Medicaid reimbursed for 548,136 emergency room visits in 2013 in Oklahoma. Almost 30 percent of SoonerCare clients, 289,135, used emergency rooms.
The year before, 250,030 people in Medicaid made emergency room visits and Medicaid reimbursed a total 528,264 visits, an average of more than two visits per person.
That average includes many who visited emergency rooms much more often.
Devon Herrick, global health policy fellow at the National Center for Policy Analysis in Dallas, told Oklahoma Watchdog says “frequent flyers” – those who visit ERs three or more times a year – “are apt to be Medicaid enrollees.”
Of the $178.3 million in ER costs in 2013, a little more than $37 million paid for doctors, pharmacy, lab, radiology, ambulance and other ancillary costs.
The average cost per ER visit by a Medicaid enrollee was $325.34.
In FY 2012, when total Medicaid costs for ER services reached $169.6 million (including ancillary costs) The average cost per ER visit for Medicaid patients was $321.
Medicaid spending in the U.S. increased by 10.8 percent while total state spending increased by 7.3 percent in 2011. Then, in Fiscal Year 2012 state Legislatures enacted funding increases for Medicaid that averaged 28.7 percent, “the largest annual increase in the program’s history.”
Several legislators have suggested Oklahoma could get a better handle on ER costs if the state joined 39 others in offering some form of privately managed care.
State Sen. Kim David, R-Porter, has offered up Senate Bill 1495, creating a pilot program that would put counselors in ERs to direct Medicaid recipients to more appropriate and much less expensive general care.
David’s bill is based S.B.1495 is based on market-oriented models in Florida, Louisiana and Kansas.
Florida has had success in easing costs and improving patient satisfaction among diabetes and high blood pressure patients.
David’s bill is the best place to start improving Medicaid outcomes without the “expansion” envisioned in the Affordable Care Act, Small said.