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Washington can’t afford blank checks for ER visits

Post by TNT Editorial Board / The News Tribune on Sep. 26, 2011 at 7:38 pm |
September 26, 2011 4:41 pm

This editorial will appear in tomorrow’s print edition.

Welcome, Medicaid patients, to the new world of parsimonious medicine.

At the behest of the Legislature, the state Health Care Authority – in the face of protests from emergency room doctors – is rolling out new restrictions on Medicaid payments for ER use. The docs say the rules threaten patients with real medical emergencies; the state says the rules merely target excessive use of some of the most expensive care on Earth.

The state has the better part of this argument. It is moving in the right direction – aggressive cost control – so long as it remains willing to adjust the regulations as needed if problems arise.

The big picture here is the human impact of any kind of unnecessary medical care. If one Medicaid patient with a $100 medical problem winds up creating a $1,000 emergency room bill, that’s $900 that might have been spent on care for nine other patients.

The Health Care Authority estimates that more than $50 million could be saved by shifting routine ailments away from emergency rooms. That money could be spent instead on broader medical coverage, child protective services, mental health counseling, etc. Unnecessary state services – including excessive ER use – rob necessary services that protect the vulnerable.

Getting down to particulars, ER physicians are alarmed that the state is reclassifying some dire-sounding diagnoses – such as chest pain – from emergency to non-emergency conditions.

The concern is legitimate. Any Medicaid client who shows up at a hospital with a serious cardiac problem – or signs of another life-threatening illness – should certainly be treated as an emergency patient. The hospital and his or her doctors should be reimbursed accordingly.

But Jeffery Thompson, the Health Care Authority’s chief medical officer, says flatly, “All emergencies will be covered.” The new regulations, he said, target the small percentage of Medicaid clients who use emergency rooms for routine ailments or even fictional problems.

Let’s say a client shows up with chest pain, and the ER staff finds no cardiac problem. He shows up twice more – with the same results. After the third time in a given year, Medicaid will stop paying.

In some such cases, clients should have been getting care from ordinary clinics. In others, they should have been referred to mental health treatment. In a small percentage of cases, they’re simply seeking narcotics. Rarely do they need yet another – and another, and another – full emergency work-up for the same symptoms.

Yes, any restriction on reimbursement creates the possibility that someone won’t get needed treatment. Thompson says the Health Care Authority will be paying close attention to how patients fare under the restrictions. We trust the state’s emergency physicians to scream bloody murder if the plan goes awry.

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