I am writing as a practicing physician in a flag-ship public hospital which cares for a large number of Medicaid patients. The proposed change to Medicaid reimbursements for "avoidable visits" is a misplaced policy which will hurt those of us who care for Medicaid patients without improving patient outcomes. 

Reducing payment to the Emergency Department for "avoidable services" does nothing change the patient incentive to do so. It also does nothing to help the patient know what represents true emergency vs non-emergent care.

The patient is still entitled under EMTALA to seek Emergency Department care regardless of ability to pay. This program does nothing to increase access to Primary or alternative care sites. If the unwritten goal is to force hospitals to provide more of these services, why not provide carrots instead of sticks? 

Analysis of the medical literature on reducing Emergency Department utilization require either intensive personalized resources via care-management, improved mental health care or most-importantly, addressing social determinants of health such as homelessness. (see Moe J. 2017. Acad Emerg Med. and similar articles). 

Again, this proposed change does nothing to incentive changes to these processes except punish those who are already legally required to provide the care. It does not serve health equity through access to care or help protect the patient safety net. 

Therefore please do not adopt these changes. 

Sincerely,

B. Chopski DO, FHM
Assistant Professor of Medicine
VCU Health

Opinions expressed are my own and do not represent that of VCU Health.