Emergency in the ER: Medicaid shortfall could cost us all

SANDUSKY Hospital ERs face a fiscal emergency, and the prognosis doesn't look good. An increasing number of Medicaid p
Sandusky Register Staff
May 24, 2010

SANDUSKY

Hospital ERs face a fiscal emergency, and the prognosis doesn't look good.

An increasing number of Medicaid patients coupled with a lower reimbursement rate for services means financial trouble for health care providers and physicians.

According to the Ohio Hospital Association, 73 percent of emergency departments nationwide have inadequate on-call coverage by specialist physicians such as neurosurgeons, trauma surgeons, and neurologists.

"Inadequate reimbursement -- both for physician specialists and for hospitals -- further jeopardizes on-call coverage and ultimately patients' health and costs," according to the Ohio Hospital Association.

In November, Gov. Ted Strickland announced hospitals would not receive the 3.3 percent increase for Medicaid reimbursement scheduled to take effect in January. According to the Ohio Hospital Association, physicians have not seen a reimbursement rate increase since 2000.

Keith Dailey, spokesman for Strickland, said the Medicaid caseload throughout the state continues to exceed projections, which makes it increasingly important for the administration to be fiscally responsible.

The Medicaid caseload in Ohio has increased 1.2 percent during the last quarter, said Scarlett Bouder, spokeswoman for the Ohio Department of Job and Family Services. That's an increase of about 18,000 people.

Bouder explained the number doesn't seem too startling, but once it is combined with the existing economic state and bleak economic projections the problem becomes more significant.

There are 1.7 million Ohioans eligible for Medicaid. Since 2003, the total number of emergency rooms visits by Medicaid patients in Ohio rose by 13.9 percent.

"We're seeing the same trends that they're seeing statewide," said Dan Moncher, executive vice president and chief financial officer at Firelands Regional Medical Center.

While the overall number of ER visits at Firelands has remained stable over the last few years, the percentage of Medicaid and self-pay patients have increased, Moncher said.

He said that though the Medicaid reimbursement rate hasn't increased with the number of patients, the quality of care will remain the same.

"Our medical staff is very, very cognizant of the responsibilities that they have," Moncher said. "That does not mean they have not approached us for ways to compensated."

In 2005, Medicaid patients accounted for 14 percent of all ER visits at The Bellevue Hospital. In 2007, that number increased to 17 percent.

JoAnn Ventura, director of marketing for The Bellevue Hospital, said that Medicaid only reimburses the hospital 79 percent of the actual cost of care.

According to the Ohio Hospital Association, the average hospital is reimbursed 92 cents for every dollar spent on the care provided for Medicaid patients.

Ventura said many patients with Medicaid often don't have a primary care physician -- or they wait until an emergency situation to seek treatment.

Because ER treatment costs much more, this is an expensive cycle for both the patients and the health care providers.