, Muskogee, OK

February 22, 2010

SoonerCare Crisis

Local dentist believes trouble is on the way

By Keith Purtell

Dr. David Reifsteck said he has seen the beginning of the coming crisis with SoonerCare and has a pretty good idea how events will play out.

“What will happen is that less dentists will take SoonerCare because it’s not profitable,” Reifsteck said about the state program that provides health care for low-income families. “It gets to the point where by the time you pay everybody there’s no profit. And if there no profit, you just don’t do it. Those that have higher overheads in their office just won’t do SoonerCare anymore, and so there will be less and less availability.”

The Oklahoma Health Care Authority Board approved a $17 million cut in the state’s Medicaid program SoonerCare late last year and some effects have already been felt.

Metha Christopher has already had her share of ups and downs with SoonerCare.

“What I’ve been told is that they want us to go to welfare, because welfare knows we can get by on $400 or $500 a month,” she said. “But my brother is on disability. He said SoonerCare called him and told him they would help him with a dentist. He hasn’t seen one since 1978.”

Reifsteck, with Dental Care of Muskogee, said he has between 1,000 and 2,000 patients on SoonerCare.

“Whenever you have cutbacks, it’s going to affect it for everybody,” he said. “It wouldn’t be any difference if the price of gasoline goes up 20 percent, you’ve got to pay more for it, and that affects everybody. And when the reimbursement goes down, that affects everybody because it affects your overhead, salaries, any potential bonuses, increased salaries, increased overhead to buy equipment — it affects all of that.”

Reifsteck said that on a state average SoonerCare only pays 65 to 70 percent of what the normal and usual fee is.

“When they cut it back it definitely affects what your overall production is, and a lot of the dentists will drop doing SoonerCare just like they did in the 1980s we had a similar thing happen when the oil prices got real high,” he said. “A lot of dentists quit taking it, and it finally gets to the point where not enough people are taking it, and people are complaining enough that they can’t get an appointment, then the state will change again, or the economy will change and the state will have more money.”

Reifsteck said Oklahoma already ranks last for people who have visited a dentist in the last year. A cutback in available services would just make things worse.

“That bothers me because of the other health issues that there are,” he said. “We know that periodontal gums disease makes you three to four more likely to have diabetes or heart problems. So, it’s a big health issue as well as just a dental issue.”

If the SoonerCare cuts arrive as expected, changes to services will start small and grow from there.

“In this office we’re pretty tolerant about people that reschedule or who don’t show up,” he said. “We’ll be stricter in the policy when the change comes. If they don’t show up, they won’t get reappointed because that makes it even less of a scenario that we can handle.”

Dr. Cindy Durr, a pediatrician at the Children’s Clinic, said the clinic has thousands of children on the SoonerCare program — about 50 percent of their practice. She said the state has not directly told SoonerCare providers what will be cut back.

“I think they’re talking about 2.5 percent to 4 percent across the board for payments,” she said. “And so to get suggestions about how they can save money without making across-the-board cuts, they set up a person at the state capital with an e-mail address. One of my suggestions was to do what Missouri Medicaid has done for years and that is not to pay for routine male baby circumcisions. That would not be covered and so parents would have to pay cash if they wanted to have that done.”

Durr said there are already parents who drive their kids from Tulsa to Muskogee because they have very little access to SoonerCare pediatrics in Tulsa.

“So we kind of feel obligated to go ahead and take those kids, but it’s hard to recruit pediatricians here,” she said. “They work harder for less and less money. The big concern that I would have would be that people that I refer to would not see these children. Or just not have room to see them, or not be able to see them for four to six months.”

Durr said private insurance might be the solution for some parents.

“As far as what parents can do, probably their best bet is to carry private insurance on their kids because there will be fewer and fewer people who will accept SoonerCare if the cuts keep on happening.”

Reach Keith Purtell at 684-2925 or kpurtell