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Medical community opposes Medicaid's new rules on ER visits

The issue of patients going to hospital emergency rooms for routine medical care isn’t going away, but Medicaid coverage for expensive and often unnecessary ER visits is, at least to some extent.

“This is a very frustrating thing for us and our physicians,” said Scott Bosch, CEO of Harrison Medical Center in Bremerton. “We think it’s bad medicine, period.”

What Bosch and many doctors don’t like is the recent decision by the state Medicaid program to limit coverage of non-emergency trips to an emergency room to three per year. The fourth or additional such visits by Medicaid patients will not be paid for by the program, and hospitals will be able to bill those patients for the treatment they receive.

“Many of these people don’t have a lot of resources, and they don’t have lot of alternatives,” Bosch said. “They don’t have a primary care physician, because they can’t afford one.”

He said doctors, particularly ER physicians, think the list of medical conditions that Medicaid designates as not requiring emergency care is too extensive. Their concern, he said, is that worries about getting billed for an ER visit may result in people “delaying getting care or ignoring altogether a serious medical condition.”

He acknowledged that overuse of emergency rooms is a problem, and a costly one that needs to be addressed.

“But this solution of limiting the payments for services after three visits doesn’t seem like the right solution,” Bosch said.

He said the new coverage limits would result in Harrison — which operates a 24/7 urgent care center in Port Orchard — absorbing about $200,000 a year in costs of treating people who can’t pay for ER visits.

“This is one more way for the state to cut the Medicaid budget, but it’s putting the burden of trying to manage this population on us,” he said.

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