Medicaid users wasting millions in ER visits

Medicaid users wasting millions in ER visits
Published: Aug. 8, 2016 at 3:11 PM EDT|Updated: Aug. 9, 2016 at 3:14 AM EDT
Email This Link
Share on Pinterest
Share on LinkedIn
Chart showing Kentucky Medicaid Emergency Room Utilization during Calendar Year 2015. (Source:...
Chart showing Kentucky Medicaid Emergency Room Utilization during Calendar Year 2015. (Source: Kentucky Cabinet for Health and Family Services)
Chart showing Emergency Room visits paid non-emergent by MCO. (Source: Kentucky Cabinet for...
Chart showing Emergency Room visits paid non-emergent by MCO. (Source: Kentucky Cabinet for Health and Family Services)

LOUISVILLE, KY (WAVE) - It is the state of Kentucky's $384 million dilemma. That's how much Kentucky taxpayers spent on emergency room visits for people on Medicaid last year.

"It's like the fast pass at Disney," said Louisville Metro Councilman James Peaden. "Call an ambulance."

Now, a WAVE 3 News Investigation uncovered tens of thousands of those ER visits, were for non-emergencies. Things that could have handled by a regular doctor, saving taxpayers millions.

Records obtained by WAVE 3 News show Kentucky is wasting millions of dollars on unnecessary Emergency Room visits for Medicaid users. Like more than $143,000 in ER visits in 2015 for Diaper Dermatitis, also known as diaper rash.

>> Emergency Room Utilization - Calendar Year 2015

Ashley Duncan, who has an 8-month-old daughter named McKinley, said you don't exactly need a medical degree to treat that.

"They call it Butt Paste, it's kind of a funny name," Duncan said holding the cream mom's commonly use to treat diaper rash. Butt Paste is available at about any drug store.

WAVE 3 News also found taxpayers are paying millions of dollars for people to be treated in the Emergency Rooms for constipation, headaches and ear aches.

And that's just the start.

Taxpayers spent around $300,000 in ER visits for various forms of rhinitis, or runny nose. Even when it's caused by the family pet.

Medicaid users come to the ER for cramps, insect bites, sunburn, acne.

They come because they can't quit smoking.

They get emergency treatment for a headache after sex.

And remember, you are paying for virtually all of it. Why? While many are faced with huge co-pays from our private insurance companies when they use the Emergency Room, people on Medicaid don't have that problem.

Vickie Yates Brown Glisson is the Secretary for the Cabinet for Health and Family Services. She said she's concerned taxpayer dollars are being wasted.

"When I see numbers that you are quoting, what it just says to me is, they're in the wrong treatment spot," Glisson said.

Kentucky Medicaid Commissioner Stephen Miller agreed.

"ER is not where you deliver primary care," Miller said.

So how big is this problem? WAVE 3 News discovered Kentucky Medicaid users went to the ER for non-emergencies almost 200,000 times in 2015, which cost taxpayers more than $9.3 million.
One person visited the ER a staggering 382 times. More than once a day. His ER bills alone cost taxpayers a whopping $71,000 that year.

Governor Matt Bevin is now proposing Medicaid expansion users pay up to a $75 penalty when they use the ER for non-emergencies. It's part of a controversial proposal to overhaul Kentucky's Medicaid system in an effort to save hundreds of millions of dollars.

Traditional Medicaid recipients, meaning the poorest of the poor, would still be about to use the ER, for any reason, for $8.

But doctors at Norton Healthcare, have another idea to address the problem.

"Typically if someone is coming there it's often because they don't know where to go," said Chief Medical Officer for Norton Healthcare Dr. Steven Hester.

Norton just launched a pilot program targeting frequent ER users. The hospital calls in social workers to help them understand about where they should be going instead.

Norton said the concept has brought down wasted Emergency Room visits by half. But since federal law requires doctors treat everyone who comes into the ER regardless of the reason, it's up to the patients to make the change.

Even if that starts with the change of a diaper and some Butt Paste.

Drug use and doctor shopping also drive up the number of times Medicaid users visit the ER for non-emergency reasons. Records show some patients visited as many as 22 different emergency rooms in a single year.

Copyright 2016 WAVE 3 News. All rights reserved.