Lisa Maurer, MD, FACEP

One of WACEP’s three priority issues this year is to improve Wisconsin's Medicaid reimbursement for emergency care.  For many of you who are seasoned members of this organization, you know that this is not a new goal.  Before your eyes glaze over and you scroll on, know that this is now a truly re-energized movement for the last few years, and we are closer than ever.  We are currently having active meetings with the decision makers within DHS, who now recognize that as our emergency physicians are being reimbursed worse than any other state in the nation, our healthcare safety net is not sustainable.  Record-low reimbursement for federally-mandated care is making it hard for our physician groups and hospitals to compete with Illinois and Minnesota for quality emergency physicians. 

Perhaps we are getting such a captive audience within DHS because we come with solutions on how to trim unnecessary costs from the Medicaid budget, which funds could then be used for proper reimbursement.  It makes sense, right? We are emergency physicians, we are the solutions people. Our board has been working for years on gathering data on several ideas of how the state might not only maintain or improve quality of care delivered in the emergency department, but how they can save money doing it.

What would you do?

Looking at Medicaid waiver demonstrations in many states, the current trend to save money i state budgets is to implement work requirements as a condition of eligibility for Medicaid, increase cost-sharing for Medicaid enrollees, and - right in our backyard - add ED copays.  In fact, Wisconsin DHS has applied for a waiver demonstration in our state that would implement work requirements, impose drug screening, and also add copays for ED care.  To clarify, whereas traditionally allowed ED copays for Medicaid enrollees are applied to visits determined to be “non-emergent,” the proposed ED copays in Wisconsin would be for any ED visit.  This does sound appealing at first glance, but history has proven that states that implement ED copays do not actually reduce non-emergent visits to the emergency department nor save money on their Medicaid budgets.

So again, if our state is currently using the above-mentioned methods for saving money and attempts at decreasing non-emergency visits to the emergency department, but perhaps will not be very successful, what should we tell them to do instead? Is there a certain health system flaw in Wisconsin that leads patients to your ED unnecessarily?  Have you found a practice pattern that helps Medicaid beneficiaries to get plugged into the appropriate outpatient resources in your community?  Do you think that if EM physicians participate more actively in determining which visits were non-emergent, then the ED co-pays would be more effective?  I sincerely believe that emergency physicians are unavoidably systems-minded physicians and have many solutions to offer that might be more insightful than what the agency professionals can see from the outside. Let's help them, let's be part of the solution. Let's get this system change done this year to bolster our state’s emergency medicine network.  Send me your ideas!