Money woes shut down mobile dental clinic

Posted Aug. 02, 2008, at 12 a.m.

The big, bright blue Miles for Smiles mobile dental clinic for children is up for sale, its last young patients seen on Thursday in Presque Isle.

The public health dentistry program is a victim of hard economic times, high gas prices and low MaineCare reimbursements.

A public health official said Friday that the clinic’ s loss would make it harder for low-income children in rural areas to get the dental care they need.

Since it first rolled into Bangor in the fall of 2003, the specially equipped recreational vehicle has provided routine cleanings, simple fillings and other basic dental services to thousands of low-income children throughout the northern half of Maine.

A joint project of the private, for-profit Anthem Blue Cross and Blue Shield of Maine insurance company and the federally funded Penobscot Community Health Center in Bangor, the mobile clinic has served rural communities in Penobscot, Piscataquis, Somerset and Aroostook counties, where dentists are scarce — and dentists willing to work for MaineCare wages are even scarcer.

All of the roughly 3,500 children served by Miles for Smiles have been enrolled in MaineCare, which pays only about 50 percent of what private insurance pays and doesn’ t cover some common procedures at all.

David Drohan, dental director for the Penobscot Community Health Center clinic on Union Street, said Friday that the loss of the Miles for Smiles clinic is a “great tragedy.”

“We just couldn’ t sustain the losses any more,” he said.

For one thing, the cost of fueling the diesel-guzzling RV has become unmanageable, he said. And while MaineCare, Maine’ s Medicaid program for low-income residents, pays more to PCHC than it does to private dental practices because of its administrative structure and low-income patient base, Drohan said it still isn’ t enough to offset the high cost of providing such far-flung services.

Another critical factor in the demise of Miles for Smiles is the overall shortage of dentists in Maine. The mobile unit has been staffed with dentists and hygienists drawn from the Union Street clinic. That has left the clinic critically short-staffed at a time when PCHC is already scrambling to replace four of its nine dentists, Drohan said.

“Dentists today have lots of options in front of them,” he said, and living in the middle of Maine, serving a low-income population and earning comparatively low public health wages isn’ t for everyone. Some of the clinic’ s former dentists have recently moved to warmer climates to be nearer their families, Drohan said, while others have joined private dental practices in more prosperous areas where they can be assured of a higher income.

“For a public health dental clinic to be competitive with the private sector is almost impossible,” he said.

Judith Feinstein, director of the Maine Oral Health program, said Friday that losing Miles for Smiles “creates a gap in an already fragile infrastructure for public health.” Especially in Aroostook County, she said, there are few dentists willing to accept MaineCare patients because it costs more to provide the services than the program pays.

Feinstein said there is a relatively new public dental clinic in Fort Kent that will take MaineCare, but other than that, low-income families will likely have a hard time obtaining dental care for their children.

Miles for Smiles was funded with a five-year, $1.4 million grant from Anthem Blue Cross and Blue Shield with the agreement that Penobscot Community Health Center would develop other funding sources over time. Those sources have proven elusive, according to the Rev. Robert Carlson, president of the PCHC board.

“We did our best to try and raise donated funds & but the reality is [donors] don’ t pay for operational costs,” he said. It cost $700,000 to $750,000 a year to keep Miles for Smiles on the road, Carleson said, and each year the program has ended up at least $100,000 in the red.

At Anthem Blue Cross and Blue Shield, spokesman Mark Ishkanian said the company was disappointed that the project has been scrapped. “We’ re sorry that PCHC has made the decision to take the van off the road, but proud of having been part of it over the past five years,” he said.

Any children seen in the Miles for Smiles program can now receive dental services at the Union Street clinic in Bangor. In addition, Drohan said, a dental clinic will be established by the end of this year at PCHC’ s Helen Hunt Health Center in Old Town.

In its five years of existence, Miles for Smiles provided dental care to about 3,500 children throughout the northern Maine service area.

Earlier this month, letters were sent to the families of more than 1,000 current patients informing them that the program would be ending.

mhaskell@bangordailynews.net

990-8291

Miles for Smiles bites the dust

“We just couldn’ t sustain the losses any more.”

David Drohan, dental director, Penobscot Community Health Center clinic

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