Washington ACEP Aims to Overturn Medicaid Limits

The suit alleges that despite the state’s budgetary issues, the new policy is illegal. The HCA did not follow the legislature’s directive to work cooperatively with the medical societies, and the agency also did not properly adhere to a rule-making process, the suit claims. The policy also conflicts with federal law and "is arbitrary and capricious" because it "includes numerous diagnoses that represent true emergencies," according to the Sept. 30 filing in the Superior Court of Washington for Thurston County.

Dr. Thompson said that there are numerous exceptions to the policy, including if the patient has abnormal vital signs on presentation, has trauma, or abnormal lab findings. Patients who arrive by ambulance or police, for mental health services, or who are admitted will also be exempt.

The emergency room physicians "are in total control of all the coding," said Dr. Thompson.

Dr. Anderson said the exemptions list is "convoluted" and that having to document the exceptions is "one more thing to take you away from treating the patient." And, he said, if the hospital is denied payment but has already paid the physician, the HCA reserves the right to retroactively recover that money from the doctor.

He said he is hopeful that there may be some common ground between ACEP and the HCA in the chapter’s new proposal.

In the meantime, others are taking notice of the HCA’s actions. Dr. Thompson recently gave a Grand Rounds presentation on the ED policy at Johns Hopkins University School of Medicine in Baltimore.