Emergency Rooms

Last week Kaiser ran a Phil Galewitz story on for-profit hospitals that were screening emergency room patients.  Patients deemed to have non-emergency conditions were required to make a pre-payment, as much as $150 in HCA's case.

This week Kaiser noted a Wall Street Journal article on a Washington state Medicaid plan to stop reimbursing emergency rooms for providing non-emergency treatment.

Is there a meaningful difference between these policies?  For-profit corporation and state program alike, they both utilize financial incentives to prevent emergency rooms from being used for non-emergency care.  They demonstrate the point that rationing care isn't really optional, it is already happening.

What is optional is how much discretion and transparency we allow in the process of rationing.  The for-profits and Washington are opting for rote standards where care givers have no flexibility in distinguishing what care is necessary (and reimbursable) from what is not.  Contrast that with Oregon's CCO plan, which goes the opposite way in trying to find savings by empowering providers.  I don't know which approach will prove the better, but I know which one I'm rooting for.