Faced with rising Medicaid costs, most states are trying to
come up with ways to save money. About a dozen states have proposed plans that
would refuse to pay emergency room costs for patients whose problems could have
been solved with a doctor office visit.
Proponents are basing their proposal on a widely held belief
that people without private health insurance use public emergency rooms for
minor or routine complaints. The supporters believe that this policy would
encourage those individuals to get, and be treated by a primary care doctor
where the care may be better and the price tag is cheaper.
The obvious
problem that arises, however, is in figuring out how patients will know what is
an emergency verses what can be treated with an office visit. As an NPR Shots article
points out, people come to the ER with symptoms, not diagnoses. Opponents say
that enacting a policy like this can discourage people from using the emergency
room in cases where they should be there. Chest pains, for example, can be a
heart attack or indigestion, but patients need to be in the ER if it is the
former.
Under
the Affordable Care Act, Medicare and private insurers are required to pay for
emergency room visits that a “prudent layperson” would consider necessary; like
the chest pains visit that turns out to be indigestion. Medicaid recipients,
however, are not afforded the same protection.
One
study cited in the article looked at the discharge records for 35,000 people
that visited the emergency room in 2009. When researcher separated out the
people that had primary care treatable problems, they were found to only make
up six percent of all the records in their study. Additionally, the six percent
of primary care treatable patients presented with the same symptoms as 89
percent of people that went to an ER.
Washington
passed a plan to cut ER payments that was later overturned by the governor.
Without state Medicaid programs paying, the cost for these ER visits would be
passed on to the hospitals.
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