Washington State ER Medicaid Trap

The 2/7/2012 Seattle Times reports, "State Medicaid to quit paying for ER visits deemed unnecessary".

From the article:

Medicaid officials say the program will no longer pay for any medically unnecessary emergency-room visits, even when patients or parents have reason to believe they're having an emergency...

They would apply to all adults and children on Medicaid, with no exceptions, such as someone being brought in by ambulance or from a nursing home, or when patients have neurological symptoms or unstable vital signs...

Under federal law, patients that show up at the ER cannot be turned away, at least not until the treating physician determines they are not having a medical emergency. But for many conditions (which includes neurological impairment or unstable vital signs), it can be unclear whether or not there is a true emergency until after a fair amount of skilled testing and evaluation.

As the article notes:

For Medicaid patients, Schlicher said, the plan suggests that even before heading to the ER, they should know what their ultimate diagnosis will be.

"If we don't know without an X-ray or CT scan, how can they know it?"

For doctors, the plan could place them in legal jeopardy, Schlicher said.

If they turn patients away, "it's not good care and it doesn't meet the legal standard," he said. "I can't tell any provider to commit medical malpractice, no matter how much the state wants us to do that."

So in essence, the state will compel ERs and doctors to render medical services to these patients, then penalize them economically if the government deems that the condition wasn't a real emergency.

Note the trap: The government tells doctors, "We don't want to tell you how to practice medicine. But we have to control what gets paid for, for the good of 'society'." Doctors no longer have genuine freedom to practice medicine as they see fit, and patients suffer as a result.

(Read the full text of "State Medicaid to quit paying for ER visits deemed unnecessary".)

Right now, this affects only Washington state. But don't be surprised if we start seeing similar proposals in the rest of the country.

(Seattle Times link via a reader.)