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ACEP Fights State Medicaid Cuts in WA

 |  By cclark@healthleadersmedia.com  
   October 17, 2011

The state of Washington's new policy of re-classifying 700 potentially life-threatening patient conditions as non-emergent, for which it will not pay, will have "potentially devastating consequences" for patients, families, and for the long-term health of the Medicaid system, the state chapter of the American College of Emergency Physicians said in a statement Sunday.

The chapter has filed a request for a temporary injunction with Superior Court in Thurston County and has an alternative plan to achieve the $72 million in annual savings that the state's new policy aims for.

According toWA- ACEP, the impacts of the new state policy include:

Sicker Patients, More Admissions


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Patients who have exceeded their three visit limit that need emergent care (e.g. asthma exacerbations) will wait for care in a broken system that will now not guarantee them access. Their emergency department visits that would have been 'unnecessary' now will be inpatient 'necessary' admissions for exponentially higher costs.

Costly Litigation

Expensive litigation against the state for implementing a plan that is on its face in violation of federal and state law will occur if we fail to create a better solution. The prudent layperson standard in the state and now federal law under (Patient Protection and Affordable Care Act) prohibits this type of retrospective denial.

Costly Implementation

To establish a program to review, deny, and deal with appeals of denials is an additional administrative cost that provides no patient benefit or actual medical care. A program that is sustainable and improves quality of care as proposed by WA-ACEP is the right answer.

Harm to the working poor

Shifting the burden of emergency care from the state health plan to the working poor that already suffer from problems of lack of access, challenges with employers and excused absences, and limited finances is unjust. We can do better for the citizens of Washington."

As the WA-ACEP awaits a ruling on its request for the injunction, the chapter on Sunday proposed several alternatives that it believes will reduce the cost of care and reduce "perceived overutilization" and inappropriate use of the ED without imposing arbitrary caps of three patient visits for Medicaid patients.

Among the premises behind the group's proposal is that much of the avoidable use of the ED is because of the lack of patients' access to primary care providers and because of the patients' own substance abuse issues.

The problems can substantially abated with improvements in access, quality and case management, the group says. It has proposed the following measures:

Access:
  • Timely (24-48 hour) follow-up care by the primary care provider
  • Develop a working group for treatment of dental disorders in a cost effective setting
  • Discontinue coverage of "cabulance" services for non-emergent conditions
Quality
  • Implement a single state-wide, real time data feeds to track emergency department visits
  • Impose a statewide prescription monitoring program
  • Support generic drug use for certain patients
  • Support enhancing the locked-in program
  • Adopt opioid prescribing guidelines for emergency physicians to reduce prescription drug abuse
Case Management
  • Notify patients after each unnecessary ED visit
  • Notify primary care providers after each visit to the emergency department
  • Ensure each high utilize patient has a primary care provider
  • Enhance the care plan utilization with ED tracking system

The group said that its solutions can achieve the same $72 million in annual savings that the Medicaid program hoped to achieve with the monthly visit caps and elimination of 700 symptoms it deems non-emergent, estimated as follows:

  • $28 million from reducing abusive ED visits for narcotic seeking behavior, achieved through integrated statewide case management and a visit tracking program.
  • $12 million for use of next day or same-day visits in a primary care setting and patient notification of non-urgent visits and implementation of medical screening exams, which would reduce unnecessary visits to the ED by 50%.
  • $20 million from the removal of brand name narcotic pain medications and psychiatric medications from the state's preferred provider list or Medicaid.
  • $12 million: Additional savings will be realized by removal of "cabulance" services for truly non-emergent conditions, improved access to care, and visit tracking programs to reduce ED shopping.

"The alternative plan proposed by Washington ACEP is based in reasonable savings that improves the quality of care and does not shift the cost of care to the poor inappropriately," the group said in its statement.

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