Medicaid Stops Paying for Non-ER, ER Care
The new cuts, set for April 1, focus on about 500 diagnoses including common infections, mild burns, strains and bruises. If an enrollee comes to an emergency room and is diagnosed with one of these conditions, the Washington Medicaid program won’t pay the hospital and doctors…Some 43 states have Medicaid initiatives designed to deter unnecessary use of emergency rooms, according to the Kaiser Family Foundation, a nonpartisan, nonprofit organization that studies health issues. Several states now charge patients copays for nonemergency services in an ER…
“If you fall down the stairs, and your ankle is twice its normal size, and I X-ray it and it’s broken, they’ll pay me, and if I X-ray it and it’s not broken, they won’t,” said one doctor.
Full article by Anna Wilde Mathews on this plan by Medicaid to stop paying for certain emergency-room visits in The Wall Street Journal.
Advocates for the poor may view these cost-saving initiatives — designed to steer Medicaid enrollees away from the emergency room (ER) — as draconian. However, it is wise to educate people that the emergency room is not where you seek primary care for minor ailments. For their part, hospitals who fear not getting paid for primary care provdied in the ER should establish primary care centers nearby to refer patients who inappropriately seek care in the ER.
As long as they have fairly clear definitions of what constitutes emergencies.
So, someone shows up at ER with possibly broken ankle that is impossible to diagnose without an X-Ray. Government only pays if ankle is broken. If it isn’t, hospital eats the cost.
No problem with incentives here!
Videos titled, “Autistic Adult in Crisis Goes Unnoticed” and “Shocking Patient Neglect of Autistic Person” on ytouube warrant immediate attention to dangers of managed care and general hospital medical mismanagement of severely autistic patients in California. What we witness here is a FAILURE to care, as in from the heart. There is little intrinsic motivation for many nurses, doctors to really HELP their patients, especially complex ones that require complex care management and higher critical thinking skills to diagnosis and evaluate and treat.