Tagged Dental Health

Must-Reads Of The Week

Well, there is nothing like a militarily enforced curfew, complete with hovering choppers and redundant fencing, to guarantee some quality reading time.

Two big stories of the moment — racial justice and the pandemic — sadly converged in the autopsy of George Floyd, which found he had survived the coronavirus before being killed in the custody of the Minneapolis police.

The continuing protests over police brutality heightened concerns that the demonstrations could hasten the viral spread just as many areas of the country are reopening. It’s not merely being jammed together, singing and chanting: tear gas can also spread the virus, and mass arrests provide fertile ground for new cases. Atlanta’s mayor and the CDC director are among those encouraging protesters to get a COVID test. Unfortunately, many testing sites were closed because of the demonstrations.

At the New Yorker, Dhruv Khullar notes that, paradoxically, a spike in infected demonstrators may further exacerbate the existing racial disparity in COVID illness. “If the protests do cause a surge in infections, it will likely be centered in the very communities that are now demanding that their lives be valued equally by the state,” he writes.

In Politico, Dan Diamond dissects the turnaround by public health experts who insisted on extreme precautions against COVID infections as the economy collapsed but now are sanctioning mass protests that risk contagion. “I think what’s lost on people is that there have been real sacrifices made during lockdown,” a former GOP Hill staffer told Diamond. “People who couldn’t bury loved ones. Small businesses destroyed. How can a health expert look those people in the eye and say it was worth it now?”

Masked Bandits

ProPublica had an absolutely bonkers story about coronavirus mask traders and other underground middlemen in the market for personal protective equipment. Highlights include a comedy writer and a former juicer salesman turned would-be entrepreneurs, a briefcase with $8,000 in cash and “proof of life” videos to demonstrate brokers actually have PPE to sell. “There are scandalous brokers out there,” one broker told J. David McSwane. “There are people that just make me want to take a Silkwood shower at the end of the day.”

Even the best mask shouldn’t be worn if you’ve been tear-gassed, writes Julia Scott at KQED. “In general we think that when masks become wet, that they are not as good at preventing the spread of virus,” a UC-Berkeley epidemiology professor says. (Another health risk of modern-day protests: rubber bullets.)

Meanwhile, marring what is an otherwise consistently pleasant experience, some dentists are charging $10 or $20 “infection control fees” to cover the costs of masks, gowns and other PPE, reports KHN’s Phil Galewitz. Will this be the oral version of the facility fee?

One underappreciated downside of mandated mask-wearing, according to Brian Brooks, the new acting head of the Office of the Comptroller of the Currency: Masks “create the very real risk of increases in bank robberies.” Hopefully, aspiring felons will not be monopolizing N95 and respirator masks when there are so many other options.

Running On Empty

On Thursday, the Centers for Medicare & Medicaid Services released a long-awaited dataset containing the number of coronavirus cases and deaths at more than 12,000 skilled nursing facilities. The deaths reached nearly 32,000, and more than 2,000 nursing homes reported a shortage of nurses or aides and thousands of others are on the brink of running out of gowns, masks and other protective gear. The data was more than a bit messy, with some facilities listed as having more COVID deaths than COVID cases. Some homes disputed the death totals for their facilities, although the government said the information was reported directly by the homes. The Wall Street Journal calculated a 10% drop in nursing home occupancy since the end of last year.

Testing, 1, 2, 3 …

Over at NPR, Sasha Pfeiffer and Tim Mak checked the status of the president’s promise that big retailers would be providing ubiquitous COVID testing and found a dearth that brings back memories of the worst of the Days of No Toilet Paper. Walgreens, Kroger, Rite Aid, Walmart and CVS combined have just 1,300 testing sites at 32,000 stores, about 4%. Most testing sites were at CVS, which is good news as you can simultaneously grab one of their notoriously long receipts to substitute for certain hard-to-find paper products.

In the What Else Are Law Enforcement Officers Up to These Days? Department, The Wall Street Journal follows a sergeant in the Broward County Sheriff’s Office who hunts iguanas in his free time. (Yes, of course this is Florida, and no, The Breeze doesn’t usually cover reptilian health, but today we make an exception.) Joe Harris started hunting iguanas with a slingshot, then upgraded to pellet guns and now uses a 4-foot blowgun with a 6-inch dart attached to a rod and reel, presumably sold separately. “It requires more skill and gives the animal more of a chance,” Harris tells John Clarke. One such lucky iguana was turned into hors d’oeuvres for Harris’ colleagues.

‘Watched With Glee’

Finally, after all this downbeat news, we end on an up note: the self-explanatory #docswhorock performances on Twitter that began way back when we were all staying at home. This week’s covers are from the ’60s, while previous weeks’ themes included soundtracks and the cheesy ’80s. Highlights include Dr. Parag Majmudar singing “Stand By Me,” a duet of “Homeward Bound” between Dr. Atul Grover and Dr. Maylyn Martinez, and Dr. Pete DeBalli operating on “Sympathy for the Devil.” Next week is the ’00s. Now, if physicians could just provide some tolerable waiting room music without adding an “ambiance control fee,” we’d happily deploy our “well-learned politesse” when they are running behind.

Have a good weekend — and with many restaurants offering outdoor service, we encourage you to try the iguana.

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Open (Your Wallet) Wide: Dentists Charge Extra For Infection Control

After nearly two months at home due to the COVID-19 pandemic, Erica Schoenradt was making plans in May to see her dentist for a checkup.

Then she received a notice from Swish Dental that the cost of her next visit would include a new $20 “infection control fee” that would likely not be covered by her insurer.

“I was surprised and then annoyed,” said Schoenradt, 28, of Austin, Texas. She thought it made no sense for her dentist to charge her for keeping the office clean since the practice should be doing that anyway. She canceled the appointment for now.

Swish Dental is just one of a growing number of dental practices nationwide that in the past month have begun charging patients an infection control fee between $10 and $20.

Swish and others say they need the extra money to cover the cost of masks, face shields, gowns and air purifiers to help keep their offices free of the coronavirus. The price of equipment has risen dramatically because of unprecedented demand from health workers.

Dentists say they struggle to pay these extra costs particularly after most states shut down dental offices in March and April for all but emergency care to reserve personal protective equipment for hospital use. They are also seeing fewer patients than before the pandemic because some fear going back to the dentist and at the same time dentists need to space out appointments to keep the waiting room uncrowded.

Nearly two-thirds of dental offices across the country have reopened for routine care, according to the American Dental Association.

The association, which sets industry standards, says dentists who opt to charge the extra infection control fee should disclose it to patients ahead of each visit, a spokesperson said.

“The infection control fee is helping us mitigate the costs of the extra expenses,” said Michael Scialabba, a dentist and vice president of 42 North Dental, whose 75 dental offices in New England are charging an extra $10.

Why don’t dentists just raise prices instead? Dentists said they have little or no leverage with large insurance companies to force them to raise their reimbursement rates. The ADA asked insurers to take into account additional COVID costs dentists face and many insurers responded by agreeing to pay extra fees.

For example, Harrisburg, Pennyslvania-based United Concordia Dental agreed to pay dentists $10 per patient per visit in May and June to offset their PPE expenses for all fully insured clients. The company has more than 9 million members nationwide.

The new infection control fee upsets some patients, although most understand that the cost of dentistry has increased, said Rishi Desai, director of operations and finance at Swish Dental, which has eight locations in the Austin area. “We are just as frustrated with all of these, too, but as a small business we had to reassess things.”

Erica Schoenradt, of Austin, Texas, canceled her appointment with her dentist after learning that the practice would charge a $20 fee to help defray costs of masks, gowns and other equipment needed to guard against the coronavirus. (Courtesy of Erica Schoenradt)

Desai, whose wife, Viraj, is a dentist and the founder of the dental chain, said the extra money will help the practice survive. “We are not making money off this,” he said. “This is just to sustain us so we are not bleeding out cash.”

He noted that last year Swish was paying about $6 for a box of 20 face masks. Today, $6 buys a single mask. The dental office has installed sneeze guards, staffers are wearing face shields over their masks, and the offices have added air filtration systems and hired additional sanitation staff members to clean their offices every day.

He estimates the offices are working at only about half capacity since reopening in mid-May. In weighing how to handle the extra costs, Swish was reluctant to cut employee wages, he said. “Everyone is trying to figure this out,” he added.

Kim Hartlage, office manager of Klein Dental Group in Louisville, Kentucky, said insurers recommended the office add an infection control fee. The insurers balked at raising their reimbursement rates.

She said the small office has had to buy many more disposable masks and gloves. “We’ve had to step up our game,” she said. So far, she hasn’t heard any feedback on the $10 fee. “We have very understanding clients,” she said.

Tamar Lasky, an epidemiologist, said she likes her Owings Mills, Maryland, dentist and was glad the office was communicating the many precautions it was taking to prevent the spread of COVID-19. But she was stunned when informed by email that a $15 “infection control charge” would be added to her bill.

“I can readily imagine there are a range of additional expenses, as well as a loss of revenue associated with the pandemic, but infection control is not an extra service. It is part of the practice of dentistry,” Lasky said.

“I’m not sure what is the best solution to the increased costs of tighter infection control, but this new charge may not be covered by insurance, and that passes all the burden to the patient.”

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