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Plans to Penalize Non-Emergency Use of ERs Flawed: Study
Date:3/19/2013

By Amy Norton
HealthDay Reporter

TUESDAY, March 19 (HealthDay News) -- Some U.S. states have proposed denying Medicaid payments in cases where emergency department visits turn out to be "non-emergencies," but a new study highlights the flaws in that plan.

The problem, the researchers report, is that even when an ER patient's condition turns out to be minor, the initial symptoms are usually ambiguous: chest pain, abdominal pain, high fever. These are all symptoms that could spell serious trouble, or be something much milder.

And it's unreasonable to expect the average person to know what those symptoms mean before heading to the ER, said study author Dr. Maria Raven, an assistant professor of emergency medicine at the University of California, San Francisco.

"You can have two people who come into the ER with the same symptoms, and one will turn out to have a life-threatening illness and the other has a minor illness," said Raven.

If a 65-year-old man wakes up with chest pain, Raven explained, "the only reasonable thing to do" is to get to the ER. If it ends up that he only has a severe case of heartburn, he -- and the ER -- shouldn't be penalized, she argued.

Raven said recent policy moves in some U.S. states were the motivation for her team's study, which appears in the March 20 issue of the Journal of the American Medical Association.

Several states, including Washington, Tennessee, Iowa and New Hampshire, have considered or passed new Medicaid rules that limit payments for ER visits that turn out to be non-emergencies, based on patients' discharge records.

So, Raven's team used information on nearly 35,000 U.S. ER visits in 2009, to see if discharge diagnoses are a fair way to gauge whether a patient's ER trip was justified.

They found that only 6 percent of the ER visits ended with diagnosis that could have been handled by a primary care doctor. And even then, the patients
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