I write in strong opposition to the proposed ER Utilization program due to take effect on 1 July 2020.  This program will indiscriminately penalize emergency care providers and facilities for providing appropriate and needed care to Virginians who have the least access to care and will penalize all emergency department patients.

Our group of over 140 providers of emergency care is the safety net for these patients in Hampton Roads; 26% of the patients we see have Medicaid or a Medicaid HMO.  As care providers , we do not control when and how patients seek care.  The list of over 800 conditions in this program that will be arbitrarily down-coded to the lowest possible level of service regardless of the complexity of care required to appropriately diagnose and treat involves many potentially life-threatening conditions.  This policy violates the prudent layperson standard which has long been in effect in our Commonwealth.

Emergency departments, based on EMTALA law, must evaluate and treat all patients who present to emergency departments regardless of insurance status or ability to pay.  These evaluations often mandate very expensive and time-consuming tests.  It is unforgivable to down-code these situations to a $14.95 payment because no life-threat was found during needed testing.  If enacted, this program will cripple the ability of emergency departments to provide quality access to appropriate and necessary care.

It is inappropriate to place a patient in a position where they are expected to self-diagnose a concerning symptom and to decide whether or not emergency care is needed.  Imagine some one thinking their chest pain was just heartburn and having them die at home from a massive heart attack.

DMAS should halt implementation of this faulty program and should affirm and comply with the prudent layperson standard for emergency department reimbursement