The state of Washington has now limited the number of Emergency visits that will be allowed for non-emergent care for those on Medicaid. IT’S ABOUT TIME! Most physicians have been encouraging the state to do this since Medicaid’s inception more than 30 years ago. Finally, as the state literally goes bankrupt, something is finally being done.

I do have a problem with the methodology. Sure enough, someone on Medicaid is going to go the the ER three times for their usual hang nail, snotty nose, and stubbed toe and then will present again for the real thing such as chest pain after their “three strikes and you’re out” rule. 

Wouldn’t it be better to allow as many visits as they want but require a co-pay that acts as a deterrent, just like all the insurance companies are doing? This makes the most sense to me and it takes the burden of proof away from the physician and their staff in the Emergency Room.

Of course, even if it’s the tenth time, no physician is going to turn away a patient complaining of chest pain. BUT, the state will simply refuse to reimburse the hospital and that’s going to make a few people in the administrator’s office angry. It’s also going to entice physicians to then cut corners and costs. Perhaps a second ECG won’t get done or a second set of cardiac enzymes won’t be ordered.

In addition, the reality of the situation is that there are fewer and fewer physicians accepting Medicaid patients. I know that I don’t. I run a private practice and I can’t afford to get paid $34.00 for a $117.50 office visit. And unlike the government sponsored clinics like Neighborhood Health, Indian Health, and the Farm Worker’s Clinic, no one subsidizes me when my office ends up bankrupt.