I find it a slap in the face that you would want to penalize the very people and institutions who are working to provide the much needed care for many of the people in Virginia. Yes there are some diagnoses which can be prevented, but at the time when we see them in the ED for Diabetic ketoacidosis , severe asthma attacks, et. al.,  they are presenting with potentially life threatening conditions. SO  you want to punish the ED providers and emergency departments who are working to keep our communities healthy and alive by threatening to decrease our reimbursements. SHAME ON YOU. 

Why not try a different alternative. Work to establish more primary care services with appropriate educational assistance to our communities to better educate them and aid them with taking care of themselves appropriately. I cannot tell you how many times when I question my patients as to there understanding of their disease process and how to prevent it and maintain their health, the number of blank stares I get. 

By decreasing the ED reimbursements you are putting a strain on an already stressed out system. Do not move forward with this plan . It will not help anything except the pockets of the insurance companies who do not want to pay for emergency services.