On the Texas Health and Human Services Commission’s Legislative Appropriation for Dental Plans

Fair Warning – Texans

By Darrell K. Pruitt DDS

Just like capitation dental plans, in the long run, poor, sick children in hospitals don’t save Texans money

THHS Commission’s Legislative Appropriation

As part of the Texas Health and Human Services Commission’s legislative appropriation request, the Agency is quietly pushing for approval of a short-sighted proposal to change the state’s current Medicaid/CHIP (discounted) fee-for-service delivery model to multiple corporate-run capitation plans – where executives who fund political campaigns get bonuses but cannot be held accountable for the slow lines or the fast dental work.

Expedient Deception?

If HHSC succeeds in their politically-expedient deception, not only will it be even more difficult for poor parents to find dentists who accept Medicaid or CHIP payment, but the communities’ charity dental clinics – the default hope of relief for far too many of the state’s poor already – will be unable to keep up with the surge of basic dental needs in the community. Many free dental clinics already need donations of dentists’ free time more than money.

Current Programs Marginally Acceptable 

Even though the state’s current Medicaid/CHIP program is only marginally acceptable to dentists because of next to charity fees plus aggravating and costly bureaucracy, nothing is more disgusting with dentists and patients than dental managed health organizations (DMHO). If naïve people in Austin have their way, the long waits for dentists’ time – state-paid or volunteer – will increasingly cause children to end up in hospital emergency rooms with painful, life-threatening oral infections that are expensive and preventable.


Your local dentist’s capacity to give back to your community by volunteering in neighborhood free clinics is not limitless. Let’s not make a bad situation worse with capitation. It’s a lie.


And so, your thoughts and comments on this ME-P are appreciated. The time is NOW to contact YOUR TEXAS LEGISLATOR http://www.fyi.legis.state.tx.us/ and tell them a capitated dental managed care delivery model is not in the best interest of Texas children or Texas dentists! Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

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4 Responses

  1. Capitation dentistry, midlevel providers and sinfully huge tax savings

    On December 7, I posted an opinion piece on The American Way of Dentistry titled “Is the nation really ready for two-tiered dentistry?” (On the 8th, it was picked up by the Medical Executive-Post as “Dental Therapists [Emerging New Providers?].”)


    Yesterday, a reader named Tom opened the door for me to further expound on my opinion of midlevel providers and a future of multi-tiered dentistry. I’ll be sharing this conversation with my state and national lawmakers as well. Do you think I’ll get any responses?

    Tom says: “It already exists. There are insurance based practices and fee for service practices and if you don’t think there’s a difference in quality…..”

    I agree with you, Tom. But I should warn that as dentists, you and I are now skirting the fringes of unwritten rules of “professionalism” should we openly mention that managed care dentistry is dentistry by the lowest bidders with no quality control.

    It’s also politically incorrect to reveal that one can go to the dentist rating site, DR.Oogle (doctoroogle.com), and quickly research preferred providers’ popularity with patients compared to other practices. Invariably, the managed care practices average in the lower half of the ratings by the only critics who matter.

    Indeed, dental patients across the nation confirm that there have been two tiers of dentistry for decades: First is fee-for-service controlled by freedom of choice and marketplace competition, and then there is a second, preferred-provider tier controlled by discount dentistry brokers like Delta Dental, United Concordia and BCBSTX according to cost. Now a third tier is in the race for the bottom – capitation dentistry, and it’s coming to a state near you.

    Decades ago, the concept of paying dentists on a per-head basis rather than per-filling was soundly rejected by Americans for good reason: It proved to be unethical to encourage even a professional to profit from neglecting patients’ health. It’s much, much better to make someone work for their pay. Nevertheless, capitation is returning to the dentistry marketplace. In Europe, the UK’s National Health Service (NHS) which provides free dentistry as an entitlement will soon begin a pilot program to carefully investigate the promise that capitation will indeed solve the nation’s access problem before making the benefit plan law.

    On the other hand, the Texas Dept. of Health and Human Services has guts. Naïve leaders in the state organization intend to persuade lawmakers to turn Medicaid dentistry into capitation immediately without bothering to even ask dentists about it. How is that not bureaucratic bonehead?

    The 1980s sales pitch went something like this: “We pay dentists for quality outcomes instead of unnecessary crowns, and pass on the savings to you!”

    The difference of 25 years? This time, capitation decay will be ignored, then delayed and finally treated by non-dentists instead of dentists. The pitch: “It will cost taxpayers even less to provide dental care to the poor (including avoidable, painful complications – which are contractually up to the dentist to resolve). And who will be the unfortunate dental patients? Children in Texas from poor homes who have no choice where to go for dental care and whose complaints matter little if at all.

    There is no latent fairness in “tiered” dentistry. Only different levels of pain.

    D. Kellus Pruitt DDS


  2. Capitated Dentristy

    Federally-funded capitation dentistry by contracted dental therapists in remote locations – What can possibly go wrong with that money-saving plan for increasing access to dental care for the poor?

    Yesterday, Rebecca Robinson, writing for the Lund Report, posted “Oral Health Advocates Push for Dental Therapists — A new mid-level provider is opposed by the Oregon Dental Association.”


    According to Robinson, ADA President Dr. Raymond Gist claims the Alaska study cited as favorable by therapist stakeholders “did not provide the robust examination or projectable metrics on which to base important policy and public health decisions.” I discovered the article because “Dr. Raymond Gist” is one of my Google Alerts. When given the opportunity, I try to always help bring attention to the President’s messages. He must know who I am by now because I’m his only tangible fan on the Internet. I imagine by now, my attaboys increasingly appear on his first page when he Googles his own name. Sweet.

    Here’s today’s attaboy


    At some point during the nation’s real-time experiment in dental care by novices, I expect stakeholders in the dental therapist market, like Judith Woodruff, Dr. Tom Bornstein and Dr. Mary Willard who were mentioned in the article, to do the right thing and properly disclose to the principals – that would be the patients who aren’t involved in dentistry for profit – that the discounted care they will receive from non-dentists is of lesser value than more expensive, but arguably less costly dentistry done by properly trained dentists “the first time.”

    What’s especially frightening to me is that the three ambitious entrepreneurs seem unfazed by the obvious danger of sending inadequately-trained – but cheap – providers into the remote areas of the US. These are less desirable parts of the nation where infrastructure is less reliable, and where poor parents have no choice in care for their children. Let’s at least be honest with those less fortunate if we are too cheap to provide their children with care from real dentists.

    Dentistry is difficult enough in the suburbs with oral surgeons close by – in case an unanticipated problem arises which is beyond even the training of a general dentist.

    How could dentalcare stakeholders possibly make this deception any more harmful to naïve and poverty-stricken families in Texas? How about mixing in harmful temptations inherent in capitation (pay per head instead of pay per filling) dentistry run by Dental Health Maintenance Organizations (DHMO)? If the Texas Dept. of HHS has its way, in a few years, it’s possible that almost-dentists working in a clinic in the middle of a poor neighborhood in Fort Worth will be rewarded for neglecting decay until it can no longer be ignored, and has to be treated by a real dentist.

    In my opinion, the ADA’s new President, Dr. Raymond Gist, is a wonderfully fresh change for the ADA. He has already proven by his numerous press releases his desire to become part of the community he serves. I just think he needs to be a little more forceful to be effective. It’s not unprofessional to be assertive, it just looks bad.

    D. Kellus Pruitt DDS


  3. Medicaid economics

    Let’s look at Medicaid and the economics of unneeded dental work in restrained children’s sensitive mouths performed by the lowest bidders who work really fast.

    The Crosley Law Firm, with offices in San Antonio and Houston, posted “Were your children given unnecessary dental treatment?” on dentalabuse.com:


    Are your children on Medicaid? Have they been to a chain dental clinic recently? Did they get more than 5 steel crowns? More than 5 root canals or pulpotomies? Was your child restrained or tied down? Are their steel crowns falling out now?

    Some dentists and orthodontists may have targeted children on Medicaid for unnecessary and excessive dental work. If your child has received more than 5 steel crowns or root canals, or other excessive dental work, they may be entitled to money damages.

    Call the Crosley Law Firm right now or complete our online form for a free legal case evaluation.

    Remember, if your child was given unnecessary or excessive dental treatment, you have rights!


    Regardless what one thinks of attorneys who fish for plaintiffs with the lure of cash awards, they aren’t to blame for the ethical problems we are witnessing in Medicaid dentistry. Nevertheless, the Crosley Law Firm’s frightening words discourage the best dentists from signing up with Medicaid – causing even more kids from poor families to go to bed with toothaches. Apart from careless treatment creating long-lasting fear in children, lack of accessible dental care is arguably the most devastating harm that occurs when a small number of greedy, inhumane dentists dentally abuse children for Medicaid money.

    Economic law clearly suggests that if Medicaid pays dentists a more competitive wage, improvements in quality will naturally follow – eliminating additional costs of unnecessary dental work, plaintiffs’ attorneys and micromanagement of dentists by CMS.

    What’s more, should the Accountable Care Act move forward, the eligibility expansion will add millions of children in 2014 who will be entitled to dental care. Are we going to leave even more kids whose parents have no choice, to the mercy of poorly-paid dentists – or even worse – to poorly-trained, poorly-paid dental therapists?

    If it were your children, what level of quality would you prefer? I thought so.

    D. Kellus Pruitt DDS


  4. MCNA is cruel to Texas’ poor

    I learned from a Medicaid dentalcare provider that Managed Care of North America, Inc. (MCNA), the dental managed care company that has recently contracted with Texas to handle Medicaid claims, requires pre-approval for surgical extractions–even if a patient is in excruciating pain. What’s more, it takes weeks for pre-approval from MCNA Inc.

    So if the dentist goes ahead and treats the patient out of sympathy without getting an approval, the dentist is invariably paid the lower fee by MCNA by default for not seeking approval.

    On the other hand, if the dentist and patient wait for the pre-approval, MCNA consultants – who must be incredibly talented surgeons (if they are dentists at all) – usually determine that almost all extractions are routine, pre-approved or not. It’s a racket.

    What’s more, many times there is no way to predict complicating factors up until the point when a routine extraction becomes surgical.

    As anyone can see, MCNA’s sleazy, profiteering business ethics encourage dentists to await pre-approval instead of treating the poor in a timely manner. Texans must stop the cruelty to their poor.

    D. Kellus Pruitt DDS


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