A Letter from the President of Iowa ACEP to Governor Branstand

Dear Governor Branstad,

I appreciated showing you the Emergency Department at the University of Iowa prior to your latest election and appreciate this opportunity to comment on the Healthy Iowa Plan 1115 WAIVER APPLICATION and the Iowa Medicaid expansion issue.

The Iowa chapter of the American College of Emergency Physicians strongly supports increased access to care for all Iowans. We appreciate that the state is expanding its Medicaid program to provide more access for our population.

However, we are very concerned that the Healthy Iowa plan includes a provision for co-pays for Emergency Department visits if the visit is later determined to be non-urgent. Determining the legitimacy of an emergency department visit from the final diagnosis documented is not appropriate and contradicts the Prudent Layperson Law (Effective 8/15/97, R.S. 22:657 (D) (2)). We also feel such a copay, applied only after the diagnosis is made, puts patient safety at risk and will weaken the already fragile safety net emergency departments across the state provide. Studies show that most emergency department visits are true emergencies.*

*http://www.rand.org/pubs/external_publications/EP20040204.html

*http://www.cdc.gov/nchs/data/databriefs/db38.pdf

*http://www.ncbi.nlm.nih.gov/m/pubmed/23512061/

To provide an example: think about the situation of the patient who hurts their ankle. If the patient trips, their ankle is swollen, tender and they are concerned that they have an ankle fracture. X-rays however reveal that the ankle is not broken. The final diagnosis is ankle sprain which is considered a non emergent diagnosis. Yet if the same patient had the x-rays and it was positive for fracture, the diagnosis is ankle fracture, very much an emergent diagnosis. There is no way for a layperson (or a physician!) to know ahead of time if the x-rays were to be positive or negative and further care drastically different. Imagine a similar complaint of chest pain. Is it indigestion or a heart attack? An Iowan will die instead of seeking care if such a provision is not corrected.

Thank you for the opportunity to work together to improve healthcare for Iowans. Please feel free to contact me anytime, as we would be happy to provide council as you work to address these important healthcare issues for Iowans.

Sincerely,

Michael P Miller, MD FACEP

President

Iowa American College of Emergency Physicians

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