The state’s goal, of course, is to convince Medicaid patients to make fewer trips to the emergency room by defining what constitutes an emergency. A list of more than 700 diagnoses put into that category has drawn fire from hospitals and doctors’ groups over inclusions whose symptoms seem awfully similar to emergencies:
• Shortness of breath and some types of asthma attacks.
• Kidney stones.
• Hypoglycemic coma.
• Nonspecific chest pain or abdominal pain.
• Nonspecific congestive heart failure.
“Do (patients) know the difference necessarily between heartburn, heart attack, a blood clot in my lungs and a sore rib?” asked Dr. Stephen Anderson, president of the American College of Emergency Physicians’ state chapter. “These people shouldn’t be sitting at home trying to self-diagnose.
“My worry is, the message we’re going to be sending is the wrong message, which is, you should not be coming to the emergency department; you should be staying away,” said the Auburn Regional Medical Center doctor.
Doctors have sued to stop the move.
If this latest quest by the state isn’t an indictment of this nation’s health care delivery system, we don’t know what is. It’s also a signal of just how desperate state budget writers are as they search for ways to cut spending without increasing taxes. The state Health Care Authority is trying to save an estimated $72 million in federal and state Medicaid spending by limiting Medicaid patients to three non-emergency visits in a calendar year.
But we have to ask: At what cost to the health and lives of low-income people who rely on Medicaid?
Doctor and hospital groups who are pressuring the state to change course say refusing to pay for non-emergencies opens the state to costly lawsuits. Yes, wrongful death lawsuits.
We understand the problem — 46,000 emergency room visits by Medicaid patients in 2010 were nonemergencies. One patient visited an emergency room 125 times.
But that’s abuse and should be dealt with separately. We have to ask whether the new system is the answer when just 3 percent of Medicaid ER patients seek emergency care more than three times a year? Are all being punished for the misuse of a few?
The state Medicaid office gave clients a month warning about the shift in policy. In a Sept. 1 letter to Medicaid patients, officials with the state Health Care Authority wrote, “As of October 1, 2011, Medicaid will only pay for three non-emergency visits to the emergency room visits per client per year.” The letter went on to say, “When you have your third non-emergency visit to an emergency room, Medicaid will notify you by letter that you reached your limit. After the third non-emergent visit, you may be responsible for payment for future non-emergent visits to the emergency room.”
That’s the big scare. Go to the emergency room after your three non-emergency visits and you “may” have to pay the exorbitant hospital costs out of your own pocket.
But reality is something quite different.
Hospitals, of course, cannot turn any patient away. Any patient who walks through the emergency room door will be treated.
The government is essentially shifting the cost of providing care to frequent users of emergency rooms to hospitals. That will drive up the cost of care and shift the burden to people who have insurance who will pay higher premiums.
Medicaid officials want patients to get their routine care from primary care physicians. The problem, of course, is that primary care physicians are taking fewer Medicaid patients because of low reimbursement rates.
Some doctors worry that insurance companies will follow the state’s lead.
That’s our concern, as well.
Are we getting to the point where that all important medical insurance card in your wallet or purse is only good some of the time? If that’s the case, then this nation’s health care system is seriously broken.
