“Dollars and Dentists” a joint project of PBS Frontline and the Center for Public Integrity, looked at the consequences of a broken dental care system. In this piece, Frontline Producer Jill Rosenbaum shares how the investigation got started, where they found data, who the key sources were and some ideas of stories that are ripe for coverage.
By Jill Rosenbaum
The reporting for “Dollars and Dentists” began with a casual comment from Frontline’s Executive Producer David Fanning that he was interested in “something about dentists.”
About the same time, I learned that New York’s then attorney general, Andrew Cuomo, was investigating abuse of high interest health care credit cards and that many of the consumers complaining about the cards had gotten them from their dentists. It soon became clear that these patients were part of a huge, under-reported story about lack of access to dental care.
This country has two classes when it comes to oral health: haves and have nots. There is no dental safety net equivalent to the emergency room for medical care, many dentists don’t accept public insurance liked Medicaid and CHIP and Medicare has no dental benefit. Dental treatments can be extremely costly and people who can’t afford to pay out of pocket are often left with two options: no care or huge debt. Those who go without care face painful dental infection and, in rare cases, death.
Some of the data we needed was readily available. Health Resources and Services Administration (HRSA), a division of the U.S. Department of Health and Human Services, keeps tabs on professional shortage areas, for example, and the Pew Charitable Trusts does an annual scorecard ranking states on children’s dental access. But when we decided to look at the care provided at corporate dental chains catering to kids on Medicaid and CHIP, we had to do our own analysis.
For this project, I teamed up with David Heath, a reporter with the Center for Public Integrity. He was able to obtain Medicaid claims data from two states, Texas and Virginia, to look for patterns in restorative care for kids. He found that Kool Smiles, a chain we reported on, was much more likely than other Medicaid providers to put crowns on cavities for kids under age 8. Dental experts suggested that age cutoff because we wanted to look at baby teeth only.
Our key interviews came from four groups: concerned dentists, including Terry Dickinson, the founder of the Missions of Mercy volunteer dental projects; dental school faculty, such as Frank Catalanotto, D.M.D., from the University of Florida; public health officials, such as Donna Balaski, D.M.D., of Connecticut; and former employees of dental chains. Because the oral health story has not gotten much attention, we had to work hard to find sources who could help us review patients’ dental records, set up criteria for data analysis and verify the claims of former employees of dental chains, many of whom had confidentiality agreements and so could not speak on the record.
There are tens of millions of Americans with limited or no access to dental care. We wanted to look at some of the new models that have come along to help them. We had little trouble reporting on dental therapists — the new nurse practitioner-like mid-level providers, or on nonprofit clinics like Sarrell Dental. But, when we started looking at the corporate chains, we found that because they are largely owned or backed by private equity firms, there is little publicly available information about them.
Because most chains require employees to sign confidentiality and non-disclosure agreements, it was nearly impossible to find folks to talk on the record, or on camera. Many spoke to us on background and in most cases we were able to get documentation for what they told us. But, it took a lot of time, and a lot of reporting.
In addition, when it comes to dental care, every state is different. They have different Medicaid reimbursement rates and participation rates among dentists. Some state dental boards do a good job at oversight while others seem to have little power or interest in regulating their peers. Because Medicare has no dental benefit, no federal agency looks at care or claims data on a national level. Dentists are, in fact, relatively unregulated.
I would tell other reporters that there is a lot of fertile ground here. There is a lot of local reporting to be done, as well as reporting on dental access, inadequate regulation, the role of corporations in providing dental care, and the growing shortage of dentists in this country.
There is also a great deal of need.
Jill Rosenbaum is a producer with Frontline.
