Washington say suspends Medicaid emergency department limits
Washington say emergency doctors are claiming a victory with the governors decision to suspend a zero-tolerance Medicaid emergency department payment policy that was scheduled to kick in on April 1.
The American College of Emergency Physicians praised Gov. Chris Gregoire for putting a hold on the implementation of the policy, which would have denied Medicaid payment for ED care given to patients diagnosed with one of about 500 conditions deemed by the say to be nonurgent. State legislators approved the limits as a way to cut down on paying EDs for care that patients should be receiving in doctor offices or other less pricey settings.
ACEP and its say chapter warned that the exclusion list was too broad and would apply to many patients who legitimately believed they were dealing with emergency situations when they showed up at EDs. A prohibition on paying for the treatment of sprains in the ED, for instance, would affect Medicaid patients who needed to rule out the possibility that they had broken bones, the organizations said.
We commend Gov. Gregoire for recognizing the flaws in this plan and for not only standing up for Medicaid patients but for all patients, stated David Seaberg, MD, ACEPs president. The proposed list of nonemergent diagnoses puts patients in danger and unfairly targets the poor and those in most need of care.
Emergency doctors in the say stated a more rational way to restrain Medicaid costs would be to educate patients and doctors about how to avoid unnecessary ED care. Physicians support the prudent lay person standard for emergency care, which dictates that a payer should cover ED care if a person had a reasonable assumption that he or she was dealing with an emergency situation.
At this articles deadline, Washington say lawmakers were working to wrap up their 2012 session, during which ACEP was hopeful an alternative plan based on physicians input would be adopted. That proposal would require follow-up by primary care doctors with Medicaid patients who had visited EDs, install a database to track beneficiaries ED use and implement better case management techniques.
ACEP stated it dedicated more than $150,000 through its Emergency Medicine Action Fund to fight the proposed limits on ED payment both in the statehouse and in the courts.
Copyright 2012 American Medical Association. All rights reserved.
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Submited at Friday, April 6th, 2012 at 11:00 pm on Uncategorized by jessica
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