Emergency departments, by federal law (EMTALA, or the Emergency Medical Treatment and Labor Act), must treat all patients regardless of insurance status ability to pay. Emergency physicians also believe in this decades old law’s moral principle: All people deserve care.
Virginia's actions will cripple emergency physicians', staff, and hospitals’ ability to provide quality access to care — both during the current COVID-19 crisis and long after. This issue is also exacerbated by louder calls for greater social justice and racial equality in healthcare.
Patients should never be put in a position where they are expected to self-diagnose and determine whether an emergency condition exists before being seen by a medical professional. This is called the “prudent layperson” standard and it requires care to be provided if the patient believes they are having an emergency. We believe that CMS guidance obligates state Medicaid programs and managed care organizations (MCOs) to reimburse doctors and hospitals for the delivery of such emergency medical care based on presenting symptoms, not using a diagnosis list.
While Medicaid patients will continue to receive care and will never be billed for the difference if the visit is determined to be non-emergent, patients will be impacted because:
Medicaid reimbursements would be automatically cut to only $14.98 if an ER visit is on the list of “preventable” codes. Such a low reimbursement makes full staffing of a hospital emergency department very precarious, especially in urban and rural areas who typically have high Medicaid populations.
We ask that DMAS temporarily halt implementation July 1st to comply with the prudent layperson standard and ensure equal access to healthcare for all Virginians.
Charles S. Graffeo MD ABEM-UHM
Professor and Asst. Residency Director
Eastern Virginia Medical School
Emergency Physicians of Tidewater
Norfolk, Virginia