Citing Medicaid Limits, ED Docs Sue WA State

John Commins, for HealthLeaders Media , October 4, 2011

"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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4 comments on "Citing Medicaid Limits, ED Docs Sue WA State"

Julie Lohman (10/18/2011 at 6:46 PM)
Medicaid has allowed their clients to receive this kind of care for years - they are not introducing an approach that would ease these clients into the new culture - the patients and the hospitals are going to suffer radically for the culture that medicaid allowed -It could be interpreted that they errored and the patient and hospital will be punished.

Louise B. Andrew MD JD (10/8/2011 at 5:46 PM)
This is a blatant attempt to cut costs in order to meet a state budget, by circumventing federal "prudent layperson" law and forcing Emergency physicians to assume financial responsibility for screening indigent patients for emergencies. The state provides no other mechanism to do so. Other federal law (EMTALA) requires that it be done. So ED's are left as the safety net, which also must eat the costs. Attempting to frame this as a drug seeking or ED abuse issue is disingenuous at best and ill-informed at least. It will probably take a few out-of-hospital deaths of Medicaid patients with so called "non emergent" presenting complaints to make this issue public enough that the law will be changed legislatively, if the lawsuit is unsuccessful at toppling an unsound, fiscally motivated, and basically unconscionable piece of legislation.

Lisa Barber RN (10/5/2011 at 4:33 PM)
This program discriminates against poor and rural areas that have limited number of clinic physicians and no Urgent care clinics available. This proposal will cause patients needing care to wait until they are much sicker before seeking care and end up causing the tax payers more money. As the director of a rural emergency department, most patients we see frequently have psychiatric issues or have learning dosabilities and have difficulty understanding the difference between clinic care and emergency care. They only know they need help.




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