Low Medicaid reimbursements hurting NJ in the ER: Opinion – The Star-Ledger – NJ.com (blog)

By David Adinaro

Anyone. Anytime. 24/7/365. This is the motto that emergency physicians embrace. It is also the basis of the federal Emergency Medical Treatment & Active Labor Act that requires hospitals to provide evaluation and stabilizing care to everyone who comes to the emergency department.

As president of the New Jersey Chapter of the American College of Emergency Physicians and an emergency physician for many years, I am proud to be part of the medical safety net that Americans rely on, and that more than 300,000 patients use every day.

Emergency physicians are, however, dependent on access to other medical specialists to properly care for our patients. These on-call specialists are a vital part of the safety net and often have responsibilities to the patient far beyond their time in the ER. Access to these specialists in New Jersey is endangered by low reimbursements from Medicaid and the disastrous state of medical liability. Every day the families of children with broken bones, for example, are unable to arrange follow-up care because so few orthopedists accept Medicaid.

This week, ACEP, the national organization focused on supporting quality emergency care, released the 2014 National Report Card on the State of Emergency Medicine. This report card assesses the support each state provides their emergency care systems. New Jersey received a D-plus — a significantly lower score than the C-plus the state received in the last report in 2009. That decline is due in large part to poor access to needed specialists.

New Jersey received an F for its Medical Liability Environment, as it did in 2009. Malpractice insurance premiums in our state continue to be more than 30 percent higher than the national average. A small pool of insurers, a lack of pretrial screening, and no caps on awards for noneconomic damages are major contributors to this problem.

The report also noted that New Jersey’s Medicaid fees for physicians were only 40 percent of the national average. This ranks our state among the lowest in the country for Medicaid physician reimbursement and is a major impediment to recruiting and retaining vital specialists to the state. While recent changes from the Affordable Care Act will temporarily increase Medicaid rates for primary care, it leaves reimbursement for specialty care unreasonably low.

This combination of low reimbursement and high liability cause needed specialists to decline to be on call for ER patients. ACEP proposes that New Jersey join Florida and other states in enacting legislation that provides liability protection for physicians who provide emergency care mandated under the Emergency Medical Treatment act.
This would encourage more specialists to provide on-call service to local hospital emergency departments, helping to ensure all patients get quality, timely care and appropriate follow-up. That would mean more orthopedists to reset broken bones. More ophthalmologists to tend to eye injuries. More cardiologists to treat life-threatening heart attacks.

We also call on Gov. Chris Christie and the state Legislature to take a serious look at the very low reimbursement that Medicaid offers physicians to take care of some of the sickest patients in our state. It has been many years since New Jersey has raised the Medicaid rates for physicians. Having insurance means nothing if patients cannot obtain the care they need because doctors are unavailable.

New Jersey emergency physicians are proud of the quality care we provide our neighbors, friends and family. Along with emergency nurses and many other dedicated professionals, we look forward to providing state-of-the-art care for more than 3 million ER patients in 2014.

We will be there for our patients 24/7/365.

David Adinaro, MD, FACEP (@PatersonER), is the chief of Adult Emergency Services at St. Joseph’s Regional Medical Center in Paterson and president of New Jersey Chapter of the American College of Emergency Physicians (@NJACEP and NJEmergencyDocs.com).