Baylor official attributes action to reduced payments from Ryan White Act; “‘temporary suspension’ may be lifted in spring, summer 2008
Ryan White Act funding cutbacks are creating a pain for clients of Dallas’ HIV service agencies in an unexpected area their mouths.
Baylor College of Dentistry, which has accepted referrals of HIV-positive clients from Dallas agencies for 12 years, has temporarily suspended the acceptance of new patients to its clinical program because of rising deficits, according to Dean Hudson, associate dean for clinical affairs.
“It’s a temporary suspension until we can get hold of the red ink that’s killing us here,” Hudson said.
Hudson said that the college has provided $3.2 million in dental care services for HIV-positive patients during the past 12 years. Of that, only $1.8 million has been reimbursed from federal funds, creating a deficit of $1.4 million, he noted.
This year, the college has already provided $260,000 in dental care services, and it has received only $111,000 in reimbursements, according to college officials.
The dental care services include procedures such as root canals, dental surgery and other specialty services.
Hudson said the college is currently being reimbursed at only 40 percent of the total cost of care billed, compared to a 75 percent reimbursement ratio in previous years.
“In those days we were writing off $100,000 or less, and that was acceptable,” Hudson said. “But at 40 percent, I think the handwriting is on the wall. Until that funding is reinstituted at a higher level, we will continue at some level but at a reduced level of care.”
The college is part of the Texas A&M Health Science Center, and the clinical operations are sustained by clinic revenue, Hudson said. The college’s mission is to develop clinicians and educators and at the same time to care for the needs of a diverse community.
“The long and short of the story is that we’ve tried to be all things to all people as long as we possibly could,” Hudson said. “Looking at the future in order to sustain this program at any level at all, we’re going to have to manage it very closely.”
Ladawn Brock, communications manager for the dental college, said the temporary suspension of new patients’ referrals from Dallas agencies is just one measure underway to better manage the clinic’s finances.
“We are looking more closely at all of our accounts receivable, and Ryan White was a part of that,” Brock said. “Our goal is to become more fiscally responsible so we can provide the best quality of care for the patient.”
Hudson said he is unsure when the college would be able to resume the acceptance of new patients referred by Dallas’ HIV service agencies into its program, but it would likely not be before the spring of 2008. Treatment for HIV-positive patients already enrolled in the program is being continued, he said.
“We are going to reassess this semi-annually to be able to project where we are,” Hudson said. “It’s been a very difficult thing to manage because these grants are paid two years in arrears.”
Bret Camp, clinic director for the Resource Center of Dallas, said the financial problems the dental college is experiencing are similar to the ones being experienced by HIV service agencies themselves. Congress has made fewer funds available for HIV services across the board, he said.
“It’s not any different than anyone else’s boat,” Camp said. “It just hurts more when it’s a toothache.”
Camp said the HIV-positive patients suffering most from the funding cutbacks are those who cannot afford to pay for care. The dental college would accept the HIV-positive patients into its general program, but they would have to pay for the services, he said.
“A lot of things could be done as a fee for service, but the people generally don’t have the money,” Camp said. “The Resource Center does not have the funds for the kind of stuff we send them to Baylor for.”
Camp said the inability to obtain dental care is a big concern because of concerns about further compromising an HIV-positive patient’s health.
“Oral health is very important for people who have HIV,” Camp said. “It’s already an area that is difficult to keep up with the demand.”
Hudson said Dallas’ dental college is not the only one struggling to provide care to HIV-positive clients and to be financially responsible.
“Other dental schools in the nation are all looking at it,” Hudson said. “What do we do now? It’s a big question.”
Camp said he also is struggling to answer that same question.
“It’s got my mind to thinking what I can do to overcome it,” Camp said.
“I’m going to try some outside-the-box thinking on this one.”
This article appeared in the Dallas Voice print edition November 2, 2007