In an effort to avoid dangerous changes to the state Medicaid ER payment structure, WA/ACEP, working with the Washington State Medical Association (WSMA) and the Washington State Hospital Association (WSHA), successfully convinced state lawmakers to enact a budget provisio that includes a “Best Practices” approach to reduce unnecessary ER visits. Initially, the state sought to deny Medicaid payments for hundreds of common ER diagnosis, putting patients, hospitals and physicians at risk. This Best Practice approach is the product of more than a year of hard work by leaders of WA/ACEP, WSMA and WSHA. In order to avoid the Medicaid no-payment policy on July 1, 2012, hospitals are expected to adopt and implement the seven Best Practices by June 15, 2012. An attestation letter must also be submitted to the Health Care Authority. Please visit the links below to see how your Emergency Department can utilize these Best Practices to better serve its patients.
Best Practices Tool Kit
Seven Best Practices
Instructions for completing best practice documentation
Webinar Schedule (under Calendar of Events)
Prescribing Pain Medication Patient Education Poster (available in several languages)
Help Patients Choose the Right Place for Care – Patient education brochure
(Versions: English, Russian, Vietnamese, Spanish)
More Information ER is for Emergencies
Prescription Monitoring Program
Washington State Hospital Association
A Letter from the WA/ACEP Board of Directors Regarding Opioid Guidelines
March 31 – Washington Gov. Chris Gregoire suspended the April 1 implementation of the Zero Tolerance Policy that would have denied payments for treatment of Medicaid patients that the state retrospectively deemed to be non-emergency visits, according to WA/ACEP member Dr. Nathan Schlicher. The state legislature is still in special session this week considering its budget, which is now expected to include a physician-penned alternative plan, designed to help the state reach some of its budget tightening goals, but also uphold the national prudent layperson standard. “We hope that the legislature will close business next week, include in their work our alternative plan that is already drafted into a proviso in the house budget, and let us get to the work of improving the delivery of care,” said Dr. Schlicher, Associate Medical Director at St. Joseph Medical Center in Tacoma, WA and Legislative Affairs Chairman for the Washington ACEP Chapter. The Washington Health Care Authority (HCA) originally had proposed limiting Medicaid patients to three ED visits that the state determined were not emergencies. But as a legal battle got underway, the state revised their plan and offered the Zero Tolerance Policy. Read more
On April 1, the Washington State Healthcare Authority (HCA) plans to stop paying for all emergency department visits for Medicaid patients if HCA deems those visits “not medically necessary” in the ED setting. The HCA is pointing the finger squarely at Medicaid patients and distorting the issue to deny care to people with real emergencies.
Help protect Medicaid patients by asking your legislators to support an alternative plan proposed by the Washington Chapter of the American Academy of Emergency Physicians (WA/ACEP), Washington State Medical Association (WSMA), and Washington State Hospital Association (WSHA). Find out how you can help.