As it is July in Missouri, many of us are enjoying the predictably hot and humid days, county fairs, and the end of summer vacation. However, despite the rising thermostat, the MOCEP board of directors has not slowed down their work yet. At times it seems that we are playing a never ending game of “whack a mole” as new threats to the care of emergency medicine patients keep arising. The newest attack has come in the form of “avoidable ER visits.” If you have not already been confronted with this issue at your hospital, we can expect it to continue to spread over the course of the next year.
A perception has been created by insurers that hordes of patients with low acuity complaints are flooding emergency departments across the country which is driving up costs for all of us. However, they fail to mention that the CDC released in 2014 that 96% of ED visits are at least urgent. They also failed to mention that emergency medicine costs are only 2-4% of all health care expenditures. Despite these facts, insurers such as Anthem are developing plans to stop paying for “low acuity” visits. As of June 1st, Anthem notified its customers that if an ED visit was determined to be “low acuity” after being first identified on a list of nearly 2000 ICD-10 codes, the claim would be denied. They also claim to fulfill the prudent layperson standard by reviewing the ED record to determine if it was possible the patient could have thought he/she had an emergency. Obviously this policy is fraught with peril. Please know that MOCEP in conjunction with its partners at MSMA and MHA are working tirelessly to protect our patients’ right to access emergency care. We will continue to provide updates on our progress as they become available. Similarly, we continue to work on our counter proposal to MO HealthNet’s low acuity non-emergency (LANE) proposal. We hope to have a final plan to present in September.
Finally, MOCEP is also currently reviewing and monitoring the governor’s executive order on the establishment of a prescription drug monitoring program (PDMP). MOCEP has always been a staunch supporter of a statewide, functioning PDMP program. However, the PDMP created by the executive order focuses on “catching” or punishing patients inappropriately attaining prescription opioids and physicians prescribing opioids inappropriately. How patients and physicians will be identified is unclear at this point. However, we do know that a PDMP that is available to physicians to query at the time of care delivery is essential. MOCEP will continue to work with its partners on a solution that will improve the quality of care that can be delivered.
As always, please do not hesitate to contact me with any questions or concerns.
Jonathan Heidt, MD, MHA, FACEP
President – MOCEP