To whom it may concern,

I strongly recommend the state reconsider implementing the ER utilization program.

The emergency department has long served as the safety net for all.  No matter the day, time, or condition they are there to provide care. The proposed program as it stands would drastically reduce funding to many emergency departments leading to reduction in staffing and services for all.  Hospitals with the largest Medicaid populations would be affected the most.  These hospitals already provide critical access to care to an underserved population with a disproportionate number of patients being minorities.  Such drastic reduction in payments will lead to fewer physicians in the emergency department with the effect of longer wait times and a substantial decrease in the quality of care in the most vulnerable of populations.  Emergency physicians are dedicated to the national mission to promote and strive toward health equity within the communities we serve.  Allowing such an unfair policy to go into effect in Virginia would be a significant step backwards towards racial equality and social equity.

Federal law (EMTALA) already defines an emergency medical condition as a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in placing the health of the individual in serious jeopardy.  The above definition of a medical condition is determined not by a healthcare provider after evaluation but by prudent layperson standard.  Further, once a person determines they have an emergency medical condition and presents to the emergency department the providers in that emergency department, under EMTALA, are obligated to see the patient and stabilize the patient if needed.  Sometimes chest pain is heart burn other times it is a heart attack and without evaluation by a medical professional you cannot know.  Discouraging people from seeking early care for a condition they consider an emergency and defunding the emergency departments will lead to patients presenting with more advanced disease.  This will increase morbidity and mortality and lead to increased long-term costs. 

Emergency physicians everywhere remain dedicated to care for all at any time no matter their race, gender, or religion.  I implore you to reconsider such drastic funding cuts to a system that everyone relies on being there in their time of need.

Thank You,

Michael Homeyer MD FACEP FAAEM