Unnecessary trips to ER must end

Frivolous trips to the ER are driving up the costs of medical care and insurance and are a drain on state government.


Unnecessary visits to hospital emergency rooms are a major reason medical costs -- and health-insurance costs -- have soared in this country. And these frivolous and frequent ER visits have also created an enormous economic problem for the Washington state government as taxpayers have picked up the tab for low-income people who have state-subsidized health-care insurance.

Last year state lawmakers took action to curb unnecessary, irresponsible use of ERs. It cut $33 million out of the state budget in mandating tighter ER rules for Medicaid payments. Medicaid would no longer pay for more than three ER visits in a year for a patient's nonemergency conditions

But this rule was challenged in court by doctors and hospitals. The court blocked implementation of the mandate on procedural grounds.

This expensive problem, however, has not vanished. The state Health Care Authority has adopted a new rule, set to go into effect on April 1, that reduces the number of conditions not covered at ERs but offers no three-visit grace. Medicaid will not pay for even one unnecessary ER visit.

But this rule does not leave the patient on the hook for the unnecessary visit, that responsibility will fall to the hospitals.

The hospitals and doctors didn't do themselves any favors in filing suit. Nor did they help taxpayers.

The new rule -- which will certainly be challenged in court -- will not necessarily discourage the practice of running to the ER for minor medical problems. There is almost no incentive for the ER abusers to stop.

In the end, this approach might well be put on hold. Still, something needs to be done -- and done quickly.

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.

A doctor's office visit can also be inconvenient for those with private health-care insurance but those insurance carriers impose such high co-pays and deductibles -- pushing the total out-of-pocket cost to well over $1,000 -- that they find the time to make a doctor's appointment or go to a walk-in clinic.

Now, to be fair, the problem of ER abuse is caused by a very small number of individuals. Just 3 percent of Medicaid patients seek ER care more than three times a year.

Nevertheless, more than 46,000 times in 2010, ERs in Washington state treated Medicaid patients on at least their fourth trip to the ER for nonemergencies. One person visited 125 times.

Unnecessary, frequent and expensive visits to hospital emergency rooms are an affront to taxpayers and a drain on the state budget.

If the latest effort of the state to crackdown is overturned, state officials must offer another plan. This problem must be fixed.


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