Citing Medicaid Limits, ED Docs Sue WA State
"In point of fact, 97% of our clients can live very comfortably with this three-visit limit," Jeffery Thompson, MD, the authority's Medicaid's CMO, said in a media release. "The small number who exceed that limit are responsible for scores of visits – and most of them are for chronic conditions and complaints of pain – visits that usually end with a narcotics script."
Anderson says the new restrictions have the potential to "punish" that same 97% of Medicaid patients for the sake of clamping down on the 3% who allegedly abuse the system. "My bigger concern from a provider standpoint is that somebody is going to sit at home with their sick kid who has already had to go in three times, and now they're at home having trouble breathing," Anderson says.
"Or somebody is going to sit home with chest pains, or they are going to sit at home with a stroke. Some of these diagnoses are absolutely against the mission statement of the American Heart Association and the American Stroke Association about seeking care promptly."
Anderson says ACEP has alternative ideas for saving money that will not drastically impact care, including:
- implementing a stricter prescription narcotics policy for EDs that could save $30 million by reducing the number of people who come to the ED for pain relievers;
- increasing the use of psychiatric generic medicines, which could save the state about $130 million a year;
- increasing the use of generics in the emergency department;
- creating hotlines staffed by RNs who would steer patients to primary care alternatives.
"We want to save the state money because we shouldn't be at the table complaining unless we have alternatives," he said.
John Commins is a senior editor with HealthLeaders Media.
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