Bacon's Rebellion

Democracy Thrives in Sunlight

Take a Seat, the Doctor Will See You Shortly

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by

Dick Hall-Sizemore
in

By Dick Hall-Sizemore

The latest action by Virginia hospitals is sheer chutzpah.

The 2020 General Assembly adopted actions aimed to reduce state Medicaid payments for emergency room services later deemed to be unnecessary. As described by the Richmond Times-Dispatch, the aim was to discourage Medicaid recipients from unnecessary use of emergency departments instead of seeking care from their doctors or urgent care centers. “They should talk to their primary care physician,” said Del. Mark Sickles (D., Fairfax), chairman of the House Health, Welfare, and Institutions Committee and vice-chair of the House Appropriations Committee.

The Virginia Hospital & Healthcare Association has sued. The suit filed in federal court claims that the budget cuts enacted along with the provisions regarding emergency rooms “will cause irreparable harm not only to needy patient populations, but to hospitals and physicians” which are struggling as a result of the challenges posed by the pandemic.

According to the RTD, the hospitals acknowledge the need to reduce unnecessary use of emergency rooms for conditions that could be treated more efficiently and less expensively elsewhere. However, and this is where the chutzpah comes in, they lament that they have no choice under law but to treat Medicaid patients that show up at emergency rooms for treatment.

That is true; they are required to treat whoever shows up. But, they are not required to blanket the landscape with huge billboards advertising short wait times in their emergency rooms. It does not take a genius to figure out which facility that a mother with a feverish, cranky kid is going to choose: an urgent care center where she may have to wait 30 minutes or an emergency room that advertises in three-foot tall red lights a wait time of 13 minutes.

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9 responses to “Take a Seat, the Doctor Will See You Shortly”

  1. LarrytheG Avatar
    LarrytheG

    re: ” The Virginia Hospital & Healthcare Association has sued. The suit filed in federal court claims that the budget cuts enacted along with the provisions regarding emergency rooms “will cause irreparable harm not only to needy patient populations, but to hospitals and physicians” which are struggling as a result of the challenges posed by the pandemic.”

    Now this is really ugly. Perhaps Dick and Jim Sherlock have some common ground? 😉

  2. James A. Bacon Avatar
    James A. Bacon

    Haha, Dick, you and I were writing on the same topic at the same time. You make a very good point that I overlooked — maybe hospitals need to stop advertising their emergency rooms.

    The fact that hospitals do advertise their emergency rooms prompts questions. How profitable are emergency rooms to hospitals? Would they advertise if ERs were not extremely profitable? How are ER reimbursement rates set? How come ER physicians are organized in their own independent physician groups?

    1. LarrytheG Avatar
      LarrytheG

      I don’t really have a problem with advertising emergency room wait times. First, it’s competition and second, apparently a lot of people who SHOULD have gone to an ER have not – because they were afraid of the virus and some died… so ER’s provide an essential life-saving service and need to do that.

  3. djrippert Avatar
    djrippert

    “Free stuff” meets marginal cost. A 24 X 7 X 365 emergency room has doctors, nurses, equipment, lighting, etc even if there is nobody receiving treatment. The marginal cost of seeing a patient is low. Most adults in Medicaid have small copayments for some services. The copayments are usually $1.00 to $3.00 for each service. What is the Medicaid co-payment for an ER visit?

    So long as the marginal cost for an ER visit is lower than the reimbursement hospitals receive those hospitals will want patients in the ER. Marginal costs for basically idle ER facilities must be very low. Hence the wait time advertising.

    So long as the out of pocket costs for an ER visit are very low people will use the ER. Why call and try to find a doctor who takes Medicaid then schedule the appointment then wait when you can just go to the ER?

    Of course it’s the working families in Virginia who subsidize all this. Hospitals rake in profits which lets them pay off the politicians. Medicaid recipients don’t have to wrangle with primary care physicians, just walk into an ER day or night. Both visible and hidden taxes keep rising as the General Assembly passes various laws and pockets various political contributions.

    Given the economic incentive systems in place this is inevitable.

    1. Dick Hall-Sizemore Avatar
      Dick Hall-Sizemore

      The provisions that the GA enacted this past session and about which the hospitals are complaining show that the politicians are not completely in the pockets of the hospitals as you claim.

      1. djrippert Avatar
        djrippert

        The Certificate of Need process in Virgina shows they are. Pandemics end but payola in Virginia goes on forever.

  4. LarrytheG Avatar
    LarrytheG

    The thing to recognize is that reimbursement whether it be employer-provided health insurance or MediCARE or Medicaid means the insurance company is deciding what services you can receive that are “covered” – not you.

    If a Medicaid person wants into an ER – the question is – is Medicaid going to cover it.

    Yes, taxpayers are paying for this – and all the more reason that reimbursements BE stingy and only what is absolutely necessary.

    We have no answers to alternatives to Medicaid. We’ve spent decades yammering about it and no answers were forthcoming other that some who were blathering about the “free market” as if that would actually help those who qualified for Medicaid.

  5. Baconator with extra cheese Avatar
    Baconator with extra cheese

    The premise of telling Medicaid patients who and when they can see a provider is hilarious. This is the same system which gives EBT benefits to people who disproportionally are obese and have diabetes yet won’t restrict the goods, like the WIC program, that can be bought with those “benefits”. Laughable….. and not very woke.

    1. LarrytheG Avatar
      LarrytheG

      You must not be on Medicare or you would not have made that statement but what entitles anyone to Medicare to start with? And why would you be able to tell Medicare who you want to see any more than say an insurance company that tells you who is in your network?

      Should Medicare deny you insurance because you are old or have diabetes , etc? They could save a crap-load of money if they actually did that – probably only 1 or 2 in ten would actually qualify for Medicare.

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