Testimony - Ohio Commission to Reform Medicaid Public Hearing - April 20, 2004

Dr. David Chauvin, M.D. Premier Health Care Services

Testimony on behalf of Emergency Physicians

I wish to thank the committee members for the opportunity to come before you today and participate in the public hearing to discuss Medicaid reform.

My name is Dave Chauvin; I am an Emergency Physician practicing in Ohio for 14 years.  I am here today on behalf of all Emergency Physicians as well as Premier Health Care Services, a physician owned and operated organization representing over 250 emergency physicians in urban and rural facilities serving a large Medicaid population.

We have read the testimony and presentations from the past meetings and commend the committee for their due diligence exploring ways to reform Ohio's system.

I would like to provide you with the perspective of our specialty of physicians and what we face

  • Emergency physicians provide an essential community service, 24 / 7.
  • Emergency physicians are vital to the nation's health care safety net, caring for all patients who come through the door, regardless of their ability to pay or insurance status.
  • Health care safety net providers are those that have a legal mandate or mission to offer medical care to all patients, regardless of their ability to pay, and have a substantial number of patients who are uninsured or on Medicaid.
  • Emergency providers have the only legal mandate to provide health care - the Emergency Medical Treatment and Labor Act (EMTALA). This law ensures that anyone who comes to an emergency department, regardless of their insurance status or ability to pay, must receive a medical screening exam and be stabilized.
  • According to Centers for Medicaid and Medicare Services (CMS) more than 40 million Americans are uninsured, and 55 percent of emergency services go uncompensated.
  • Emergency physicians bear the brunt of uncompensated care, according to the American Medical Association; they each average $138,300 annually in lost revenue
  • Emergency physicians have the daily "front line" to many social problems including drug and alcohol abuse, child abuse, domestic violence, elder abandonment, infectious diseases and sexually transmitted diseases.
  • Emergency physicians have become significant providers for the working poor, indigent and Medicaid population due to the lack of other medical access.

Even though the emergency physicians are truly a safety net provider, budget issues have driven states to continue to reduce the provider fee schedule as a measure to "balance" limited dollars.

Reducing eligibility also is a budgetary measure that creates additional burden of uncompensated care onto the Emergency Physician.

These traditional measures can not continue as the burden on the physician will increase access to care issues.

Emergency Physicians throughout the nation have been working collaboratively with government creating innovative solutions for a win - win solution to impact escalating medical costs

The reform most prominent reform for emergency physician is in the state of Michigan. In essence, case rates were developed for two levels of care.

One rate for patients that were treated and released and another rate for patients that were treated / admitted / or transferred.

This has proven to be advantageous to reducing the line item for emergency physician reimbursement while providing adequate reimbursement for services rendered to Medicaid recipients.

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