Inside Opinion

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Tag: emergency room


Washington can’t afford blank checks for ER visits

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.
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A 21st-century ER at MultiCare

This editorial will appear in tomorrow’s print edition.

American health care is the most expensive in the world. That’s not entirely a bad thing: We sometimes get a whole lot for the money.

MultiCare’s new $72 million emergency department, which opens today, is a good example. At 73,500 square feet, it is 10 times larger than the department it replaces and will transform the way patients are treated when rushed to Tacoma General and Mary Bridge hospitals.

The old department was created in 1992 – not so long ago, in the scheme of things – but a surge in patients and multiple revolutions in urgent care had left it looking downright primitive. And crowded: Designed for 32,000 visits a year, it reached 74,000 last year. Exam rooms were too few and too small. Non-urgent patients often had long waits in the cramped waiting room before they got seen; once through the doors, they and their doctors often wound up in the hallway.

The staff of 50 had only a single restroom, shared by male and female alike. Their lounge had been taken away, turned into a patient room. When blood spurted and hearts faltered, equipment and supplies had to be rushed from one room to another. It wasn’t exactly a sweatshop, but harried doctors and nurses couldn’t be blamed for wanting something better.
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