This budget amendment would downcode over 800 ED diagnoses for Medicaid patients to Level 1 ($15) reimbursement (Diagnoses like Diabetic Ketoacidosis, Status Asthmaticus, etc).  These are diagnoses that the insurance companies are supposed to implement plans to keep the patients out of the ED.  Instead, they convinced a group of legislators that the best way to "save" the state money was if they didn't have to pay when a Medicaid patient goes to the ED with this condition.  So their failure to manage the condition they are paid to create a process to manage becomes a financial penalty for hospitals and Emergency Physicians.

Come spend some time in an Emergency Department and shadow an Emergency Physician to find out what we deal with with EVERY DAY!

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.

Peter A. Sim, MD, FACEP (Emergency Physician for 43 years and counting)