VIRGINIA COLLEGE OF

EMERGENCY PHYSICIANS
2020 Board of Directors March 20, 2020
K. Scott Hickey, MD, FACEP
President Scott Hickey, MD
Cameron Olderog, MD, FACEP
President
President-Elect
Todd Parker, MD, FACEP
VA College of Emergency Physicians
Secretary-Treasurer 2924 Emerywood Parkway, Suite 202
Bruce Lo, MD, MBA, FACEP Richmond, VA 23294
Immediate Past President
By email
Trisha Anest, MD, MPH, FACEP
Jon D’Souza, MD, FACEP Dear Governor Northam,
Josh Easter, MD, FACEP
Randy Geldreich, MD, FACEP
First, we want to express our appreciation for your support and leadership during the COVID-
Jared Goldberg, MD, FACEP
19 outbreak—never in the history of the Commonwealth has it been so important to have a
Christopher Hogan, MD, FACEP
physician as our Governor as it is today. We are proud to be serving on the front lines,
David Fosnocht, MD, FACEP
Sarah Klemencic, MD, FACEP
continuing to help patients as we navigate these new waters together.
David Kruse, MD, FACEP
Joseph Lang, MD, FACEP I am writing to you today, amid this unprecedented healthcare crisis, knowing that you still
Joran Sequeira, MD, FACEP have a duty to balance our budget as the economy is being shaken to the core. On behalf of
C. Christopher Turnbull, MD the Virginia College of Emergency Physicians, I am asking you to stand up for our healthcare
Shanon Walsh MD, FACEP safety net and the emergency physicians by vetoing budget amendment Item 313#28c.

Executive Director This amendment wrongly re-instates a Department of Medical Assistance Services (DMAS)
Sarah Marshall program that the General Assembly eliminated in 2015 to allow Managed Care Organizations
Cell: (804) 503-1865 (MCOs) to reduce the payments to emergency physicians if the patient’s visit ends up being
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on an “avoidable” emergency room (ER) visit list. To be clear, if the Medicaid visit is found
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to be “avoidable,” the MCOs would be allowed to pay level two (low/moderate complexity-
2924 Emerywood Pkwy. $29.21), level three (moderate complexity- $43.70) and four (high complexity-$82.90) cases
Suite 202 at the level one payment of $14.98.
Richmond, VA 23294
This policy is wrongheaded for a variety of reasons, including the following:
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Fax: (804) 747-5022
1. It is not supported by DMAS. At their June 11, 2013 board meeting, the Board of
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Medical Assistance Services voted to support the termination of the DMAS practice
of pending 99283 emergency services claims, the final vestiges of a program that had
slowly been eliminated since its inception in the late 1980s. That policy position has
not been reversed. This amendment was NOT requested by DMAS for inclusion in
the biennial budget nor did you include it.
2. Emergency physicians cannot turn anyone away and are legally required to treat
them under the Federal EMTLA law and the Federal and State “prudent layperson”
standard that says we must treat patients for their presenting symptoms. Not only is
prudent layperson in our current Code, but in SB172, Senator Favola’s bill to ban
surprise billing, all the parties involved agreed to put even stronger language in the
law that makes it clear that a determination cannot be made on the basis of diagnosis.
a. A qualifying medical screening examination can rarely be performed based
on the limited information obtained at triage, and life-threatening conditions
may be present, even with apparently benign initial presentations. Further,
under Federal and state “prudent layperson” standards, patients who seek
treatment when concerned they have an emergency condition must be
covered. For example, a sore throat may be a minor infection, an infection
requiring surgery, or even a stroke. Chest pain may be a pulled muscle,
heartburn, or a heart attack or blood clot in the lungs.
b. Instead, under this policy the state would allow the MCOs- who are the
ones getting paid to specifically manage the Medicaid patient’s care—to be
able to look at the final diagnosis and pay an emergency physician $14.98 if
a headache was diagnosed after an evaluation to rule out an aneurysm.
 3. It is an incorrect assumption to equate reducing payments to emergency physicians
with reducing the number of Medicaid patients who use the emergency department.
Not paying physicians will have ZERO impact on a patient’s decision to use the
emergency department.
4. In 2017, Virginia made a commitment to implement the Emergency Department
Care Coordination Program to appropriately address the issue of over-utilization in
the emergency department. Now, all the emergency departments across the
Commonwealth are connected, are given real-time patient data access to the
emergency physicians, MCOs and private insurers which include care plans for the
“super utilizers” including information on their primary care physician, mental health
provider and history of opioid usage. Continued investment in EDCC is the way to
reduce over-utilization, not allowing MCOs to deny payment to physicians for care
they have given.

Emergency physicians have always been dedicated to taking care of all patients, regardless of
their ability to pay. I have never been prouder to be an emergency physician than in the last
month when we have rallied together to take care of patients during the deadly COVID-19
outbreak. If this policy went into effect as written, Medicaid patients who have the symptoms
of COVID-19 who are treated in our ED as such, but when a test comes back negative, would
allow the MCO’s to pay us only $14.98 if the visit was determined to be “avoidable.” We do
not believe this policy is aligned with your Administration’s goals and as such, ask you to
veto Item 313#28. Instead, keep Item 313#50c that establishes a workgroup to look into how
to appropriately reduce ER utilization.

Thank you for your leadership, your service and your attention to this issue at a time when
you have so many more pressing issues on your plate. If you have any questions, please don’t
hesitate to contact Aimee Perron Seibert, [email protected] or
804.647.3140.

Sincerely,

Scott Hickey, MD
President
Virginia College of Emergency Physicians

cc: Clark Mercer, Chief of Staff