Non-Emergency Visits Costing North Texas Taxpayers Millions

NORTH TEXAS (CBS11) - Acne, bad breath and ingrown nails: all seem like relatively minor health issues. But a Consumer Justice investigation found millions of taxpayer dollars paying for Medicaid patients to use the emergency room for non-emergency medical attention.

Data from the Texas Health and Human Services Commission showed Medicaid patients using ERs in Collin, Dallas, Denton and Tarrant County emergency rooms for just about any health problem.

Thousands of people checked in for routine issues like seasonal allergies, birth control, pregnancy tests, immunizations -- even prescription refills and cavities. There were the common illnesses, like bronchitis, strep throat and coughs, along with unusual afflictions, like excessive crying or nightmares.

It all adds up. Emergency rooms billed $750,000 to treat acid reflux and heartburn, and $3.2 million to treat headaches (not migraines). Another $3.8 million went to treat constipation and excessive gas. Upper respiratory infections alone cost taxpayers almost $9.2 million.

"There's a high number of emergency room visits that are not for emergencies," said Dr. John Carlo, president of the Dallas County Medical Society. "It's a huge drain of resources, absolutely."

Dr. Carlo says there are a few reasons why Medicaid patients choose the ER over a primary care physician or walk-in clinic. "After-hours visits. People that might have a job during the day and cannot take time off," said Carlo. "People are choosing ERs because they're easier to get to," he added, "Keep in mind these centers are well-located on public transportation routes."

State Senator Kelly Hancock agrees.

"There is no incentive to keep people out of the emergency room," said Sen. Hancock.

He pointed to a federal law that requires ERs to treat patients no matter the issue.

"It's great in theory, it's just working out to where it's very costly to the taxpayer and it's really creating a lot of logjams in the emergency rooms."

According to the Texas Association of Health Plans, the state can submit a waiver to the federal government to implement a co-pay for Medicaid patients who use the emergency room for non-emergency reasons. Supporters say while this wouldn't stop emergency room abuse, it could curb it.

Hancock says he is interested in studying the issue. "We'll have a very large working group together and we'll be working on this from here till [the legislative] session starts to try to come up with something."

Still, he warns against a "one size fits all" policy that could hurt people that need the care most. Hancock worries that even a relatively small co-pay could be too much for people on Medicaid.

"We want emergency rooms to treat emergencies. But at the same time, we gotta make sure that we parse out the details and we're not harming the individuals we're trying to help," said Sen. Hancock.