It is the state’s obligation to provide quality medical care

Jeffery Thompson, chief medical officer for Washington’s Medicaid program, was quoted in as blaming the “tremendous overuse and abuse” of the state’s emergency departments on emergency room doctors [“State to sharply limit payment for ER visits,” NWWednesday, Feb. 8].

“The ER physicians and hospitals have been abusing their privileges as providers of ER services for years, having the state pay for non-medically necessary services in the ER,” Thompson said.

As an ER doctor in this state, I find Thompson’s remarks incredibly offensive. His statements demonstrate that what is truly lacking is any sense of responsibility by our state government. Every ER physician I know would wholeheartedly agree that nonemergent medical conditions would more appropriately be treated in lower-acuity settings.

But how, exactly, are Medicaid patients supposed to do that, Thompson? Urgent-care centers, for the most part, will not treat Medicaid patients. The state does not provide enough community clinics so that Medicaid patients can be seen for acute illnesses in a timely manner.

Medicaid patients often can’t find private primary-care providers. Medicaid patients have restricted access to care under Thomson's system and his "solution" only makes this problem worse.

Of the tens of millions of dollars the state intends to save with this measure, how much of that money is going to be reinvested in providing these more appropriate venues?

Thompson blames ER physicians for inappropriate ER visits while failing to acknowledge that ER physicians are required by federal law to see every patient who comes to the ER.

Every ER physician I know works his or her tail off to provide care to everyone that no one else will care for. We do it at night and on weekends, and spend holidays apart from our families because we understand that patients need expert medical care at all hours.

We’re not interested in policing the state to determine who needs care and who doesn’t. We’re interested in relieving pain, treating disease and saving lives.

Thompson is interested in saving the state money. My question is this: If it is not Thompson’s job to see that the state fulfills its obligation to provide quality medical care to its Medicaid patients, whose job is it?

— Reginald Duling, ER physician, Sammamish

These cutbacks will create bigger problems

Regarding the controversial issue of Medicaid cutbacks for ER visits, few would disagree that there is substantial misuse/abuse of the ER for minor problems and for “narcotics-seeking,” and that this is costing state/federal governments a lot of money.

Significant tightening of what is covered is long overdue, but I think this should be done in collaboration with ER physicians, and not as a fiat from state Medicaid officials.

If Medicaid recipients start to receive bills for disallowed ER visits, they are in for a real shock — especially if they are expected to pay the full cost (the “amount charged”) as opposed to the contracted amount (the “amount allowed”), because the former is many times the latter.

Either way, such bills are very unlikely to be paid, and the hospitals will then have to write off the bill completely, resulting in increased insurance premiums for all who pay them.

— Bob Knudson, M.D., Seattle