Physicians File Suit to Prevent Washington State Plan that Classifies more than 700 diagnoses as “non-emergent” for Medicaid Patients

Emergency physicians in Washington State today filed suit in the Superior Court of Washington for Thurston County against a state plan that would limit payment for Medicaid visits to three "non-emergency" visits to emergency departments each year and classify more than 700 diagnoses as "non-emergent," including chest pain, abdominal pain, miscarriage and breathing problems.

The Washington Chapter of the American College of Emergency Physicians said the basis for the suit is multi-factorial and includes:

*The state has not implemented a rule making process that included stakeholder comments; yet the plan is being forced on hospitals and providers with no warning.

*The state has violated requirements that this be a collaborative process as outlined by the legislature.

*The state has violated the requirements that this be a collaborative process as outlined by the legislature.

*The state has misconstrued the ability to bill patients for services.  Federal law prevents physicians from meeting Medicaid requirements for billing patients through EMTALA, and state law blocks hospitals from billing under charity requirements.

*The state is violating the federal Prudent Layperson standard by applying it to managed care patients.

Top 10 Doctor Movies

One of my social media buddies recently challenged me to share my "Top 10 Emergency Doctor Movies."  Although I could not rattle off ten movies that have an emergency doc as the main character, I did come up with 10 of my favorite doctor movies.  My favorite "doctor movie" is based on the true story of an emergency doc in a busy urban ED who could not get a specialist to take care of a critical patient.  (Sound familiar?  It's a way of life for many of my colleagues.)  The movie stars Joe Mantagne, and depicts the choices that face emergency physicians every day - choices made without enough information and without a crystal ball.

Here is my list:

1.  State of Emergency

      1994  (Joe Mantegna)

2.  M*A*S*H*

      1970

3.  The Elephant Man

      1980

4.  Beyond Borders

      2003

5.  Guess Who’s Coming to Dinner

      1967

6.  And The Band Played On

      1993

7.  Spellbound

      1945

8.  Miss Evers’ Boys

      1997

9.  Flatliners

      1990

10.  The Hospital

      1971

Honorable mention:  What About Bob?  (1991)

A parting thought:  As one of a generation of emergency doctors who grew up with Hawkeye Pierce for a hero, let me say that he COULD have been an ER doc, but was created one war too early.

Happy Holidays to all!

Long term prognosis for emergency care

This is a link to an article in Congressional Quarterly this week, written by Rebecca Adams. It is a fairly impartial assessment of the emergency department environments and the unanticipated consequences of health reform legislation.

http://www.cqpolitics.com/wmspage.cfm?docID=weeklyreport-000003259823

H.R. 3962 Passed....What Now For Emergency Medicine?

Last night the U.S. House of Representatives passed a health reform bill, H.R. 3962. Emergency physicians are divided in their thoughts about the consequences of this legislation, as is the house of medicine and the country in general. However, there are many aspects of the bill that are positive for emergency patients and for emergency physicians.

Some of these include:

*Inclusion of emergency services as part of an essential health benefits package

*Statutory authorization of ECCC (Emergency Care Coordination Center) and ECCC Council of Emergency Medicine.

*Health and Human services annual report to Congress on ECCC activities, with focus on emergency department crowding, boarding and delays in ED care following presentation.

*Emergency care/trauma regionalization pilot project grants.

*Trauma stabilization grants.

*Health and Human Services incentive payments to states that establish medical liability reforms (Certificate of Merit/early offer)

*Health and Human Services demo project to reimburse private psychiatric hospitals that provide EMTALA services to Medicaid beneficiaries.

The American College of Emergency Physicians has worked diligently to represent emergency physicians and emergency patients throughout this volatile process. As the process continues toward final legislation, ACEP will continue to focus on the needs of emergency patients, future emergency patients, and the physicians who care for them.

Please Help Us Fix the SGR

Starting this week, the Senate will take a series of critical votes on a bill, the Medicare Physicians Fairness Act of 2009 (S.1776), to abolish the flawed formula used to determine Medicare reimbursement rates. This bill is critically important to all physicians, but especially to emergency physicians who will undoubtedly see a significant increase in Medicare patients if the payment cuts are enacted.

Under the current system, physicians are scheduled to receive drastic cuts to Medicare payments starting next year. Congress understands that the scheduled cuts would devastate access to care for seniors so each year they "patch" the system by voting at the last minute to cancel the funding cut. However, even though the cut is not enacted, the total accumulated debt for physician reimbursement under Medicare continues to grow. Picture it as a credit card with a huge balance and a high interest rate. Congress "forgives" a payment on the debt each year, but that amount is added to the balance, and interest continues to add up. Without action by Congress, physicians are scheduled to take a 21 percent reduction in reimbursement for Medicare patients next year, with cuts totaling 40 percent in future years.

Having health insurance coverage is not the same thing as having access to medical care. All seniors over age 65 are entitled to insurance under the Medicare program. Increasingly, however, primary care physicians and other specialists are refusing to take new Medicare
patients because of low reimbursement rates. It's not that those doctors lack compassion, it's that many lose money on Medicare patients and a 40 percent cut in payments would make it impossible for them to continue to treat those individuals.

With an aging population, emergency departments already anticipate an increased volume of seniors needing care. If, however, Congress does not fix the flawed Medicare formula, that increase could be catastrophic. Seniors unable to find doctors accepting Medicare may have no choice but to seek care in emergency departments, which the Institute of Medicine already calls "dangerously overcrowded."

Passage of this bill would help to prevent more crowding in emergency departments, provide a reasonable level of compensation to emergency physicians, and help attract on-call specialists. This is a non-partisan issue. Republicans and Democrats claim to care equally about ensuring
access to care for seniors. If our elected representatives are sincere in these views, they will take a principled stand on this issue and support S.1776 now.

You can help assure passage of this critical legislation. Contact your two U.S. Senators now and tell them to support S. 1776. Here's how:

* Call 1-800-833-6354 to be automatically connected to your two Senators. Urge them to support all procedural motions and final passage of S.1776.

* Go to ACEP's Advocacy Center: www.acep.org and send an e-mail urging your Senators to support S. 1776.