Senate Special Committee on Aging Issues Testimony From Scranton Primary Health Care Center CEO

WASHINGTON, Aug. 30 -- The Senate Special Committee on Aging issued the following testimony by Joseph H. Hollander, chief executive officer of the Scranton Primary Health Care Center, at a hearing entitled "Eyes, Ears and Teeth: Expanding Medicare to Cover Whole Person Care":

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Chairman Casey, thank you for the opportunity to testify this morning on the need to expand Dental Coverage for Seniors.

My name is Joseph Hollander, I am proud to say for the last 7 - 1/2 years I have been the Chief Executive Officer of Lackawanna County's only Federally Qualified Health Center, Scranton Primary Health Care Center. We have three offices located in Lackawanna County, and have been providing care to the community for over forty-two (42) years.

Scranton Primary Health Care provides care to everyone regardless of their ability to pay. We offer pediatrics, family medicine, internal medicine, women's health, gynecology, perinatal care, (we had 253 deliveries last year), infectious disease care, behavioral health care and general dentistry which includes diagnosis, treatment and management of your overall oral health care needs including preventive education, dental hygiene and cleanings, sealants, fluoride varnish, gum care, fillings, root canals, extractions, crowns, bridges, partials, full dentures, and mouth guards.

All of our providers are board certified and employees of the health center. We also assist members of the community in navigating and making application to the insurance marketplace. Our patient base ranges from newborns to a senior who still lives alone and will be celebrating her 104th birthday in November.

I think it is important to understand our patient demographics, 61% of Scranton Primary Health Care's patients are at or below 200% of the Federal Poverty Level. When we combine all of our services, 14% of our patients are uninsured, I am certain when it comes to Dental that number is at least 20%. 60% of our patients are covered by Medicaid, 9% by Medicare, 2% CHIP and the balance have private insurance.

We take our mission very seriously and as a result of that, never closed at any time during the pandemic. We literally spent hundreds of thousands of dollars installing HEPA filtration systems and UV-C filtration systems in an attempt to keep our staff and patients safe. We also purchased special equipment to control aerosol generation during dental procedures in an effort to keep our dental clinic open and operating throughout the pandemic, fully understanding the emergency departments in the area were overwhelmed and not in a position to see dental emergencies.

I cannot stress to you how important the link is between good oral health and good physical health. Common sense tells us if your diet is severely limited because you are unable to chew your food and eat a healthy diet, you can't get the nutrients and nourishment you need. For some reason this is stressed to us, over and over when we are young, but ignored when it comes time to care for our Seniors.

We have always been taught, "do what ever is necessary to preserve your teeth, extractions should be a last resort". Most individuals by the time they qualify for Medicare have had many of their teeth restored, some teeth multiple times, leaving two choices: the expensive option of root canals and / or crowns, or the less costly and more common option of extractions. As you can imagine, extractions cause their diet and nutrition to suffer. This can also affect their speech as well as their appearance, which can affect their mental health and cause anxiety and depression. Every one of these factors affects their physical health and well-being, drives up the cost of medical care.

In a recent report by the Kaiser Family Foundation/1, it was disclosed that 47% of Medicare beneficiaries do not purchase dental coverage. In 2018, that same percentage, 47%, did not have a dental visit during the past year, with minorities and those with low incomes at a much higher rate. One in five Medicare beneficiaries who did visit a dentist, spent in excess of $1,000.00 for out of pocket dental care.

A great many Seniors do not understand that standard Medicare does not include dental care until it is too late. We believe rather than trying to educate seniors, dental care should be included to help them preserve their health and their dignity.

The percentage of Emergency Department visits as a result of dental issues has been rising every year. The latest studies estimate that in excess of two (2) billion dollars annually is spent on dental emergency room visits. The average visit results in a prescription for antibiotics, pain medication or both. We have been unable to find studies linking the prescribing of pain meds to subsequent opioid abuse, but are certain there is a link. This leads me to believe, one way or another, we are all paying for dental care, why not make it preventive dentistry instead of reactive dentistry beginning with a very expensive ER visit. To further complicate matters, many dental offices don't take Medicare Advantage plans because the reimbursements are so low. There is one large provider in the area, you would be shocked if I named them, who will see Medicare Advantage

patients, but are currently scheduling them thirteen, yes 13 months from now for oral surgery. Yet patients with private insurance can make an appointment and be seen in less than three (3) weeks. I would suggest our Seniors deserve better than this.

When I began at Scranton Primary Health Care approximately 7-1/2 years ago, I told our employees, while I did not have a medical or dental degree, I knew in my mind what constitutes good medical / dental care, and that was to treat all patients with dignity and respect. Understanding the patient base we primarily serve, I made it a point to stress that this applied to all regardless of their means or status in the community. Whether it be a homeless individual living on the street to people with insurance or the ability to pay cash, everyone receives the same care and are treated the same way. In reflecting on this vision of how I wanted Scranton Primary to operate, our management team decided we needed to practice what we preached. How could we work hard to promote our dental clinic and good oral health if we weren't going to offer this option to all patients.

We know we are one of the few FQHC's in the state that offers comprehensive dental services like root canals, crowns, partials, bridges and dentures for all, regardless of their ability to pay. We have patients who drive from over three hours away to obtain care, because they are unable to find anyone closer. We take our mission very seriously and work hard to take care of our patients - we strongly believe they deserve to be treated with dignity and compassion.

In closing, please indulge me and allow me to read a copy of a note we received from a gentleman who received care from our Dental Clinic. In an effort to protect the individual's privacy, I will call him George. George wrote; I am a 66 year old veteran of the US Navy and have been a patient of the Ed Dulworth Dental Center for the past several months. I have been dealing with dental problems almost my entire life, which finally culminated in the loss of most of my teeth, which made it almost impossible to chew most foods. Since my dental problems were not 100% service related, the Navy would not cover the cost of treatment. I searched far and wide for help when I came across SPHCC. They were a

Godsend!! Dr. Dellaglio started my treatment and now I am so excited, I am just a few weeks away from getting my dentures and being able to eat again! The greatest thing about the Dental Clinic was they worked hard to set up a payment plan I could afford and didn't make me pay in advance. After they learned more about my personal financial situation, they actually forgave my remaining debt and thanked ME for my service to our Country!! I have NEVER been so touched in my life! THANK YOU, THANK YOU, THANK YOU, THANK YOU! I CAN NOT RECOMMEND THESE GUYS ENOUGH! With today's news being filled with man's inhumanity to man, it's nice to know there are still people who care!

George - U.S.N., 1970-74

Thank you for your time this morning.

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Footnote:

1 Medicare and Dental Coverage: A Closer Look: Meredith Freed, Nancy Ochieng, Nolan Sroczynski, Anthony Damico, & Krutika Amin. Published: July 28, 2021Kaiser Family Foundation