To whom it may concern, 

On behalf of the physicians, physician assistants, residents, medical students, and physician assistant students within the Commonwealth of Virginia, the Medical Society of Virginia would like to comment on the ER Utilization Program and the reimbursement policy surrounding emergency care.  

As you know, Virginia’s biennial budget contains a new Medicaid reimbursement policy which stipulates that these reimbursements can be reduced for emergency care if the visit is deemed, after the fact to have been “preventable.” As of this year, there are nearly 800 emergency conditions that are listed as “Preventable ER visits” on their code list. Many of these conditions present to Emergency Departments as potential emergencies, before being coded down after the fact, including diabetic ketoacidosis, status asthmaticus, and abdominal pain. 

The Medical Society of Virginia believes this program will negatively impact patients. Emergency physicians serve as the health care safety net when Medicaid recipients do not have access to primary care and are exposed to public health threats. Under this rule, these patients would continue to be disproportionally impacted as critical-access hospitals lose Medicaid funding, which is essential to their survival. It will also encourage patients to self-diagnose and attempt to determine if an emergency condition exists PRIOR to being seen or seeking out a medical professional. It is a necessity for CMS guidance to mandate that state Medicaid programs and MCOs reimburse physicians and hospitals for delivering emergency care based on the patient’s presenting symptoms rather than a diagnosis list. 

Additionally, the dramatically reduced payments to providers will result in fewer physicians in Emergency Departments across Virginia. This will directly lead to an increase in wait times, predominantly in rural and urban hospitals, which have a higher percentage of Medicaid patients. It is of the utmost importance to ensure that the patients of Virginia have access to healthcare providers in emergency departments, especially in light of the recent COVID-19 pandemic. 

The physician community of Virginia seeks to provide the best care to their patients. Per federal law, Emergency Departments must treat all patients regardless of insurance status or their ability to pay. Emergency Department staffing will be decimated by this proposed program as physicians will not be adequately reimbursed for their care. The COVID-19 pandemic has exposed the necessity for quality physicians and appropriate staffing in hospitals and emergency clinics across Virginia. Inadequate reimbursements will continue to drive providers away from Emergency Departments, placing patients at risk and an unnecessary strain on the health care system.  

It is absolutely necessary to ensure that all people in the Commonwealth can access the care they deserve, please consider this when reviewing the new ER Utilization Program. Now is not the time to further place patients at risk, including those in rural and urban areas who are already struggling to obtain proper care. 

Best regards, 

Clark Barrineau  

Assistant Vice President of Government Affairs at The Medical Society of Virginia