The physicians’ proposal is designed to reduce overuse of the ED while maintaining patients’ access to needed emergency care. The proposal aims to lower unnecessary ED visits by improving care coordination through case management, a prescription drug monitoring program, ED utilization tracking and coordination with primary care physicians. The physicians supporting the proposal say it will generate savings by implementing best practices across the state.
This proposal was submitted as an alternative to a zero-tolerance policy the Washington legislature was planning. This policy, which Washington Gov. Chris Gregoire (D) suspended before it became effective, would limit Medicaid payments to EDs for certain conditions, such as certain burns and strains, considered not medically necessary in an ED. The policy was created to encourage Medicaid patients to use other care settings, such as a physician’s office, for minor injuries. The Washington legislature estimated this zero-tolerance policy could save the state $35 million annually.
Physicians opposed this approach on the grounds that cutting Medicaid funds would decrease patients’ access to care and force physicians and hospitals to provide free care for Medicaid patients whose conditions were deemed not medically necessary.
More Articles on Washington Medicaid:
Washington State Suspends Medicaid ER Limits
ACEP: Washington Medicaid Endangers ED Patients
Washington Medicaid Won’t Reimburse for “Unnecessary” ER Visits
At the Becker's 11th Annual IT + Revenue Cycle Conference: The Future of AI & Digital Health, taking place September 14–17 in Chicago, healthcare executives and digital leaders from across the country will come together to explore how AI, interoperability, cybersecurity, and revenue cycle innovation are transforming care delivery, strengthening financial performance, and driving the next era of digital health. Apply for complimentary registration now.
