Saturday, March 22, 2014

no emergency no service

Here's an interesting development: In Washington the state refuses to pay for visits that are not emergencies for medicaid patients. They have a list of conditions that they don't consider emergencies and neither the hospital or DOCTOR will get paid if they treat these conditions.

There has been a 10% decrease in visits, saving $34 million dollars in a year. They track frequent flyers who hospital shop.  They use the state prescription tracking program to track narcotic prescriptions and have reduced the prescribing of narcotics by 24%.

Will this go nationwide? Hopefully. You might think that this program discriminates against patients on medicaid.  The thing is, if you work in an ER these days you know that the people using the ER as a clinic are those on medicaid. Sure there are a few people with insurance who do it too but the vast majority are those on medicaid.

As I have said before, todays ER patients fall into 3 categories:

1) people who use it as a clinic
2) the chronically ill
3) those who have an actually emergency: trauma, cardiac events, other critical events

"Regular" people with insurance are not going to ERs for routine illness or minor things. They are either going to their doctors, urgent care or just not coming at all. As far as them still being able to go to ERs for nonemergencies, that will probably stop also in the future.  Insurance companies will probably start doing this too.

What I find interesting about this is, once again, government is having to intervene and change things because the health care system refusing to change on its own.


Unknown said...

Interesting info about Washington! They sound like the smartest state in the union. Why should taxpayers ie you and me have to sponsor these visits? I'm fed up with it. Yesterday EMS brought in a patient and told the registrar "make sure you don't have this patient's out of state address on file because then Medicaid won't pay for her visit" then he turns to me and says "I don't know why I'm helping protect this fraud" I said "you shouldn't be! Put her out of state address down and let HER get the bill why should I be footing this bill??" (Of course it was a totally non-emergent visit that goes without saying) in trying to be "nice" we as a society have become a bunch of fools.

Anonymous said...

I have Medicaid AND a PCP. I go to the ER when I can't get a hold of my regular doctor-at night or on the weekends. Otherwise I pay the $2 and see my regular PCP during business hours if I am sick.

People in the medical field are prejudiced against people with Medicaid and lump everyone together who has it. Not everyone who does abuses the system.