This week’s Grand Rounds at Suture For A Living is an excellent round-up of healthcare posts. This one from Movin’ Meat will be a particularly interesting read for anyone who’s curious about ways that states might attempt to cut their Medicaid budgets. It’s specific to Washington State, but we know that state governments are always watching each other. And we know that pretty much every state government is broke right now and they’re all looking for ways to trim costs and/or increase revenues.
Basically, WA legislators told the state Health Care Authority to come up with a way to cut $72 million from the Medicaid budget, specifically from Emergency Department utilization. The recommendations haven’t gone into effect yet, but in an effort to reduce ED overutilization for non-emergency situations, the plan is that Medicaid will only pay for three “non-emergency” visits per year for each Medicaid patient. That sounds fair enough, and Movin’ Meat points out that there are indeed some non-emergency conditions that would be better treated elsewhere (although he also notes that primary care for people with Medicaid is hard to come by). But the list of “non-emergent” conditions gets a little ridiculous. Chest pain? Hypoglycemic coma? Kidney stones? Abdominal pain? All on the list. It’s a bit reminiscent of CMS’s “never-events” list.
Movin’ Meat’s analysis of the plan is pretty spot-on. ED docs won’t be able to tell which patients have already had their three “non-emergent” visits for the year, and it’s highly unlikely that the patients are going to be able to pay for their own visits. The ED will end up treating these patients (who may very well be having a true emergency) and Medicaid will deny the claim. Since the ED isn’t likely to be able to get payment from the patient, this new ruling looks like it will just transfer cost from the Medicaid program to the EDs that are providing care. EDs that treat a high proportion of Medicaid patients (like Colorado’s Denver Health) will likely bear the brunt of a rule that cuts back on Medicaid reimbursement for “non-emergent” treatment in the ED.
Most states are in a pickle right now budget-wise, and it’s reasonable to assume that some other states will consider this idea for their own Medicaid programs. Although it’s a myth that uninsured patients use the ED more than the general population, it’s true that Medicaid patients do have a higher ED utilization than most other populations. Of course, this is probably related to the fact that it’s tough to find primary care docs and clinics that accept new Medicaid patients. Denying arbitrary “non-emergent” ED claims for Medicaid patients doesn’t seem like a way to actually reduce ED overutilization. Instead, it seems like a way to cut Medicaid costs by increasing the number of unpaid claims that EDs have to write off each year. In order to cover their costs, hospitals will have to further increase prices for privately insured patients. That in turn causes health insurance premium hikes, which leads to calls for negotiations to artificially lower premiums. Where does it end?