Medical Association Reacts To Blue Cross Blue Shield Of Ga. ER Policy

Starting July 1, Blue Cross Blue Shield of Georgia (BCBSGa), the health care insurance company, will deny coverage  for any emergency room trip it deems unnecessary. And some physicians groups are upset about that.

“Morning Edition” host Denis O’Hayer talked with Donald Palmisano, the executive director of the Medical Association of Georgia, which has 7,800 members in the state. 

On whether or not this policy encourages patients to use primary care physicians and urgent care facilities instead of using the ER too frequently: 

Donald Palmisano: Well, I think one is patient education on what is an emergency and what is not an emergency, identifying those patients who tend to use the emergency room as their primary care physician. However, we don’t want patients making their own medical diagnoses because they don’t possess that clinical knowledge to diagnose themselves, and that’s the real problem with this particular policy.

On becoming smarter consumers of health care and the benefits of keeping costs down:

DP: I would agree that when things hit you in the wallet, you do pay more attention, but there are other ways to incentivize the patients. I mean, Blue Cross Blue Shield, in this circumstance, clearly knows who those patients are and should be trying to educate them more on this issue, in terms of where is the proper place to utilize care. We’ve offered to work with BCBS on this issue to help them work with those patients because we do need to find a way to bend this health care curve. But we also need to know the data points on that curve to know exactly where that problem is. Only BCBS possesses that data and they’re not sharing that data with us.

On his solution:

DP: Once you’ve identified the patients, then, 1. ensuring that they’re educated and giving them more information on what is an emergency, what is not an emergency. But 2., ensuring that they are seeing their primary care physician. Because we believe that the primary care physician should be directing the care of that particular patient. The third point is to ensure that the networks of the physicians that the patients have on their insurance plans are actually adequate. 

On the health care bill and repealing the Affordable Care Act:

DP: We believe something needs to be done because right now, Blue Cross Blue Shield Georgia, will be the only insurer in the exchange in South Georgia. With only one company in South Georgia, we have concerns that people need to have more choice with their insurers. So, whether it’s fixing portions of the Affordable Care Act or whether it’s coming up with a new solution, something needs to be done because the status quo clearly is not working.

On whether Republicans and Democrats should be working together on this policy: 

DP: In order to find a solution that is going to work for everyone and be a long-term solution, both parties have to work together. If they don’t, then you’re not going to get a solution that is best for the public.