It seems these days that the way to get things done in this country is to work through the courts instead of the legislature. This has been done successfully of late in several states by advocates for same-sex marriage. Now, California Emergency docs have sued their state for fair compensation from the state’s medicaid system (Medi-Cal). After a decade of unsuccessful lobbying efforts with the state’s congress, the docs of 5 EM groups have banded together in a class action suit to try to force some changes to the way they render care and are compensated for medicaid patients. To no one’s surprise, the docs claim that they lose money on every Medi-Cal patient they see (although other states may pay better, I don’t know too many ER docs anywhere that claim they make any average profit seeing medicaid patients). Some may say that seeing medicaid patients is part of a doctor’s obligation to treat patients and to some degree I agree. However, we are under a different set of legal obligations than all other docs (unless they are on call which technically, they can decide not to do). We have EMTALA which requires us by law to treat everyone that presents to the ER regardless of their ability to pay. No other docs have this rule. So as quoted in the article:
“The plaintiffs argue that DHCS violates the Equal Protection Clause of the U.S. Constitution and a section of the California Constitution because EPs are treated in an unlawful and unequal manner compared with non-emergency physicians, who retain the right to choose which patients to treat.”
They also go on to state:
“The suit also maintains that the plaintiffs’ medical services constitute a property interest because they offer the value of their medical education, professional experience, and actual care rendered. Providing these medical services to Medi-Cal patients without appropriate reimbursement results in a violation of the Fifth Amendment and the California Constitution, which prohibit unlawful takings, according to the suit.”
Whether this suit will be successful is up in the air (personally I think it won’t be), however it will be interesting to hear the debate on the subject (and how it will apply to any future health care reforms).
Here is my opinion on this. We all pay taxes to support our states’ medicaid funding. Doctors pay more on average because we make more than average income. This includes ER docs of course. However, we are also “paying” again to treat them in the ER at a financial loss (65 dollars max payment for a Medi-Cal patient does not even come close to cover operating expenses). Also, we are exposing ourselves to legal risk treating them (and thus pay higher malpractise premiums than most docs). So we are “paying” 2 * times! (The * is the potential for a lawsuit). Again, this is because of EMTALA.
My argument would be if increased payments to ER docs is not possible (due to a myriad of reasons), that we should get a tax credit for providing such care. If you work in an ER, you should get a tax break commensurate with how much medicaid care you provide because of EMTALA. I have no problem providing care to these patients but it makes sense that we don’t get double dipped (and then sued for our mandated efforts…..).