My wife and I came to Lynchburg in 1992, taking a chance in joining a relatively new ER group consisting of 7 family practice trained physicians seeing 50,000+ emergency department (ED) visits annually. Over the years through our dedication to patient care and hard work we were able to attract more residency trained emergency physicians and improve the quality of emergency care we provided to the residents of Central Virginia. However, due to a disproportionately medicaid, medicare and self-pay population in our service area, it was always a struggle to hire enough physicians to adequately staff the ED to meet the rapidly growing patient census.

In 2006 during the height of the recession our collection percentage dropped to $0.33 on the dollar. With several departures from the practice we were working 50-60 hours per week to staff the ED. By mid year we gave the hospital notification that we would no longer be able to meet our contractual agreement to see ED patients. Thankfully Centra Health stepped forward and assumed daily ED operations, hiring many of the existing emergency physicians as well as a number of locum tenens physicians, saving emergency care in Lynchburg and surrounding 4 county area from collapse. Since that time it has taken 10-12 years to attract enough emergency physicians to become fully staffed.

My concern is that the implementation of retrospective down coding of level 2, 3 & 4 ED visits -which comprises the majority of ED levels of service- will severely undermine the ability of ED's across the Commonwealth, particularly those with a high percentage of medicaid, medicare and self-pay patients, to provide emergency medical services. Patients come to the ED out of fear that they may have an injury or medical condition that requires immediate treatment. We provide emergency medical evaluations as mandated by EMTALA day and night, weekends and holidays while others are enjoying time with friends & family. We provide these services to the community at risk to our own health, whether during the current Covid-19 pandemic or in evaluating the violent patient. If you are thankful that highly trained emergency physicians stand ready to assist the residents of Virginia in their time of medical or psychiatric need, then provide us with fair reimbursement for our services so we can continue providing high quality emergency medical care to our communities.

Sincerely,

Brian A. Anderson, MD. FACEP