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February 13, 2012 at 6:00 PM

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Medicaid cuts for emergency services

There are some important points to consider

Carol Ostrom’s article on state Medicaid cuts for emergency services contains some very pointed barbs at emergency-room doctors and emergency rooms in general [“State to sharply limit payment for ER visits,” NWWednesday, Feb. 8].

As a career emergency department physician, I take great umbrage at Medicaid chief Jeffrey Thompson’s quote, “The ER physicians and hospitals have been abusing their privileges as providers of ER services for years, having the state pay for non-medically necessary ER services.”

Thompson ignores the blatant fact that emergency rooms and their physicians have been providing the only safety net available to the poor and low-income citizens who have no other access to health care.

We have done so willingly and at great financial loss. To turn around and blame us for the failings of our very broken health-care system is unconscionable. We did not create this situation, but we are dealing with it in the only humane way possible.

Thompson’s definition of “non-medically necessary” differs radically from the federally mandated definition. He would have you believe the pretzel logic that after we do an adequate evaluation to rule out a true life threat, and (happily) come up with a benign diagnosis, then what we did was of course “unnecessary.” An example is that all cerebral aneurysms have headaches as symptoms and “headache” is on the list of “non-necessary” medical diagnoses.

Thompson, you owe the emergency-medicine community an apology.

— Tony Haftel, vice president and quality and associate chief medical officer, Franciscan Health System, Gig Harbor

We have systems in place already

This past week, the Healthcare Authority (HCA) announced that there is going to be a list of diagnoses that will not be paid for from the state. This is quite troubling having a group of nonpracticing, nonemergency physicians dictate the definition of something that they can’t and don’t want to take care of.

Working in an urban hospital emergency room, I deal with all the problems no one else wants to, whether it medical or social. We address the abusers and have put systems in place to fix the current culture of using the emergency department. We have discovered how to save the system money, but the HCA doesn’t want to listen. They are the experts, right?

No, they don’t practice medicine and haven’t spent eight hours in an ER in the last 10 years. This is a group that is so non-innovative that have been tasked with trying to come up with funds from public programs.

— Hamad Husainy, Gig Harbor

Address the actual issues the system faces and don’t put patients at risk

The chief medical officer for Washington’s Medicaid program identifies “ 4,000 frequent ER users — primarily patients seeking narcotics” as the “ones who use ERs far too much, running up total bills of about $7 million” annually. If that is the case, then why is the plan to penalize all Medicaid patients?

Too often these frequent ER users come to emergency departments because they have no primary-care provider or effective case management. Frankly, they have no other place to go.

In addition, these “patients seeking narcotics” often have mental illness or chronic-pain issues that need coordinated care outside the emergency department.

In an effort to decrease these visits, the Washington state Department of Health, emergency physicians, emergency nurses, Washington state Medical Association and the Washington state Hospital Association have developed opiate prescribing guidelines which limit the amount of narcotics prescribed to these patients from emergency doctors.

Instead of putting all Medicaid patients at risk through draconian budget cuts, it makes more sense to address the actual issues the system faces. It would save money without putting tens of thousands of patients at risk.

— Roger Casey, president, Washington State Council of the Emergency Nurses Association

Let’s start by changing the list of conditions

As a health-care employee of over 25 years, I can agree with both sides of the issue to a point. Clearly an ear infection, a diaper rash and acne are not life-threatening events worthy of a visit to an ER. Consequently Medicaid wants to block emergency-room payments for 500 conditions as opposed to 200 conditions offered as a counter proposal by emergency physicians and hospitals.

How about a compromise? Let’s start with the 200 conditions recommended and agreed to by both sides, and then re-evaluate the process after a period of time. That Medicaid’s chief medical officer, Jeff Thompson, needs to shrink the budget by $21 million over 15 months (beginning April 1) is not justification to inflate the list of conditions by 300 in order to reach that mark.

Though I haven’t seen either side’s list of conditions, the disparity between the numbers is significant. I would suggest a more conservative approach in implementing such a change, because in the end, we’re talking about people’s lives, and just one death resulting from Medicaid’s new mandate would be one too many.

— Barbara Gust, Lynnwood


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