Doctors Sue Over ER Limits in Washington State

jackalope

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Doctors Sue Over ER Limits in Washington State
By OLIVIA KATRANDJIAN
Oct. 1, 2011


The American College of Emergency Physicians is suing the state of Washington in an effort to overturn the decision that low-income Medicaid patients will be limited to three non-emergency visits to the emergency room each year, which goes into effect today.

The suit seeks to get rid of the limit, which it says puts patients at risk.

The limit, which was created to reduce costs in emergency rooms, comes with a new list of 700 non-emergency symptoms, including difficulty breathing, dizziness, early-pregnancy hemorrhage, gall stones, abdominal pains and chest pains not related to a heart attack.

Patients with any of the 700 symptoms are urged to visit the regular doctor's office instead of the emergency room.

But doctors say patients may not be able to tell if their symptoms are indicative of an emergency.

For example, if a child burns himself on the stove, a parent may not know the difference between first, second and third degree burns.

"The ACEP is opposing the limit primarily because of the list of diagnoses that the state is proposing to be non-emergencies, like chest pains and heart arrhythmias and dysrhythmias, which can result in sudden death, sudden blindness, and hemorrhages during miscarriage," ACEP Washington Chapter president Steve Anderson said. "Their proposal is dangerous. It's almost funny it's so scary they would have them on the list.

(snip ... )

"There is a national legislation called the Prudent Lay Person Law, which says that your average Joe, if he has what he thinks is an emergency, is entitled to go to the ER, be evaluated and treated for it, and his insurance company can't retrospectively deny it," Anderson said. "That's in place to protect everybody. Not just Medicaid patients -- everybody. Our concern is that the health care authority said that doesn't apply to our clients. We're terrified that other places in the country will feel that it doesn't apply to their clients and constituents as well."


more: Doctors Sue Over ER Limits in Washington State - ABC News

Limit non-emergency ER visits annually - good idea or bad idea? Are the docs right about the list of non-emergency symptoms being too broad?
 

Blueneck

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Perhaps when they show up at the ER, the staff there could get them an appointment at a regular physician if it's not a real emergency. Of course they'd have to have a list of doctors who'd be willing to take them on short notice and treat them if they weren't insured.
 
Sep 2011
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From what I've read is if they go to the ER and the visit is indeed an "emergency" then they would still have x3 visits left to determine a legit trip to the ED. There are many drug seekers who use the ER for a fix. I say give it a try and see if it cuts down on abuse of the ER.

What I will say about Medicaid payments thought is this:

My friend works in a public mental health hospital. Medicaid patients use the hospital as a vacation between their government checks and the next drug binge. All they have to do to be admitted is say they are suicidal and they are in for x3 days, x3 meals/day (extra portions), a warm/cool environment, TV, and minimal to zero participation in treatment which can hardly be effected in x3 days. They leave and never follow up with outside referral programs set up for them. It's wash, rinse, repeat. Some of the doctors are so overworked they keep the patients longer than necessary and over medicate them to create a faux diagnose of need. It is absolutely amazing the amount of Medicaid fraud there. Once the hospital admitted a patient who was literally passed out in the sheriff's car outside who could not make it into the facility and eventually sent to the ER. If my friend spoke out she would lose her job. Meanwhile, this hospital is a bilge pump to our state's Medicaid program.
 
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Sep 2011
1,471
1,101
Perhaps when they show up at the ER, the staff there could get them an appointment at a regular physician if it's not a real emergency. Of course they'd have to have a list of doctors who'd be willing to take them on short notice and treat them if they weren't insured.
Once in the ER, only a physician could make that determination. As a nurse, I can tell you that it would be considered "practicing medicine" if I were to advise someone with a stubbed toe to take it to another provider. If they had a heart attack and died on the way, I would be libel.

They could begin the teaching process of providing abusers with alternatives of providers. Problem is if these folks are using the ER for drug seeking then it is going to be difficult to change that behavior no matter the "penalty".
 
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jackalope

Former Staff
Jan 2010
51,139
17,672
Maine
From what I've read is if they go to the ER and the visit is indeed an "emergency" then they would still have x3 visits left to determine a legit trip to the ED. There are many drug seekers who use the ER for a fix. I say give it a try and see if it cuts down on abuse of the ER.

What I will say about Medicaid payments thought is this:

My friend works in a public mental health hospital. Medicaid patients use the hospital as a vacation between their government checks and the next drug binge. All they have to do to be admitted is say they are suicidal and they are in for x3 days, x3 meals/day (extra portions), a warm/cool environment, TV, and minimal to zero participation in treatment which can hardly be effected in x3 days. They leave and never follow up with outside referral programs set up for them. It's wash, rinse, repeat. Some of the doctors are so overworked they keep the patients longer than necessary and over medicate them to create a faux diagnose of need. It is absolutely amazing the amount of Medicaid fraud there. Once the hospital admitted a patient who was literally passed out in the sheriff's car outside who could not make it into the facility and eventually sent to the ER. If my friend spoke out she would lose her job. Meanwhile, this hospital is a bilge pump to our state's Medicaid program.


I did not know that ...



I understand the docs concerns, but as someone pointed out, it's not 3 ER visits a year, it's 3 NON-emergency ER visits a year. Upon each of the non-emerg ER visits, I'm sure the patient would be advised that the ER is not the place to go for that kind of visit, and give them info/resources on appropriate med provider.


Seems like it would only hit the ones who use ERs like their family doc ... and they'd be given info on what should be the place to seek med care for non-ER ER visits.
 

Rasselas

Moderator
Feb 2010
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I did not know that ...



I understand the docs concerns, but as someone pointed out, it's not 3 ER visits a year, it's 3 NON-emergency ER visits a year. Upon each of the non-emerg ER visits, I'm sure the patient would be advised that the ER is not the place to go for that kind of visit, and give them info/resources on appropriate med provider.


Seems like it would only hit the ones who use ERs like their family doc ... and they'd be given info on what should be the place to seek med care for non-ER ER visits.
I remember reading a few months ago about the ways people use the ER. The most common reason is a common symptom for a child--like fever. Probably not a good reason to go to the ER...if it's routine. The first time a kid dies from meningitis and the family says "we didn't take him to the ER because we were afraid it wouldn't be an emergency....."
 

jackalope

Former Staff
Jan 2010
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I remember reading a few months ago about the ways people use the ER. The most common reason is a common symptom for a child--like fever. Probably not a good reason to go to the ER...if it's routine. The first time a kid dies from meningitis and the family says "we didn't take him to the ER because we were afraid it wouldn't be an emergency....."

I know .... that's a valid concern ...
 

freecell

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Jul 2006
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I remember reading a few months ago about the ways people use the ER. The most common reason is a common symptom for a child--like fever. Probably not a good reason to go to the ER...if it's routine. The first time a kid dies from meningitis and the family says "we didn't take him to the ER because we were afraid it wouldn't be an emergency....."
I am sure some abuse the ER especially on the weekends when regular Dr.s are not open. I would rather they abuse the ER than let a child die.
 

Seraphima

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Aug 2010
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I remember reading a few months ago about the ways people use the ER. The most common reason is a common symptom for a child--like fever. Probably not a good reason to go to the ER...if it's routine. The first time a kid dies from meningitis and the family says "we didn't take him to the ER because we were afraid it wouldn't be an emergency....."
I think if a child is sick or an elderly person or someone with an existing conditions which puts them at risk, they should just go. Healthy [young] adults with a cold need to shut down the Web MD Symptom Checker and get their hypochondria in check. Working in healthcare I am amazed at how inconsiderate and silly some people can be.

But that sort of goes both ways too. Some people need to learn to go sooner rather than later. I have actually seen auto amputation (toes/fingers literally fall off) in diabetic patients because they didn't see a doctor quick enough.
 

Rasselas

Moderator
Feb 2010
72,645
50,371
USA
I think if a child is sick or an elderly person or someone with an existing conditions which puts them at risk, they should just go. Healthy [young] adults with a cold need to shut down the Web MD Symptom Checker and get their hypochondria in check. Working in healthcare I am amazed at how inconsiderate and silly some people can be.

But that sort of goes both ways too. Some people need to learn to go sooner rather than later. I have actually seen auto amputation (toes/fingers literally fall off) in diabetic patients because they didn't see a doctor quick enough.
Obviously it's their own fault for having diabetes in the first place. If you're poor, don't get diabetes--simple.