WASHINGTON - A bill (AJR 9) before the Nevada Legislature that would have amended the state's constitution to cap expenses for emergency care services died without a vote late Monday - a victory for emergency patients.
"States need to make sure that health plans provide fair payment for emergency services, or patients will suffer," said Dr. Andrew Sama, president of the American College of Emergency Physicians (ACEP). "For now, the safety net of emergency health care in Nevada has been protected, but there is no question that if it had become law, this amendment would have set a dangerous precedent for the entire nation. Efforts by health insurance companies or government entities to deny payment for emergency services are unfair to and dangerous for patients. These kind of caps may sound good, but they create huge benefits for health insurance companies while endangering the medical safety net."
This bill would discourage medical specialists who provide critical services to emergency patients from providing those services, because it would limit charges to no more than 200 percent of the federal Medicare reimbursement rate. Unlike emergency physicians, those specialists are not mandated by federal law to see emergency patients.
The Nevada Chapter of ACEP was vocal in opposing this proposed amendment and said it would "destroy" the safety net of medical care in the state.
"If legislation like this is passed that limits or does not allow medical specialists to collect their costs - they simply will stop treating emergency patients, putting those patients at greater risk," said Dr. Greg Juhl, president of the Nevada Chapter of ACEP. "The defeat of AJR 9 is a resounding success for any patient who needs treatment in a Nevada emergency department, and we are anxious to meet with legislators to craft policy that controls health care costs while keeping the safety net intact."
Nevada's proposal is just the latest attempt by state legislatures to make cuts to emergency care services. Last year, Washington State's governor suspended a "Zero Tolerance Policy" that would have denied payments for treating Medicaid emergency patients. Those denials would have been based on a list of 500 final diagnoses the state deemed to be nonurgent. It was also a direct violation of the national prudent layperson standard which requires health plans to cover visits to emergency departments based on a patient's symptoms, not final diagnoses.
"Emergency departments are the only part of the health care system that are always open - all day, all night, all year," said Dr. Sama. "We know from a recent RAND report that even primary care physicians are increasingly dependent on ERs to see their patients after hours, perform complex diagnostic workups and facilitate admissions of acutely ill patients. Health plans also should pay for emergency services based on usual and customary charges, rather than arbitrarily setting rates that are unfair."
ACEP is the national medical specialty society representing emergency medicine. ACEP is committed to advancing emergency care through continuing education, research and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies.