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Seattle Medical Center Finds Solution to People Seeking Dental Care in the ER

April 18, 2014

The number of people seeking treatment in one Seattle emergency department has dropped significantly since the inception of a program that refers patients with non-emergency dental problems to local community health centers.

The Seattle model for underserved patients owes its success to a partnership among Swedish Medical Center’s Community Specialty Clinic (SCSC), Swedish General Practice Residency, which is a post-graduate training program in general dentistry based in the hospital, area community health centers, and a patient navigation organization, according to Dr. Noah Letwin, dental director of the SCSC.

The residency program, which is post-graduate training that involves practicing dentistry, started in 2009 in conjunction with Seattle Special Care Dentistry, a private practice that hosts dental residents who provide care for emergency dental problems at the hospital. Recognizing that many patients with dental problems were visiting the emergency room for non-emergency needs – like simple toothaches without facial swelling – the hospital developed the “Golden Ticket” referral program, an arrangement with one of the local community health centers, Neighborcare Rainier Beach.

“Patients who showed up in the emergency room with dental pain were triaged by the emergency room physician,” Dr. Letwin said. “Those with non-emergent dental concerns would receive a ‘golden ticket,’ which was a guaranteed slot the next morning at the community health center.”

Dental residents provide care for those patients with emergency needs.

The state cut all adult Medicaid funding except for a few select populations in 2010, and area community health clinics shifted their focus on pediatric patients. Although the state restored some adult Medicaid dental coverage this year, the process of integrating it is lumbering to a start.

As a result of the cuts in 2010, there was an uptick in the number of adults repeatedly visiting emergency rooms.

“In setting up the ‘Golden Ticket’ program, however, we learned that the community health centers had a very large hole in their safety net,” said Dr. Letwin. “While they perform most single simple extractions, when faced with a patient who requires advanced oral surgical care services, they had nowhere to send the patients.”

That same year, Swedish made plans to build a new, larger clinic to expand its burgeoning medical operation, including a dental component that provides advanced oral surgery procedures that opened in 2011.

An essential part of the program is Project Access Northwest, a patient navigation organization that receives and screens referrals from the community health clinics, which determine what teeth need to be extracted and the ancillary procedures to be performed. The organization schedules appointments and provides coordination of services such as transportation and translators, according to Dr. Letwin.
Patients qualify for care if they fall at 200 percent or lower of the federal poverty level.

“If the patient’s care needs to be phased over two or more sessions based on their needs or the length of procedure, Project Access Northwest manages those multiple appointments,” said Dr. Letwin. “After the care is completed, the patient returns to the community health center, which becomes their dental home.”

There’s no doubt that the model works.

In 2013, the SCSC provided more than $1.6 million dollars in free dental care. About 5,000 decayed or diseased teeth that were removed – 40 percent of them surgically – any one of which could have resulted in an emergency department visit or hospitalization.

Other health organizations throughout the state are considering adopting a similar model, Dr. Letwin noted.

“It is a model that has required a lot of work and dedication to set up by so many different partners, but in the end, it is a model that works,” he said.