Dear Department of Medical Assistance Services,

My name is James Chung and I am a medical student at Eastern Virginia Medical School (EVMS).  Thank you for taking the time to read this and many other letters sent to you regarding the new ER Utilization Program.  Reading about this program seemed very alarming to me, as its policies would significantly alter the structure and practice of Emergency Medicine.  These effects would lead to creating (rather than reducing) more disparity in healthcare for those in need, specifically those in lower socioeconomic classes who are a major population of patients cared for in Emergency Medicine. Additionally, it would burden hospitals to cut costs and triage on what treatments can be given as well reduce the amount of practicing ER physicians in Virginia (also as an effort to reduce cost).   These effects stand to not only impact the field of Emergency Medicine but also can lead to reduced quality of care in other fields, as they no longer have an effective Emergency Department to rely on.  As a future physician, I humbly urge you to consider this and the many other numerous letters about this issue and reverse this decision. 

While the intent of this program may be beneficent in nature, it may actually lead to less patients being cared for and further the healthcare disparity.  This new utilization program will reimburse hospitals only up to $14.98 if a patient on Medicaid receives treatment for any diagnosis on the list of the “preventable codes” under this ER Utilization program.  As practically any treatment or diagnosis normally made in the Emergency Department (ED) is on this list, this policy in reimbursement will significantly reduce the financial viability of many of these hospitals (who are already suffering from financial losses due to COVDI-19 lockdown’s and isolations that have reduced hospital volume by as much as 40%) and may lead to hospitals no longer accepting patients with Medicaid or discouraging patients with Medicaid insurance to come into the ED.  As many patients on Medicaid do not have any primary care as well as limited access to public health, the ED serves as a safety net to continue caring for the health of these patients.  Reimbursement policies that force hospitals to basically remove the field of Emergency Medicine as an option of care for these patients will force patients to assume a responsibility to self diagnose and treat their conditions even though they do not have the medical training nor clinical experience in handling these conditions.  No patient should ever be placed in this situation and such burdens on patients could actually be causing them to put themselves at risk for worsening morbidity from their conditions and ultimately an increase in the rate of mortality for populations under this Utilization program.  Furthermore, as many patients on Medicaid are also underrepresented minorities reducing care for these patients would further the inequity in healthcare and go against many of the morals and principles of Emergency Physicians including the duty to provide care for all.   

This decrease in reimbursement may also force hospitals to reduce the number of physicians working in the ER, which can lead to longer wait times and lessen the quality of treatment for patients.  If doctors are no longer able to work in the ER, other types of providers will have to replace them such as physician assistants (PA’s) or nurse practictioners (NP’s). While the intent of this program may seem cost effective in transforming the structure of the ED to less physicians, it has the potential to reduce the quality of Emergency care and also burden other specialties in medicine, further taxing and reducing the practice of medicine as a whole.  Having worked as a full time Emergency Department scribe before starting my training as a medical student, I saw many patients who were referred to the ED from places like Urgent Cares.  These Urgent Cares mainly had (PA’s) and NP’s as the only healthcare providers in these Urgent Cares and this is why many patients had to be sent to the ED----for further care and consult from experienced Emergency physicians.  If the ED were to transform into another Urgent Care, patients would not be able to receive the care they need, simply because there are not enough ED physicians to consult.  This could lead to less patients being successfully discharged from the ED and a subsequent buildup of patient volumes in the ED, which would ultimately slow the flow of healthcare in the ED.  Furthermore, this could also lead to more patients being admitted, making it more difficult for hospitalists and internist physicians to handle the volume of patients that they must tend to. This hemorrhage in healthcare can bleed even further as patients recovering from surgery or patients who need to be transferred to and from critical care wards may be overlooked, again due to the increase in hospitalized patient volume.  As you can see, the effects of transforming the ED transcend beyond this specialty and can impact the quality of care in other fields of medicine.  For these reasons, I urge you to see the important role that Emergency Medicine has in providing that first yet crucial line of defense for patients who develop acute conditions which demand quick and effective care. 

While every bill may have original good nature and intent towards its recipients, I respectfully ask that you see how this ER Utilization program has many opposite and scarring effects on medicine.  Most importantly, this Utilization program would stop care for many of those in need and ultimately destroy the bonds and trust that providers in the field of medicine have tried to create with those in our communities.  To add to these inflammatory effects, the field of Emergency Medicine may cease to exist as a whole due to lack of funding or cause this field to be restructured in a way that can lead to burdening other specialties in medicine which originally relied on the ED to carry the weight in providing quality care for patients.  Thank you for taking the time to read my comments and I hope that you can see the beneficence and compassion you would be providing in reversing this ER Utilization program. 

James Chung