It looks a little messy at the moment in the State of Washington where the state legislature directed a ban on Medicaid patients using emergency rooms for non-emergent care, which is off course an expensive delivery site. Like the austerity protests in Greece, the Washington Chapter of the American College of Emergency Physicians has mounted the battlements and filed suit to interdict the legislative decree. See Washington Chapter of the American College of Emergency Physicians v. Washington Health Care Authority, Wash. Super. Ct.,No. 11-2-0219, filed 9/3011.
The state Health Care Authority (“HCA”) which is implementing the policy has listed a number of billing codes that it considers to be potentially non-emergent. A Medicaid recipient who is deemed to have appeared for non-emergent care on three occasions strikes out and must be billed for the fourth. The ER docs assert that imposing a self limiting obligation on Medicaid patients is a “dangerous precedent,” which could easily lead to substantial patient harm as a result of “self diagnosis.”
The HCA responds that just because a condition appears on one of the “non-emergent” code lists doesn’t mean that there is an automatic “strike.” The ER must make a case by case determination of whether a particular case is emergent or not and document it accordingly. The Docs charge that some of the codes listed are emergent in every case, which the HCA disputes. While patient safety is a concern here there also appears to be a bottom line money issue. Reducing access for non-emergent care will lower the revenues generated by the ER. Hopefully Washington has enough “urgent care” centers to pick up the diversion of routine non-emergent care patients paid for by the public weal.