By Mary Otto
It is a scenario that regularly plays out in statehouses during times of fiscal austerity: funding for Medicaid dental services goes on the chopping block. A shortage of Medicaid dental providers already is major problem in many communities and dentists often blame low reimbursement rates and budget cuts for making the problem worse.
Reporter Andy Marso has been following the problem in Kansas. He recently used the story of a dental provider’s ongoing struggle to get needed care to poor and disabled patients to capture the worries about the latest round of anticipated cuts to the state’s Medicaid dental program.
In a piece that aired in August on KCUR-FM, a National Public Radio affiliate in Kansas City, Mo., Marso took listeners to the busy Prairie Village dental office of John Fasbinder, a rare Kansas dental provider who takes all comers, including patients with special needs. The dentist told Marso that he tries to persuade fellow dentists to expand their practices to include more Medicaid patients, but without much success.
“That is because Kansas Medicaid, or KanCare, pays about 40 cents on the dollar compared to private insurance for dental work,” Marso reported. “And that was before Gov. Sam Brownback cut the reimbursements another 4 percent this year to help close persistent budget gaps.”
In this Q and A, Marso offers thoughts on his oral health coverage for the Topeka-based Kansas Health Institute (KHI) News Service, which part of the Heartland Health Monitor news collaboration. He discusses issues playing out in Kansas and across the country, such as the shortage of Medicaid dentists, budget battles over funding and a long-running controversy over whether the use midlevel dental providers would ease the shortage of dental care for needy and rural state residents in places
Marso also shares some wisdom gleaned from a book-length exploration of his own life-threatening health crisis. He discusses how the journey made him a better journalist.
Q. You stay busy covering health in Kansas for KHI News Service. In recent weeks you have been following the ongoing effects of a major bottleneck in Medicaid enrollment; concerns about the safety of children in the state’s foster care system and the possible impact of state budget cuts on programs such as community care for the disabled and struggles over funding for Medicaid dental services. What led you to Dr. Fasbinder’s office?
A. Dr. Fasbinder called me. He had read some of my reporting about the state’s 4 percent cut to Medicaid reimbursements and wanted to weigh in. He said he was already getting patients from all across the state who couldn’t find anyone else to take them, and he feared the cuts would only make that situation worse.
Q. As your reporting unfolded, what surprised you most about what you learned about the state’s Medicaid dental system?
A. I knew that Medicaid reimbursement rates for dental didn’t match up with private dental rates, but I didn’t know just how wide the discrepancy was. In Kansas, dentists get about 40 cents on the dollar for Medicaid compared to private insurance.
Q. Dr. Fasbinder spoke very forcefully about the shortage of dentists serving Medicaid patients in the state. He made the point that low Medicaid reimbursement rates have discouraged many dentists from participating in Medicaid and anticipated cuts may further exacerbate the shortage of care. Since your story ran, have you heard about any efforts to address that planned cut?
A. A significant number of legislators (from both parties) have expressed interest in reversing the 4 percent cut. But the state budget is still tight, so finding the money to do it will be difficult. Gov. Brownback has floated a plan to reverse the cut if it was replaced by a tax on hospitals. The president of the Kansas Dental Association, John Fales, says taxing another health care provider is not a good alternative. Fales recently decided to drop two of the three Kansas Medicaid, or KanCare companies, from his practice. He said the 4 percent cut was the last straw. (The other company has agreed to hold off on implementing the cut until CMS approves it.)
Q. Earlier this year, you covered the big annual Mission of Mercy dental clinic at the Kansas Expocentre. You spoke with volunteers and patients like warehouse worker Daniel Veach, who waited for hours hoping for free extractions and other services. You also spoke with an advocate from the Kansas Dental Project, a group pushing lawmakers to allow the licensing of midlevel dental providers in the hope of expanding access to dental care in the state, particularly in places that lack providers. How that effort is unfolding in Kansas?
A. The Kansas Legislature discusses bills to license midlevel dental providers every year. They never get very far in the legislative process. The Kansas Dental Association traditionally opposes it. There are areas in Kansas that are short of dentists but overall the number of dentists practicing in the state is rising, from about 1,400 in 2009 to about 1,525 last year. So it is more complicated than just a shortage of dentists. Lack of dental coverage and low Medicaid reimbursements that dissuade dentists from signing with Medicaid carriers also are factors in driving Kansans to charity care such as Mission of Mercy. General education about the importance of regular, preventative dental care also is an issue. I met people at the MOM who unfortunately had let their teeth decay for far too long. There’s a coalition of groups called the Kansas Dental Project that think midlevel providers could help out. I think they will continue to lobby for that license.
Q. In addition to your beat reporting, you also wrote a book, “Worth the Pain: How Meningitis Nearly Killed Me – Then Changed my Life for the Better.” The memoir, named a 2014 Kansas Notable Book, describes a truly devastating and yet ultimately redemptive journey through illness. Considering the pain that the project must have required you to relive, tell us how you managed to get that book written.
A. Writing the book was a form of therapy for me. So yes, it was difficult emotionally but helpful for my long-term mental health. For months after my hospitalization I had nightmares about the debridement process, where dead tissue was removed from my arms and legs to try to save my limbs. I realized that I had suppressed a lot of that experience in my subconscious because I didn’t want to deal with it at the time. Writing about it forced me to drag it through my conscious mind, and analyze and come to accept that this had truly happened to me and it was over. Now I had to figure out what to do next. When I started writing about it, the nightmares stopped.
Q. Briefly, how did the experience of that serious illness and its aftereffects change you as a reporter?
A. My experience with bacterial meningitis and the 4.5 months in the hospital and 16 surgeries that followed, plus one year of rehab opened my eyes to the complex world of health care. There were many days when my father was on the phone for hours with our insurance company, making sure my care was covered. When I got an MRSA (methicillin-resistant Staphylococcus aureus infection) late in my hospitalization, a staff member told me not to worry, almost everyone who spends as much time in the hospital as I had gets MRSA. Those were some of the negatives.
But I also met people at KU Hospital’s burn and wound unit who help people with the most horrible injuries every day and do it with a kindness and positivity that is nothing short of divine. They are heroes. I learned about immunology and how meningococcal vaccines work, and about the latest advances in prosthetics, myoelectric and otherwise. I also learned about research into human limb regeneration and burn treatments that in the future could use a patient’ own cells to heal them with the pain or scarring of grafting. And I learned to empathize with people who are facing illnesses or injuries that they may not know how to overcome.
Q: Do you have any thoughts on how you choose the stories you decide to tackle?
A. Reporting on health care, like a lot of things, should ultimately be about people and their stories. I need to get better at putting human faces on policy stories. But if I know the policy side, then I know when I hear from somebody like Dr. Fasbinder that I’ve probably got a story.
Andy Marso, M.A., is a writer for the KHI News Service. ”¨He previously covered state government news for the Topeka Capital-Journal, where he won the Burton W. Marvin Kansas News Enterprise Award and received the Great Plains Journalism Award for investigative/project reporting. Marso has written for The Olathe News, the St. Cloud Times and the Washington Post. His memoir, “Worth the Pain: How Meningitis Nearly Killed Me – Then Changed My Life for the Better,” was named a 2014 Kansas Notable Book.
