 113,67 PUBLICLY FUNDED EMERGENCY-ROOM DENTAL CARE OF CHILDREN DOUBLED FROM TO Visits charged to child-specific payors KidCare, Healthy Kids, MediKids and Children s Medical Services more than doubled over the years reviewed while charges almost tripled. Unlike adults, routine dental services for low-income children are covered by STATE ORAL HEALTH ER VISITS BY CHILD AGE GROUP -4 5-9 1-14 15-19 TOTAL 4,286 2,795 1,67 5,852 14,63 4,617 2,866 1,734 6,241 15,458 4,588 2,922 1,845 6,173 15,528 12, 11, 1, Medicaid and other public-payor sources. These findings may reflect a lack of community providers and the need to better inform parents in all income brackets of the vital importance of preventive dental care. Millions POLICY SOLUTIONS The relationship between oral and overall health is well documented. As the cost of healthcare mounts, increasing access to preventive oral health services would help avoid more expensive care. Recommended policy actions include: Expand preventive services by dental hygienists Support and expand county health department dental services Expand pre-school- and school-based preventive dental services in high-risk communities $4 $3 $2 $1 '8 '9 COUNTY RESIDENT DENTAL HEALTH EMERGENCY ROOM CHARGES BY PAYOR '1 '8 '9 '1 $16,183,133 $1,217,54 $3,584,772 $9,841,628 $22,778,112 $11,167,31 $31,834,937 $12,447,36 $29,751,245 $11,42,899 $35,281,245 $12,769,24 '8 '9 '1 '8 '9 '1 Increase Medicaid reimbursement rates for preventive and restorative dental care Cover routine dental services for adults under Medicaid Work toward 1 percent community water fluoridation Thousands 28,875 14,74 48,615 13,798 35,149 13,153 5,14 14,751 4,43 11,715 49,485 14,66 *Source: The Health Council of Southeast Florida, on behalf of the Florida Public Health Institute, analysis of emergency-room Ambulatory Care-Sensitive dental data submitted to the Florida Agency for Healthcare Administration (AHCA). Funding for this study made possible through a grant from the DentaQuest Foundation To join the Florida Oral Health Coalition or for more information, please visit www.oralhealthflorida.com 6 5 4 3 2 1 '8 '9 COUNTY RESIDENT DENTAL HEALTH EMERGENCY ROOM VISITS BY PAYOR '1 '8 '9 '1 '8 '9 '1 '8 '9 '1
ORAL HEALTH EMERGENCY ROOM SPENDING IN OSCEOLA COUNTY DENTAL HEALTH EMERGENCY ROOM VISITS BY HOSPITAL : ALL PATIENTS FLORIDA HOSPITAL CELEBRATION HEALTH 576 67 59 FLORIDA HOSPITAL KISSIMMEE 51 564 56 OSCEOLA REGIONAL MEDICAL CENTER 626 71 854 ST. CLOUD REGIONAL MEDICAL CENTER 436 432 389 OSCEOLA COUNTY RESIDENT-SPECIFIC DATA: $2,, TOTAL DENTAL HEALTH EMERGENCY ROOM VISITS VS. CHARGES TO ALL PAYORS $1,68,97 5, $1,8,156 $1,424,889 1,524 1,611 1,995 $8, COUNTY RESIDENT DENTAL HEALTH EMERGENCY ROOM CHARGES BY PAYOR $6, $4, $2, $199,572 $159,4 $31,813 $347,731 $448,636 $14,765 $515,876 $316,612 $598,514 $27,95 $73,837 $169,796 1, COUNTY RESIDENT DENTAL HEALTH EMERGENCY ROOM VISITS BY PAYOR 8 6 4 2 33 221 59 464 522 154 58 355 727 27 813 248 ORAL HEALTH EMERGENCY ROOM VISITS BY NUMBER OF OSCEOLA COUNTY CHILDREN BY AGE GROUP -4 5-9 1-14 15-19 64 56 58 31 44 58 31 28 33 86 77 94 * An analysis of Florida Agency for Healthcare Administration (AHCA) - Emergency Department Database Ambulatory Care-Sensitive Dental Conditions by
ORAL HEALTH EMERGENCY ROOM SPENDING IN BREVARD COUNTY ORAL HEALTH EMERGENCY ROOM VISITS BY BREVARD COUNTY HOSPITAL: ALL PATIENTS CAPE CANAVERAL HOSPITAL 38 3 299 HOLMES REGIONAL MEDICAL CENTER 787 794 718 PALM BAY HOSPITAL 713 754 753 PARRISH MEDICAL CENTER 995 956 966 WUESTHOFF MEDICAL CENTER MELBOURNE 393 413 345 WUESTHOFF MEDICAL CENTER ROCKLEDGE 435 371 395 BREVARD COUNTY RESIDENT-SPECIFIC DATA: $2,2, $2,, $1,8, $1,6, TOTAL BREVARD COUNTY RESIDENT DENTAL HEALTH EMERGENCY ROOM VISITS VS. CHARGES $2,32,747 $1,921,749 3,587 $1,816,11 3,375 3,465 $1,, COUNTY RESIDENT DENTAL HEALTH EMERGENCY ROOM CHARGES BY PAYOR $8, $6, $4, $2, $453,735 $322,212 $769,423 $27,74 $54,549 $288,228 $914,722 $289,248 $68,74 $218,956 $819,958 $274,131 4, 3,5 3, 1,8 COUNTY RESIDENT DENTAL HEALTH EMERGENCY ROOM VISITS BY PAYOR 1,6 1,4 1,2 1, 8 6 4 2 977 524 1,643 443 1,82 429 1,587 367 1,194 34 1,461 38 ORAL HEALTH EMERGENCY ROOM VISITS BY NUMBER OF BREVARD COUNTY CHILDREN BY AGE GROUP -4 5-9 1-14 15-19 71 65 52 67 79 57 5 36 39 223 2 182 *Source: The Health Council of Southeast Florida, on behalf of the Florida Public Health Institute, review of the past three years of emergency-room Ambulatory Care-Sensitive dental data submitted to the Florida Agency for Healthcare Administration (AHCA) Emergency Department Database. To join or for more information, please visit www.oralhealthflorida.com
ORAL HEALTH EMERGENCY ROOM SPENDING IN ORANGE COUNTY DENTAL HEALTH EMERGENCY ROOM VISITS BY HOSPITAL : ALL PATIENTS ARNOLD PALMER MEDICAL CENTER 279 265 296 DR. P. PHILLIPS HOSPITAL 1,166 1,1 1,51 FLORIDA HOSPITAL 529 667 692 FLORIDA HOSPITAL APOPKA 657 64 662 FLORIDA HOSPITAL EAST ORLANDO 89 943 973 HEALTH CENTRAL 691 792 811 ORLANDO REGIONAL MEDICAL CENTER 812 925 1,29 WINTER PARK MEMORIAL HOSPITAL 421 464 46 ORANGE COUNTY RESIDENT-SPECIFIC DATA: $5,, TOTAL COUNTY RESIDENT DENTAL HEALTH EMERGENCY ROOM VISITS VS. CHARGES TO ALL PAYORS $4,358,631 $3,399,547 $3,957,829 6,4 7, 6, 5,392 5,718 $2,, COUNTY RESIDENT DENTAL HEALTH EMERGENCY ROOM CHARGES BY PAYOR $1,5, $1,, $5, $791,544 $64,57 $1,42,889 $96,544 $1,114,698 $72,698 $1,54,36 $1,86,127 $1,437,41 $46,513 $1,849,242 $611,835 5, 3, COUNTY RESIDENT DENTAL HEALTH EMERGENCY ROOM VISITS BY PAYOR 2,5 2, 1,5 1, 5 1,368 852 1,775 1,397 1,663 813 1,748 1,494 2,53 57 2,715 729 ORAL HEALTH EMERGENCY ROOM VISITS BY NUMBER OF ORANGE COUNTY CHILDREN BY AGE GROUP -4 5-9 1-14 15-19 29 256 283 187 178 166 16 86 15 37 348 323 * An analysis of Florida Agency for Healthcare Administration (AHCA) - Emergency Department Database Ambulatory Care-Sensitive Dental Conditions by
ORAL HEALTH EMERGENCY ROOM SPENDING IN SEMINOLE COUNTY* DENTAL HEALTH EMERGENCY ROOM VISITS BY SEMINOLE COUNTY HOSPITAL : ALL PATIENTS CENTRAL FLORIDA REGIONAL HOSPITAL 791 646 633 FLORIDA HOSPITAL ALTAMONTE 732 835 983 SOUTH SEMINOLE HOSPITAL 571 618 69 RESIDENT-SPECIFIC SEMINOLE COUNTY DATA: $1,4, TOTAL DENTAL HEALTH EMERGENCY ROOM VISITS VS. CHARGES TO ALL PAYORS 1,718 1,757 $1,386,764 1,639 $1,344,1 $1,354,857 1,8 1,6 $1,3, 1,4 $7, SEMINOLE COUNTY DENTAL HEALTH EMERGENCY ROOM CHARGES BY PAYOR $6, $5, $4, $3, $2, $1, $321,56 $155,136 $654,648 $212,72 $249,275 $29,767 $658,939 $268,783 $422,527 $122,839 $65,337 $159,154 Note: Due to an apparent data-entry error to the AHCA database, self-pay charges for are an estimation derived from averaging the self-pay charges for and 1,2 SEMINOLE COUNTY DENTAL HEALTH EMERGENCY ROOM VISITS BY PAYOR 1, 8 6 4 2 364 242 76 327 339 233 782 364 477 141 993 146 ORAL HEALTH EMERGENCY ROOM VISITS BY NUMBER OF SEMINOLE COUNTY CHILDREN BY AGE GROUP -4 5-9 1-14 15-19 49 49 55 29 29 38 3 3 25 99 99 92
ORAL HEALTH EMERGENCY ROOM SPENDING IN SUMTER COUNTY* DENTAL HEALTH EMERGENCY ROOM VISITS BY SUMTER COUNTY HOSPITAL : ALL PATIENTS THE VILLAGES REGIONAL HOSPITAL 389 555 473 RESIDENT-SPECIFIC SUMTERCOUNTY DATA: $5, TOTAL DENTAL HEALTH EMERGENCY ROOM VISITS VS. CHARGES TO ALL PAYORS $284,33 $268,48 $215,413 382 48 382 45 4 35 $15, SUMTER COUNTY RESIDENT DENTAL HEALTH EMERGENCY ROOM CHARGES BY PAYOR $1, $5, $45,539 $33,347 $14,89 $31,637 $1,232 $22,399 $129,355 $32,344 $13,85 $31,14 $95,647 $37,582 2 SUMTER COUNTY RESIDENT DENTAL HEALTH EMERGENCY ROOM VISITS BY PAYOR 15 1 5 12 56 186 38 148 33 189 38 156 38 145 43 ORAL HEALTH EMERGENCY ROOM VISITS BY NUMBER OF SUMTER COUNTY CHILDREN BY AGE GROUP -4 5-9 1-14 15-19 19 11 9 6 9 8 8 7 5 23 39 13 * An analysis of Florida Agency for Healthcare Administration (AHCA) - Emergency Department Database Ambulatory Care-Sensitive Dental Conditions by
ORAL HEALTH EMERGENCY ROOM SPENDING IN LAKE COUNTY NUMBER OF DENTAL HEALTH EMERGENCY ROOM VISITS BY LAKE COUNTY HOSPITAL : ALL PATIENTS FLORIDA HOSPITAL WATERMAN 771 487 473 LEESBURG REGIONAL MEDICAL CENTER 699 717 853 SOUTH LAKE HOSPITAL 765 756 696 LAKE COUNTY RESIDENT-SPECIFIC DATA: $2,, LAKE COUNTY DENTAL HEALTH EMERGENCY ROOM VISITS VS. CHARGES TO ALL PAYORS 2,5 2,22 $1,99,865 $1,91,195 1,957 $1,31,134 2,22 $7, CHARGES BY COUNTY RESIDENT FOR DENTAL HEALTH EMERGENCY ROOM VISITS - $6, $5, $4, $3, $2, $1, $218,935 $163,582 $587,973 $129,375 $359,576 $141,766 $436,438 $153,415 $459,842 $147,782 $552,566 $149,944 1,5 NUMBER OF DENTAL HEALTH EMERGENCY ROOM VISITS BY COUNTY RESIDENT - 2, 1,5 1, 5 534 314 1,151 23 7 229 858 17 755 24 879 184 ORAL HEALTH EMERGENCY ROOM VISITS BY NUMBER OF COUNTY CHILDREN BY AGE GROUP -4 5-9 1-14 15-19 71 64 65 54 38 39 33 26 28 16 12 16 * An analysis of Florida Agency for Healthcare Administration (AHCA) - Emergency Department Database Ambulatory Care-Sensitive Dental Conditions by
ORAL HEALTH EMERGENCY ROOM SPENDING IN VOLUSIA COUNTY* DENTAL HEALTH EMERGENCY ROOM VISITS BY VOLUSIA COUNTY HOSPITAL : ALL PATIENTS BERT FISH MEDICAL CENTER 851 945 67 FLORIDA HOSPITAL DELAND 1,217 1,26 1,56 FLORIDA HOSPITAL FISH MEMORIAL 926 963 892 FLORIDA HOSPITAL MEMORIAL MEDICAL CENTER 656 68 63 FLORIDA HOSPITAL OCEANSIDE 527 512 396 HALIFAX HEALTH MEDICAL CENTER 1,466 1,432 1,411 HALIFAX HEALTH MEDICAL CENTER PORT ORANGE 845 737 612 RESIDENT-SPECIFIC VOLUSIA COUNTY DATA: $5,, TOTAL DENTAL HEALTH EMERGENCY ROOM VISITS VS. CHARGES TO ALL PAYORS 8, $2,, $1,5, $1,, $5, $2,876,973 6,154 6,69 $2,36,551 $2,332,431 5,389 $2,5, VOLUSIA COUNTY RESIDENT DENTAL HEALTH EMERGENCY ROOM CHARGES BY PAYOR $486,662 $216,981 $1,935,652 $237,678 $69,734 $263,787 $1,151,154 $254,876 $76,75 $237,469 $1,84,722 $25,165 3,5 VOLUSIA COUNTY RESIDENT DENTAL HEALTH EMERGENCY ROOM VISITS BY PAYOR 3, 2,5 2, 1,5 1, 5 1,612 651 3,226 665 1,821 553 3,1 595 1,842 426 2,585 536 6, 4, ORAL HEALTH EMERGENCY ROOM VISITS BY NUMBER OF VOLUSIA COUNTY CHILDREN BY AGE GROUP -4 5-9 1-14 15-19 121 171 17 136 125 14 8 71 72 316 279 26
ORAL HEALTH EMERGENCY ROOM SPENDING IN MARION COUNTY NUMBER OF DENTAL HEALTH EMERGENCY ROOM VISITS BY MARION COUNTY HOSPITAL : ALL PATIENTS MUNROE REGIONAL MEDICAL CENTER 1,239 1,618 1,739 OCALA REGIONAL MEDICAL CENTER 1,38 1,182 1,397 WEST MARION COMMUNITY HOSPITAL 333 42 447 MARION COUNTY RESIDENT-SPECIFIC DATA $3,, $2,, $1,, TOTAL DENTAL HEALTH EMERGENCY ROOM VISITS VS. CHARGES TO ALL PAYORS $2,294,125 $2,41,574 $1,659,789 5,9 3,775 2,759 1, 5, $1,2, COUNTY RESIDENT DENTAL HEALTH EMERGENCY ROOM CHARGES BY PAYOR $1,, $8, $6, $4, $2, $555,5 $27,386 $738,753 $158,15 $897,385 $177,943 $983,49 $235,748 $971,652 $179,698 $1,61,526 $197,698 3, COUNTY RESIDENT DENTAL HEALTH EMERGENCY ROOM VISITS BY PAYOR 2,5 2, 1,5 1, 5 953 269 1,36 231 1,346 285 1,573 2,696 1,613 262 1,622 278 ORAL HEALTH EMERGENCY ROOM VISITS BY NUMBER OF MARION COUNTY CHILDREN BY AGE GROUP -4 5-9 1-14 15-19 13 76 89 95 13 96 45 48 6 167 189 198 * An analysis of Florida Agency for Healthcare Administration (AHCA) - Emergency Department Database Ambulatory Care-Sensitive Dental Conditions by