Non-Emergent Care and Medicaid

People insured by Medicaid are quite likely to be drawn to emergency rooms by marketing campaigns such as HCA's "Moving at the Speed of Life" because they often do not have a primary care physician and fewer physicians are willing to accept them because of the low payments Medicaid makes for their care. The fact that they can receive care at a much lower cost to taxpayers in a retail or urgent care clinic is not a factor in their choice of where to go for care when they need it, and they are probably unaware of the relative costs of their care at these various locations. (See yesterday's post, Emergent and Non-Emergent Care: Definitions and Consequences.) Hospitals have no incentive to divert Medicaid patients because they receive a fee for every emergency department service provided. (Kaiser Health News and The Washington Post have collaborated on this subject as well.) Here is a key quote from South Carolina's Medicaid Director Anthony Keck: "Many hospitals are actively recruiting people to come to the ER for non-emergency room reasons. When you are advertising on billboards that your ER wait time is three minutes, you are not advertising to stroke and heart attack victims."

Medicaid is a joint federal-state program, and three states, Washington, Iowa, and Tennessee, have responded by limiting what Medicaid will pay for emergency room services. An especially inappropriate new practice is making the distinction between emergent and non-emergent care at the time of the final diagnosis. A Medicaid patient arriving with chest pain in my example yesterday may be required to pay the full price of emergency room care if the final diagnosis is heartburn instead of a heart attack. Similarly, neither the doctor nor the patient knows at first whether back pain is due to muscle spasms (non-emergent care) or a life-threatening aortic dissection (emergent care).