When Chelsy Samuels of Salida started taking care of her 7-year-old sister, Kellie, she learned the girl had a mouth full of cavities.
The tooth decay was too severe to treat in a regular dental office, so Kellie was referred to Salida Surgery Center Dental Group, where dentists fixed her teeth as she lay on an operating table under anesthesia.
She had root canals, teeth pulled and caps, said the 20-year-old Samuels. If they didnt put her to sleep, I dont think she would be able to sit through the procedures.
Dental surgery centers that fill cavities and restore teeth for thousands of low-income children could close in the San Joaquin Valley unless the state grants an exemption from Medi-Cal cuts, the center owners say.
Salida Surgery Center on Pirrone Road and Central California Surgicenter in Atwater are among the centers that face a 10 percent Medi-Cal cut and a retroactive pay cut of another 10 percent.
Theyre basically going to put all of us out of business, said Dr. Alan Vallarine of Turlock, who owns a surgery center in Fresno, one of the 18 centers that are jeopardized by the cuts statewide.
Dr. Pankaj Patel of Salida Surgery Center said the retroactive pay cut will require him to return more than $1 million to the state.
The dental centers are among health providers in California that are subject to Medi-Cal cuts under Assembly Bill 97, approved by the Legislature in 2011. Provider lawsuits delayed the cuts, but the centers started getting reduced payments last month after federal courts ruled in the states favor.
Now the surgery centers are awaiting word from the state on when they have to return more than two years worth of reimbursements, Patel said.
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.
If the centers are forced to close or severely cut back, 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.
Patel said 97 percent of patients at the Salida center are on Medi-Cal, many of them children from migrant families. Referred by pediatric and general dentists, the children come in with teeth in the worst condition you can ever see, he said.
Every day, we see children who need more than half their teeth treated with fillings, crowns or extractions, Patel said. I am talking about kids who have 20 teeth that are rotting. We see 30 to 50 patients like that a month.
His center provides care to about 3,000 patients a year. About 98 percent are children, Patel said; others are people with autism, cerebral palsy or other disabilities who need extensive dental work.
On Friday, Patel talked with the parents of 4-year-old Santino Cervantes before giving him a shot in the arm and taking him to the operating room. The Modesto parents said they brought Tino to a Golden Valley Health Center after he complained his teeth hurt, and they were referred to the Salida center. Before Fridays 90-minute operation, a dentist found the child had decay on 14 teeth and would require four fillings, crowns and two extractions.
If we didnt come here, we would not be able to afford the treatment, said Daniel Cervantes, the boys father.
Patel said the treatment would cost $4,000 to $6,000 at a private dental office. Medi-Cal will pay the center $1,000, he said.
The surgery center owners said theyre especially vulnerable to the cuts because a large percentage of their patients are on Medi-Cal. Those patients may represent only 20 percent to 30 percent of the caseload at typical dental offices, which can rely on private insurance payments from the majority of patients, Patel said.
The surgery centers need to have larger staffs to support the procedures. Patel said two dentists and two anesthesiologists work at the Salida center on any given day; it also has four nurses, four dental assistants and six or seven front-office employees.
With AB 97, 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.
Surgery center owners said they have operated for years on low reimbursements from the state, and at least one center in Fresno closed before the 10 percent cut from Medi-Cal.
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. 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 centers appeal for an exemption has the support of Assemblyman Adam Gray, D-Merced. His letter Oct. 10 to state health care services director Toby Douglas was co-signed by state Sens. Anthony Cannella, R-Ceres, and Cathleen Galgiani, D-Livingston, and Assemblywoman Kristin Olsen, R-Riverbank.
This is about children and handicapped adults, Gray 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 valleys 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.
Christine Noguera, interim chief executive of Merced-based Golden Valley Health Centers, said the safety-net clinics are promoting oral health to low-income residents, but the surgery centers provide a level of care thats needed.
Before the Medi-Cal cuts, the Salida Surgery Center had profit margins of little more than 5 percent, Patel said.
He said ruefully that the claw back provision to require repayments back to June 2011 may force the center to stay in business to try to repay the Medi-Cal program. The dentists that see the patients already have been paid based on what the state paid us. I cant ask them to give it back, said Patel, a dental anesthesiologist who also owns a Bay Area center.
The Salida center will have to cut benefits for staff and suspend community work, such as dental screenings at migrant Head Start programs and education for school nurses, Patel said.
Closing the local center would mean these children will end up in the emergency rooms of hospitals where they only get pain medication and antibiotics for the infections, Patel remarked. Or they may have to travel two hours to a surgery center that hopefully does not close.
Modesto Bee staff writer Ken Carlson can be reached at email@example.com or (209)578-2321.