Chase Brexton Partnership to Provide Dental Care for ED Patients

Published in Dome - Dome May/June 2019

Thanks to a new agreement between The Johns Hopkins Hospital and Chase Brexton Health Care, patients presenting with dental issues in the emergency department (ED) will be able to receive dental care outside the hospital, often within 24 hours.

ED patients who live near the hospital and whose chief complaint is a dental-related issue will be offered an appointment the same day or the next business day at Baltimore-based Chase Brexton, a federally qualified health center with 10 dental suites at its Mount Vernon center.

Chase Brexton, which has three full-time dentists, three full-time dental residents and two hygienists, will promote its other medical services to patients during their dental appointments.

“Chase Brexton has primary care, substance use treatment, mental health treatment and more,” says Nicki McCann, chief of staff at The Johns Hopkins Hospital. “So it’s not just an opportunity to establish a dental home for the patients, but to get people connected to community-based care.”

The ED sees about three patients each day — 1,087 in fiscal year 2017 and 963 in fiscal year 2018 — with non-life-threatening dental concerns who often don’t have access to dental care or insurance coverage. Seeking non-life-threatening dental care in the ED is an inappropriate use of emergency resources with long wait times and significant costs.

Lack of access to dental care consistently appears among the top five health needs in the hospital’s community health needs assessment, a report required of hospitals covered under the Affordable Care Act.

The Johns Hopkins Hospital and Chase Brexton collaboration, made possible through a $300,000 grant to Chase Brexton from the Maryland Community Health Resources Commission and an additional $45,000 from The Johns Hopkins Hospital, kicked off May 1 and is funded through April 2021. The hospital will provide transportation services for patients.

“This collaboration primarily helps a patient with an acute dental need get to the appropriate facility so they can receive definitive care instead of palliative care that they might be getting in the emergency department,” says Brooks Woodward, dental director at Chase Brexton. (Palliative care includes treating symptoms rather than the underlying issue.) “We’re hoping that over time, patients will be educated about their options so that they don’t continue to return to the emergency department for dental issues.”

The grant funding supports setting up the program, as well as employee and administrative costs.

The collaboration will also allow Chase Brexton to gather information about barriers that made it necessary for patients to seek dental care in the emergency room.

Low-income Maryland residents typically do not have access to comprehensive dental coverage through Medicare or Medicaid.

In addition to oral health services and treatment plans, Chase Brexton aims to establish an ongoing dental home for patients; provide medical and psychosocial support services; and provide patients with eligibility assessment and enrollment services for Medicaid, qualified health plans and Chase Brexton’s sliding discount fee schedule. Chase Brexton provides these services — as well as financial assistance for medications, care coordination and outreach for missed appointments — for all patients, not just those coming from the ED.

“The hope is that patients begin to understand how to utilize our services best, that they establish a dental home, and the establishment of that dental home evolves into establishing a medical home,” says Crystalle Bortnick, senior project administrator for the The Johns Hopkins Health System Corporation who spearheaded the arrangement with Chase Brexton. “So, patients will be receiving the necessary care, treatment, prescription drugs and health maintenance regimen.”

The collaborative arrangement will be considered successful if patients establish a relationship with a community-based provider for dental and medical care, resulting in decreased reliance on hospital emergency departments for routine care. It is hoped that this connection to community-based care will continue and be expanded in the future.