Trying to manage ED abusers

LETTER — Posted Aug. 27, 2012

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Regarding “Report dispels conventional wisdom on what drives ED use” (Article, July 23): An excellent review of a tough problem.

I suggest four aspects not covered:

1. Many patients are on Medicaid because they are no longer able to afford private insurance or pay their own way because of their chronic medical conditions.

2. We try to change the whole system to solve the problems of a few (just like so many other things). With the availability of computers for Medicaid management, the obvious solution to the “abusers of the ED” is to establish counseling of those patients, and have a place for them to go that will accept them and treat their medical conditions — and their abuse of the system. Extra pay may be required. Frequent use of the emergency department is a chronic condition, just like asthma, so a case management approach would be appropriate.

3. The problem with the ED seeing these nonemergent patients is not only crowding of the ED but also that the cost of providing the same care there is higher than when the patients are seen in the non-ED setting. If the doctor/clinic had all the lab and x-ray available, the cost there would go up, most likely. The factors that make the ED more expensive for the nonemergent patient (regulations, etc.) need to be addressed.

4. If you remove the revenue source of the nonemergent patients, even though it is not great, you likely would have to supplement it for the small, rural EDs so they stay viable.

Joseph B. Reed, MD, Buckhannon, W.Va.

Note: This item originally appeared at http://www.ama-assn.org/amednews/2012/08/27/edlt0827.htm.

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