How this issue impacts physicians: 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. 
 
How this issue impacts patients: 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.  
How this impacts health equity:
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: 

? Such dramatically reduced payments will result in fewer physicians in the ER and
much longer wait times, specifically in urban and rural hospitals, which have a
higher percentage of Medicaid patients.

? The financial viability of these emergency departments and medical centers is
already threatened due to losses from COVID-19 where, during lockdowns,
volumes declined as much as 40% due to both a lack of vehicle traffic and
patients delaying care and avoiding emergency rooms.

? Underrepresented minorities have always lacked access to healthcare and
suffered the worst outcomes in the U.S. This problem was made worse in
COVID-19 pandemic. Data from Johns Hopkins University shows that blacks
are three times more likely to contract the novel coronavirus and six times
more likely to die from it than any other racial group. Emergency physicians

are the healthcare safety net when Medicaid recipients do not have adequate
access to primary care and public health. These minority groups would be
disproportionately impacted and suffer disproportionately when critical-access
hospitals lose Medicaid funding essential to their survival. 

? Minorities in the U.S. disproportionately have higher rates of co-morbidities that
increase risk factors for COVID-19 (obesity, lung disease, diabetes,
hypertension, and other immune-compromising diseases). Many of those
conditions are on the “preventable” diagnosis list.

? Emergency physicians are dedicated to our 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 backward
towards racial equality and social equity.

How this issue impacts hospitals and health systems: 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.