Well this is also nice!

[Janders]

http://www.mass.gov/eohhs/docs/masshealth/bull-2015/all-251.pdf

medicaid refusing to pay ED visits they deem non-emergent.
Can't balance bill medicaid patients.
EMTALA insists you must see all patients (at least as far as determining any potential for an emergency...)
Summation = forced to work for free

This is worst than the WA state plan where they didn't pay after 3 non-emergent visits. And it isn't based on presenting complaint, but instead final diagnosis....

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[The White Coat Investor]

It's kind of fun when they change the rules to see if you can still win the game. Now, instead of "URI," my final diagnosis for that Medicaid patient will be:

1) SIRS- Resolved
2) URI

or
1) Dyspnea
2) URI

or whatever they decide they will pay for. I mean, give me a break. This isn't that tough to beat. And Medicaid patients never paid that much anyway. I'm much more concerned about the issues with the insurance companies not having to pay us fairly.

 

[Old_Mil]

The even bigger concern will be the inevitable administrative pressure not to order things that won't be reimbursed which will increase your risk of being sued. Which will occur on an even larger scale when CMS rolls out ita doctor ranking scheme under the name of quality assurance.

All these things have one goal: Make you responsible for rationing while leaving you liable for the missed diagnoses when you do.

The only way to win is not to play.

 

[goodoldalky]

I'd be leaving MA long ago.. my .02

 

[GeneralVeers]

Australia and Dubai are looking better and better.....

 

[Janders]

In general, MA is not a bad place to practice EM. Perhaps not the best, but the combination of malpractice / pay is in the reasonable category compared to many parts of the country.

The posted policy currently only applies to one part of mass health (the part largely for non-citizen immigrants). As such, and like usual, I completely agree with whitecoatinvestor... this is not as big of a deal as allowing commercial insurance to pay next-to-nothing like the other thread. However, this is still a huge deal, and a potential massive slippery slope, just like the WA three-strikes provision a few years ago.