Virginia Regulatory Town Hall View Comments

Department of Medical Assistance Services

Board of Medical Assistance Services

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6/16/20 8:58 pm

Commenter: Jason Garrison

A Guaranteed Way to Close Your Local Emergency Department and Kill Patients

The existing federal EMTALA (Emergency Medical Treatment and Labor Act) law mandates that Emergency Departments must evaluate and treat all patients regardless of insurance status or ability to pay. Emergency physicians practice in this setting because "All Lives Matter". Virginia's DMAS actions to DEFUND emergency departments with inadequate, woefully criminal reimbursement for mandatory services provided will cripple hospitals’ ability to provide access to care, forcing many to cut services or close in bankruptcy. This issue comes when we hear louder calls for greater social justice and racial equality in healthcare. Those very places praised for their actions and availability at this critical time of need will soon be shuttered both during the current COVID-19 crisis and long after, if this action takes place.

The law premised that people should never be put in a position where they are expected to self-diagnose and determine whether an emergency medical condition exists before being seen by a medical professional when presenting to an Emergency Department. This “prudent layperson” standard requires that a complete assessment and medical care to be provided if the person believes they have an emergency. CMS guidance obligates state Medicaid programs and managed care organizations (MCOs) to reimburse doctors and hospitals for the delivery of such emergency medical care provided based on presenting symptoms, not using a diagnosis list, and that such payment follows established guidelines. Arbitrary lists and retro active denial or unilateral adjustment of reimbursement has been deemed inappropriate. Forcing one (by law/mandate) to perform (assess and treat) for little or no pay (unilateral payment rates/denials) has another name...

While Medicaid patients will continue to receive care and will never be billed for the difference, even if the visit is determined to be non-emergent, patients fear and ability to seek care will be impacted by this capricious action as:

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. Emergency physicians are the healthcare safety net when Medicaid recipients do not have adequate access to primary care and public health.

Underrepresented minorities have always lacked access to healthcare and suffered the worst outcomes in the U.S. 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 for complicated health problems (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 and significantly impact providers wanting to live/work in the Commonwealth.

Under this proposal, Medicaid reimbursements would be automatically cut to only $14.98 if an ER visit is on the list of “preventable” codes... less than the cost of Virginia State Inspection for your car or a meal at Olive Garden. Is that what a Medicaid participant's life is worth? Such a low reimbursement makes full staffing of a hospital emergency department impossible, especially in urban and rural areas who typically have high Medicaid populations. That will cost lives, when we know "All Lives Matter".

We ask/demand that DMAS halt implementation of this action to comply with the Federal Prudent Layperson ruling and ensure equal access to healthcare for all Virginians. DMAS should demand private organizations that disburse the healthcare dollar be accountable for their profits in better managing their customers health, to keep them from needing to seek care at the Emergency Department, rather than penalize those who aim to help them in their worst time of need.

CommentID: 80305