I find it unbelievable that in Maine we have this incredibly difficult Preferred Drug List, which in its defense is the most successful in the nation and does save the state hundreds of thousands of dollars yet no one at the state level will make any difficult decision on the use of the ED.
People (doctors and patients included due to the frustration of the system of the PDL) will make the somewhat understandable argument that by not allowing a script for Aciphex now will only cost more in the long run due to admissions secondary to out of control esophagitis. In actuality, this is probably not true. The director of the frustrating but incredibly successful preferred drug program (very similar to some private insurance comapany's but at a much more extreme level) will basically say he doesn't care about increased ED visits or hospital admissions; he only cares about his role in the savings of prescriptions. While this may sound cold and harsh, he is in his own unknowing way, correct.
All patients should have a higher copay at the ED than they do at a doctor's office visit including those on Medicaid. I, for one, am rather tired of hearing the argument that if a Medicaid patient were turned away from the ED due to inability to pay, there would be medicolegal implications due to any bad outcomes. But, private pay patients face the same decisions when it comes to a decision between a higher copay at the ED and a lower copay at a physician's office. And, I know that Medicaid patients don't have copays at the ED, I am just proposing that maybe they should.
I get ED reports constantly on my patients who went to the ED at 3PM, 5PM, 7PM, etc. for cough and sore throat lasting five days. This is a ridiculous use of the ED.
