Dental surgery centers that fill cavities and restore teeth for thousands of low-income children could close in the central San Joaquin Valley unless the state grants an exemption from Medi-Cal cuts, the center owners say.
The pediatric dental surgery centers face a 10% Medi-Cal cut and a retroactive pay cut of another 10%.
"They're basically going to put all of us out of business," said Dr. Alan Vallarine, owner of the Fresno Dental Surgery Center.
The centers provide care for children who are too young, too scared or have too much dental decay to be treated at a regular dental office. At the centers, the children are sedated so they are not traumatized and to allow multiple procedures to be done in one sitting.
The consequence of centers closing: More children will come to hospital emergency departments in pain, center owners said. State officials say safety-net clinics are available to children, and the state will monitor the effects of the Medi-Cal cuts on access to care.
Children are referred to dental surgery centers by pediatric and general dentists in the community.
On Friday, Curtis Lee, 4, was at the Fresno Dental Surgery Center. Parents Mary Xiong and Khu Lee said Curtis had eight cavities that needed to be filled. His dentist recommended he be sedated for the work and they agreed. "We didn't want to traumatize him because there was a lot of work that needs to be done," Xiong said.
Xiong said she expected the fillings to cost more than $1,000, but Curtis is covered by Medi-Cal. Lee works in a casino and Xiong is a movie theater supervisor.
Most of the children seen in dental surgery centers are on Medi-Cal, the state-federal insurance for the poor, Vallarine said. The Fresno Dental Surgery Center provided care to 4,059 patients last year -- all but 46 were covered by Medi-Cal, the state-federal insurance for the poor.
The Fresno center would lose about $500,000 in revenue from the 10% cut this year and have to pay back about $1.3 million, he said. "It's just going to wipe me out."
According to a list of centers provided by owners, the Valley has five centers -- a sixth in Fresno recently closed -- facing the Medi-Cal reductions.
The dental centers are among health providers in California who are subject to Medi-Cal cuts under Assembly Bill 97, which was approved by the Legislature in 2011. Providers have battled the legislation in court, but earlier this year the state received federal approval to reduce payments by 10% to dentists, doctors, pharmacists and clinics. The state began implementing the cuts last month.
Vallarine said the reimbursement reduction affects 18 for-profit dental surgery centers statewide. The state said 15 are enrolled in Denti-Cal, the dental portion of Medi-Cal.
The state granted an exemption to a not-for-profit center in Sonoma County, citing the need to "preserve and protect access to care for Medi-Cal members."
But the exemption must be approved by the federal Centers for Medicare and Medicaid Services, and the for-profit centers want to be included in that exemption. Sparing only one center from the reimbursement reduction will not ensure access for children throughout the state, Vallarine said.
Officials with the Department of Health Care Services, which oversees Denti-Cal, said the Sonoma center was exempted from the reimbursement reduction because "of the urgent nature of the dental visits/services rendered to the populations they serve." The center received approximately $1.25 million in Medi-Cal payments in 2012 and was paid about $1.2 million in 2013.
The public has until Monday to submit comments to the state about the exemption.
Several legislators have signed letters in support of expanding the exemption to include for-profit centers, including Connie Conway, R-Tulare, Assembly Republican leader.
In a statement, Conway said: "Access to quality health care in the Valley is already limited and closing these facilities jeopardize the health of thousands of children in need of medical care."
Three centers are in Tulare County: Hapy Bear Surgery Center in Tulare, and Children's Dental Surgery Center and Barnes Dental Surgery Center in Visalia.
Hapy Bear Surgery Center in Tulare likely will financially limp along if the Medi-Cal cuts are upheld, said spokesman Jeremy Pierson.
The center, which provides dental care to about 3,000 children a year, is a family-run business. Pierson's father, Kenneth Pierson, is the dentist anesthesiologist and the center's medical director.
""We feel we have a moral responsibility to provide these type of services to this community," Pierson said.
But the center faces an $800,000 retroactive payment to Medi-Cal, he said, and staying open would require changes. "We really cannot provide a service that costs more to provide than we get reimbursement on," Pierson said. "At some point we would be looking to slim down staff, which is our highest expense, in order to be able to provide the service."
Pierson said the state stands to lose money if pediatric dental surgery centers close. In 2013, they provided dental care to 32,000 patients statewide, he said. The cost was about $900 per patient or $28.8 million.
The state would gain only $2.8 million from a 10% cut, Pierson said. "Only a few kids going to the ER multiple times will way surpass that cost," he said.
Center owners said they have operated for years on low reimbursements from the state, and at least one center -- Children's Dental Surgery Center in Fresno -- closed before the 10% cut from Medi-Cal.
Dentist Wiley Elick, who operated the Fresno center, continues to operate SurgiTek Outpatient Dental Surgery Center in Hanford. But he doesn't know how long he can keep it open. "We're just going to see if we can make it," he said.
The fate of Central California Surgicenter in Atwater also remains uncertain, owners Larry and Michelle Church said.
The couple, who co-own the center with Bloss Memorial Healthcare District, opened the business in 1999. The couple also owns a center in Indio.
"We are right on the edge," Larry Church said. "One month we break even, one month we lose a little and one month we make a little."
The for-profit center's appeal for an exemption has the support of Assembly Member Adam Gray, D-Merced.
"This is about children and handicapped adults," he said in an email statement. "The work these dental specialized care centers do not only is essential to the well-being of some of the Valley's most underserved populations, it saves the state millions of dollars in the long run by avoiding myriad trips to costly hospital emergency rooms. The exemption is justified and necessary."
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