Spokane7
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September 3, 2011 in City
Medicaid cuts target ER visits
Medical services for the poor are eroding in Washington state as budget cuts take hold.
The latest round of Medicaid cutbacks will begin Oct. 1, including efforts to curb repeated use of hospital emergency rooms and similar services at private clinics.
As a financial measure the new rules seem prudent, hospital and government officials say. Medicaid will only pay for three non-emergency visits to emergency rooms per year. Taxpayers won’t be asked to pick up the tab on the fourth or additional trips.
Yet such an approach carries risk.
“We can all agree we need to reduce expenses,” said Dr. Jeff Collins, chief medical officer for Providence Sacred Heart Medical Center. “But you’re asking patients without primary care doctors to self-diagnose.”
Especially worrisome, he said, is that two-thirds of Medicaid patients are children. After the third non-emergency visit to the ER, the state will send a letter to the patient and the family warning them they will be asked to pay for the next such visit. Some worry parents will be less likely to take their children for medical help for fear that they might be billed if the malady is not on the state’s list of emergency problems.
“It’s a very difficult position and one that may put people and children with real medical needs at risk,” said Dr. Darin Neven, an emergency room doctor at Sacred Heart.
Hospitals will likely bear the brunt of the cutbacks. State law requires hospitals to treat anyone who walks into their emergency room regardless of ability to pay. Many of those who repeatedly use emergency rooms for primary medical care have mental illnesses or addictions to pain medications.
Helen Andrus, Sacred Heart’s chief financial officer, estimates there will be more than 4,500 visits to Sacred Heart’s emergency room this year that would have fallen under the new guidelines and wouldn’t be eligible for Medicaid reimbursement.
That equates to millions of dollars in uncompensated care.
The numbers are similar at Providence’s Holy Family Hospital, Andrus said. Officials at Deaconess Medical Center couldn’t be reached for comment, but that hospital’s ER serves fewer patients than both Sacred Heart and Holy Family.
Withholding such payments to emergency rooms will save the state between $34 million and $36 million. That represents about 11 percent of the $300 million in Medicaid cuts needed to meet balanced budget requirements for the 2012-2013 biennium, said Jim Stevenson, a spokesman for the Washington Department of Social and Health Services.
The remaining cuts to help achieve a balanced budget were found by lowering reimbursement rates to hospitals, changing payment methodologies to community health clinics such as the CHAS clinic in Spokane, and dropping benefits for poor adults, such as dental care, eyeglasses, hearing aids and money to help pay for prescription drugs.
Stevenson said the options for cuts were narrow. Federal matching dollars that supplement the state’s Medicaid program include requirements that some services be covered, such as medical and dental coverage for conditions that are ruled to be true emergencies.
State officials and the Washington State Hospital Association had attempted to find a compromise to the Medicaid emergency room funding cutbacks. As solutions proved elusive, the state acted and made its consideration based on budgetary needs rather than medical necessity, Collins said.
Emergency room billing is a complicated scenario. Even though hospitals will be required to continue treating anyone who arrives at the emergency room – and likely write off that cost as charity care – emergency room physicians are independent contractors who would be likely to submit their bills to the patients.
It’s why ER doctors, other physicians and hospitals have been trying to collaborate on the care for Medicaid patients who don’t have a primary care doctor yet need medical attention, said Lee Taylor, executive director of Project Access.
He said there may be ways to set up initial screenings that help direct Medicaid patients who have non-emergency conditions to the right care.
“If we can build a strong network of doctors, we may find a way of providing care consistent with what these patients need,” he said.
Parishes giving $1.5 million toward settling sex cases 
DickAdams on September 03 at 7:02 a.m.
Seems to me the story has several items medicaid pays for that even medicare does not, and even private supplemental BC & BS don`t cover. One example would be hearing aids. My supplemental BC BS use to pay for hearing aids until the federal government payment plan set the standard as to what medicare will or will not pay. My insurance immediately discontinued reimbursement for hearing aids. I guess the medicare plan decided if seniors want hearing aids they can purchase the expensive devices themselves. I forked out over $4,000.00 for my wife`s hearing aids, even though my annual payment for both medicare and my supplemental costs over $8,000.00 annually. Won`t be long the annual increases will force me to stop my supplemental, thanks to Obamacare. nuf said.
Diana on September 03 at 7:18 a.m.
“I guess the medicare plan decided if seniors want hearing aids they can purchase the expensive devices themselves”.
DickAdams, you sound like a socialist.
greyhound2 on September 03 at 7:58 a.m.
Emergency Rooms have been used as basic care for illegal aliens for a long time, where the hospital is required to treat them and the property owners get to pay for it.
JBlim on September 03 at 8:00 a.m.
Well kudos for realizing you needed a hearing aid. Rush Limbaugh didn’t realize he needed one for 10 years when he choked on a piece of food and had to stop talking.
And, welcome aboard, comrade.
jimvw2 on September 03 at 8:00 a.m.
The Healthcare Act, passed by both houses of Congress by the way, is not responsible for your decrease in supplemental or Medicare coverage and you know it, Dick. Most provisions of that bill don’t even kick in until 2014.
Problems with the cost and affordability of healthcare didn’t begin with the election of Obama and won’t disappear with repeal of the Healthcare Act or election of one of the Tea Party panderers the GOP is offering as an alternative.
Our problem is a profit-centered approach that treats medical care as a business rather than a public service. And it’s a “market” with a high cost of entry for doctors and nurses (med school student loans), and high expectations for return on that investment of time and money. For all the whining, how many poor doctors do you know? So the model of medical care we have devised over the years is way over-priced compared to our friends in Europe and Asia, who tend to treat medical care as a public utility.
That’s the root of the problem, Dick. To get a better understanding for how medical care went from a low-cost, discretionary personal service in the 1800s to the outrageously expensive industry product that it is today in the USA, I recommend that you read a Pulitzer Prize winning book from 1984 by Paul Starr, “The Social Transformation of American Medicine.”
It will give a you a historical perspective on why we’re in our current dilemma of having a cornucopia of healing technologies that ever fewer of us can afford. It’s also a very well written book.
Until then, good luck with “Ryan-care,” which is what we’ll get with a successful Tea part coup in 2012.
Diana on September 03 at 8:16 a.m.
Emergency Rooms have been used as basic care for low income Americans for a long time, where the hospital is required to treat them and the insured get to pay for it.
Fixed. Your welcome.
DickAdams on September 03 at 8:30 a.m.
Diana, as usual you missed my point. I thought my private BC & BS would pay for hearing aids, which I paid for, but instead, even though my cost increased, BC BS decided to jump in bed with medicare benefits and use the dictated edict of Obamacare. Believe me, I`m as angry at private insurance companies as anybody but I carry it to protect my wife and me and not count on government hand outs. Two of the largest insurance companies in the country are owned by Buffett and Soros both have Americans hoodwinked. Buffett even collected taxpayer stimulus money. Those two named for what`s it worth.
misjustice on September 03 at 9:16 a.m.
About time!!
kkrimmer on September 03 at 9:57 a.m.
… so this is how we pay for tax cuts for the rich, oil company subsidies?
misjustice on September 03 at 10:01 a.m.
Well, sick poor kids just need to suck it up; or move to a socialist nation where they can get their medical needs met. Seriously, who needs a bunch of poor sick kids suckling at the gubmint teat? No health care for you!
soccermomsusie on September 03 at 10:06 a.m.
Say what you want, but there are millions of Canadians who sneak across our border every day to access the BEST HEALTHCARE IN THE… NATION!
I should know, I patrolled the northern border after they kicked me and Maxie out of Arizona. They are good. They only would sneak over after I fell asleep.
When hubby’s free government scooter arrives, we are not only going to festoon it with flags and Tea Party paraphernalia, but we’re thinking of some light weaponry. Then we are heading North. That is where the battle (Armageddeh) will be.
The Socialist Hordes from the North are coming to steal our healthcare! I look forward to changed their “ehs” to “argggghhhs.”
HEAR OUR VOICE!!!
nslopeofw on September 03 at 11:52 a.m.
Soccermomsusie-
LOL
There are PLENTY of free programs for children out there. Its their no-work parents that are using the ER.
So what! They still get 3 free visits a year. Its only at 4 that they have to pay. Its a no issue for them, and a tax drain for the rest of us.
greyhound2 on September 03 at 1:27 p.m.
soccermomsuzie,
It is not true that average Canadians sneak across the border for health care. If you can afford it, the US does have the best available, but you need to have lots and lots of money to access it.
The “average” Canadian would never sneak across the border to get substandard care at inflated prices available from the medical-industrial-complex in the US. They are not stupid. The “average” Canadian is smarter, more courteous, cleaner, better educated, more thoughful and more civic minded than the “average” American. In quality of life, a Newsweek article put Canada in 7th spot while the United States was no where to be seen in the top 10. You need to avoid the brainwashing. America is, however, number one in bombs and death, nothing else.
Wiggentree_Copyright on September 03 at 2:00 p.m.
“(S)aid Dr. Jeff Collins, chief medical officer for Providence Sacred Heart Medical Center(,) “But you’re asking patients without primary care doctors to self-diagnose.”
Dr. Collins, the way I read this article, it simply states that emergency visits are covered, and no more than three non-emergency visits. Are you saying that all visits require self diagnosis, or simply non-emergency visits?
I don’t know about all patients, but I know that a broken limb that I can’t walk on, or a fall wherein I cannot get up by myself, or if I’m hit by a Kenworth crossing the street, or if I’m bleeding from a bodily orifice, is likely an emergency, and I must call 911 for transport to a hospital emergency room if I have some way of communicating that need or another person is there for that help.
I know that, as a diagnosed mentally-ill woman, I’m never in a state of crisis (or hear voices in my head) that prompt me to harm myself or do damage to others or their property, or threaten them or their property, or go wandering about at night, or even during the day, bothering people, and thus have never had a mental-health crisis or called a “help” line in a crisis that would require me to visit an emergency room.
Happily, I’m over 65, healthy as a horse physically, except for extreme myopia and a head or chest cold once every two or three years, and expect to remain so, since I’m too poor to pay for a medical doctor to diagnose me with anything. Thank God and Medicare. Medicaid coverage for non-emergency visits? Good luck with “The State!!” (The entity my very-low income divorced, healthy mother of five healthy, though poor, children used to threaten us with if we didn’t behave as we should.)
DickAdams on September 03 at 4:01 p.m.
I`d wager that Washington state, within the budget, has enough money to foot the bill if they quite their reckless spending habits. Start with traveling, expense accounts, Gregoire`s husband traveling around the country on our dime, handing out debit cards to poor people and an investigation recently tracked those given cash from ATM machines and other businesses handing out money from their cash registers also finding Casinos hand out loot, liquor stores do, grocery stores where these people buy beer and wine, bar and grills do their share as well, and according to the investigation many other spots handing out cash to the welfare recipients for other stuff they should not be purchasing with taxpayer money.
soccermomsusie on September 03 at 4:55 p.m.
I saw a lady (I won’t tell you the color of her skin) try to buy a Cadillac with her ATM card that Gregoire gave her. Luckily, the dealership only gave her some floor mats.
If you get a chance, watch Chelsea Copta on Q6. She has a special segment called CIA - Crooked Indigent Anarchists. She documents through actual hidden camera reenactment simulations what the poor are doing to us!!
IT IS SHOCKING!! Mrs. Kopta said that one make that ONE percent of all of these debit card deals could be fraudulent!!!!! She used some pretty tricky math, but I could follow it.
Chelsea Copta could be the new Lee Hess or Carl Clark of Q6, me thinks!
HEAR OUR VOICE!!!
polistra on September 03 at 6:30 p.m.
Slightly OT: An article on a similar topic in Seattle Times has several highly informative comments from physicians and dentists about how the insurance system really works.
http://community.seattletimes.nwsource.com/reader_feedback/public/display.php?source_name=mbase&source_id=2016096058
Look especially at the first comment by ‘patglof’, a family practitioner. It’s about the tenth item from the top. This is obviously the main cause of skyrocketing costs, and I’ve never seen it reported as such in the media.
Cathyblueyes on September 03 at 6:35 p.m.
While any waste and abuse of Medicaid needs to be dealt with to protect the safety net for the truly needy, what this essentially proposes is merely cost-shifting to the hospitals, who are already losing tens of millions in this region a year to uncompensated care. Which staff would you like to see less of (or not at all) due to the budget strains caused by a large increase in losses?
steptoe_fan on September 05 at 8:17 p.m.
i would like to see a lot less of people making babies when they lack the morals, knowledge, time or financial resources to be reasonable parents.
if you can’t afford to feed what you have, why are you making more ?
deport all the illegals, and there would be a lot more work to go around for those who came here legally.
steptoe_fan on September 05 at 8:22 p.m.
U can afford the tats, piercings, cigs, booze, gas money, casino visits, designer nails and other ( drugs ) ?
why are you using food stamps and at the ER ?
state should have mandatory testing for all getting aid and stamps.
given the track record of DSHS, will never happen.
gotcha on September 09 at 3:37 p.m.
Supreme court will throw out Obama care this next year… Hopefully things will go back to how they were for awhile… Our health care needs to be fixed but not that piece of crap that Obama and his morons threw at us.
ManleyPointer on September 09 at 3:47 p.m.
“The “average” Canadian is smarter, more courteous, cleaner, better educated, more thoughful and more civic minded than the “average” American. In quality of life, a Newsweek article put Canada in 7th spot while the United States was no where to be seen in the top 10. You need to avoid the brainwashing. America is, however, number one in bombs and death, nothing else.”
Sounds like SOMEONE should move to Canada. While I really like Canada, and have never met a Canadian I haven’t liked, I would still much rather be a US citizen than a Canadian citizen. I don’t understand the mentality that only sees the bad in this country, can only criticize this country, and yet doesn’t take the simple steps necessary to renounce his citizenship.
arroyoribera on September 09 at 9:02 p.m.
Just so we can get this out in the open and out of the way right away, Diane, I am a socialist and have said so publicly. http://www.spokesman.com/letters/2010/jan/11/obama-not-socialist/ So are any number of hundreds of thousands and millions of people in the US who have been attacked, intimidated and silenced by a country of gun-totting and attack-dog ideologues, organizations, think tanks, media establishments and pundits, preachers and politicians who drag out the word as a way to taint and marginalize anyone addressing one of the most widely held and practiced political viewpoints on the planet.
A large number of people believe in universal health care. The vast majority of the people in the world have it. I don’t care whether you don’t like the idea or not. That is your right. This is a democratic country and all that is needed is the political courage for people to stand up, organize, and vote for what they want and we can have it. That includes universal health care, significant and fair taxation of the rich, and an end to US imperialist over-reach of its military around the world.
The number of sick, dying, toothless, people without eyeglasses, etc is growing daily in the US. Blame it on these individual people if you like. I disagree as do millions of others. I blame it on the two-party ruling class consensus running this country via a form of extremist capitalist-imperialism that is murderously and rampantly running roughshod over the planet, leaving a trail of dead and amputee US soldiers behind it while concentrating wealth into fewer and fewer hands. I and millions would take that wealth from those fewer and fewer hands and spread it more widely in the population. And it can be done just as easily as the two-party ruling class consensus in Washington DC took what now amounts to $20 plus trillion dollars and gave it to the wealthy, powerful and corporations.
So go ahead, Diane. Call me a socialist.
We will continue to suffer from this charade and the intimidation of people like you, Diane, until people in this country simply begin to have a realistic and objective view of the reality that both the Democratic Party and the Republican Party are corporate-owned entities representing the interests of two wings of the same class of people and that both parties use their own unique forms of rhetorical populism (their distinct forms of snake-oil) to convince the US people that they have our interests in hear. Until people in this country embrace the concept of socialism (a la Canada, France, England, Denmark, Sweden, and the rest of the world), there will be not only the current class warfare which is being waged and won by the few over the poor, toothless millions, and uneducated droves, but we will also have a country which struggles harder and harder every day to cover up the lie and failure that it increasingly is becoming.
David Brookbanbk