New Medicaid Program

Two counties in Indiana have received a $1.6 million dollar grant from the Centers for Medicaid & Medicare Services, the Indiana Family and Social Services Administration in hopes to reduce costly Emergency Room visits for non-emergency care.

The two counties are Tippecanoe and Marion.

Over the next two years, these counties will create two outpatient care clinics working with Wishard Hospital in Indianapolis and Tippecanoe Community Health Clinic and St. Elizabeth's Hospital in Lafayette to provide services to Medicaid clients from the surrounding counties.

Advanced practice nurses and a patient navigator will staff both clinics.
Patients will also be screened for underlying mental health concerns, such as depression and anxiety.

The attempt is to create something that looks like a retail-based urgent care center but staffed with advanced practice nurses specifically trained with a background in screening and identifying individuals with mental health disorders.

But the problem will still remain that unless Medicaid patients are forced somehow to use these clinics, I do not see things changing.

As most everyone knows, a large percentage of ED visits could be more appropriately addressed in an outpatient setting if the patients just chose to do so.

But the statistics show that nonspecific complaints are very common in the ED and the most common non-emergency visits by Indiana Medicaid patients include complaints of:

• Ear, nose and throat
• Abdominal and back pain
• Headaches
• Anxiety and depression

This project is another attempt to get Medicaid patients to utilize the healthcare system in a more reasonable fashion.

Indiana's Medicaid recipients have a higher ED utilization rate than the national average with an average of 89 visits per 100 Medicaid recipients.

Another one of the goals of the program is to plug people in to a primary care provider for follow-up. But once again, the patients have to do this.

This initiative will also attempt to educate patients on appropriate use of the ED but as long as ED visits remain completely free for Medicaid patients, behaviors are unlikely to change.

We know that people use the emergency room as their family doctor, and that's really inappropriate but when a service costs nothing, there is never an incentive to change or realize the true value.

Over-utilization ties up costly resources and it inhibit Medicaid clients from finding true primary care providers and better overall medical care.

A better solution according to most physicians would be to place a small fee on Medicaid recipients in order to use the ED. A fee of $5 would deter many non-emergent visits and save the Medicaid program millions. The fee could be waived for true emergencies.

Without emphasizing personal and financial responsibility, these other changes will likely not work.