Effort to curb Medicaid ER abuse is prudent

A few people are making multiple trips to ERs for nonemergencies. It's costing taxpayers millions and it must stop.

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Unnecessary, frequent and expensive visits to hospital emergency rooms have been a drain on the state budget.

As a result, state lawmakers took action to save $72 million in Medicaid spending by limiting the number of nonemergency visits that folks with taxpayer-subsidized coverage could make to hospital emergency rooms.

We see this approach as prudent in theory, although we believe the list of 700 diagnoses that would not be covered must be monitored and reviewed. The bottom line is that unnecessary use of emergency rooms is an abuse of the health-care system.

Starting Saturday, Medicaid won't pay for more than three ER visits in a year for a patient's nonemergency conditions.

This approach has already come under fire by many, including hospitals and doctors' groups. Some don't want to see hospitals on the hook for unpaid bills. Others don't want to see anybody facing a serious health issue go untreated. Neither do we.

"Do (patients) know the difference necessarily between heartburn, heart attack, a blood clot in my lungs and a sore rib?" asked Dr. Stephen Anderson, president of the American College of Emergency Physicians' state chapter who works in Auburn. "These people shouldn't be sitting at home trying to self-diagnose. My worry is, the message we're going to be sending is the wrong message, which is, you should not be coming to the emergency department; you should be staying away."

His worry would have merit if the state wouldn't pay for even one nonemergency visit to the ER. But these new rules pay for up to three visits. Three trips to the ER in one year is a lot.

Many people are using ERs as their primary care facility because hospitals, by law, cannot deny service so they view this as "free" health care. Others simply find it more convenient than waiting at a doctor's office or a walk-in clinic.

Those with Medicaid aren't the only people who find it a challenge to get to a doctor's office or clinic because of work or other constraints. Yet, those whose insurance carrier forces them to pay a much higher co-pay for ER visits than office visits seem to find a way to get to the doctor's office or clinic more often than not.

It's important to note that a very small number of individuals are responsible for this huge problem. Just 3 percent of Medicaid patients seek ER care more than three times a year.

Yet, more than 46,000 times in fiscal year 2010, ERs in Washington state treated one of the 700 conditions listed as nonemergencies for Medicaid patients who already had come in to the ER for the fourth time or more. One person visited 125 times, state officials said.

"What we're talking about here is people that go to the emergency room 10, 20, 30 times," said Dr. Jeff Thompson, the state Medicaid program's chief medical officer.

Enough is enough. The state is right to attempt to crack down on this waste of tax dollars.

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