Mat-Su ER doctors: Alaska shouldn’t cut Medicaid expansion.

As emergency room doctors, we have the honor and privilege of caring for patients in the Valley from every walk of life and background. We are proud to offer the same excellent medical care for every patient who comes through our doors, whether they are homeless, suffering from substance abuse, or if they are esteemed politicians. We often end up caring for our neighbors, teachers and friends. It can be both humbling and heartbreaking.

We appreciate all of the recent conversation regarding a sustainable budget for Alaska and our state’s fiscal, ethical and logistical priorities. In the Emergency Department, we are federally mandated to see anyone who believes that they are having a medical emergency, regardless of their ability to pay, and we are available 24/7/365. This results in the department acting as the safety net for the community, and we believe this perspective allows us to see the street-level results of government and community programs in real time, before long-term studies can evaluate their efficacy.

We are realizing huge benefits here in the Mat-Su Borough, from a combination of Medicaid expansion and Senate Bill 74, Medicaid reform. They have created the means for high-quality projects here in the Valley that are just getting off the ground, saving lives and saving money.

The first major benefit has been decreasing opioid abuse. In the emergency department, we have worked with other providers in the state to create opioid guidelines, and helped to install an IT system that notifies us of care plans, PDMP (Prescription Drug Monitoring Program) notices, and recent ED visits across the Pacific Northwest. We have also worked with the state on educating patients about non-opioid alternatives. As a result we have had an almost 80% decrease in opioid prescriptions written in the emergency department at Mat-Su Regional. We have done this without a decrease in patient satisfaction and we are now seeing a decrease in opioid deaths around the state.

We have also built on these efforts by partnering with local groups such as My House, Fiend to Clean, True North, the Opioid Task Force and others to provide peer support, education and care coordination for those struggling with addiction. Some of our physicians are now providing medication-assisted treatment from the Emergency Department, and we are working with community partners to build availability. This has been made possible by Medicaid expansion, making addiction services available to those who want to get help. We all know that crime in the Valley, especially property crime, is linked to drugs or alcohol. We believe that our efforts in limiting prescription drug availability and providing resources for addicts to get clean are large factors in Wasilla’s 34% drop in property crime from 2016 to 2017. It is clear that, if we want to make our community safer, we must build treatment services and prevent addiction in the first place.

Another major positive aspect of our current legislation has been on care coordination. With the help of the Mat-Su Health Foundation, we have been integrally part of a program called HUMS (High Utilizer Mat-Su). This program is run through the ADRC (Aging and Disability Resource Center) for which we provide medical direction, and it helps to coordinate the care for some of the most challenging patients in the valley. Often they have complicated medical, behavioral, and substance abuse issues that have gone unmet for years, resulting in high emergent medical costs and oftentimes longstanding history with law enforcement or other health care providers. This program has seen over a 50% reduction in ED visits and millions of dollars in savings for the state (final numbers are currently being calculated). Investing in this type of coordination saves lives, improves health, and saves Alaska millions of dollars. Cutting this line item from the budget will result in much higher costs in other categories including increased hospital bills as well as law enforcement and criminal justice utilization. In addition to the downstream monetary cost, we cannot put a value on the lives lost to overdose and the damage to the community if these programs are terminated.

We are on the verge of a health care transformation designed to save money, make our community safer and help the health our community. In short, using mostly federal funds to increase coverage to Alaskans is working, and it is resulting in healthier Alaskans. We thank our legislators for working toward a balanced budget. We humbly ask you to help protect the Medicaid expansion and the work done as part of SB 74 and work with us and other providers to help continue to reform these programs rather than cutting off the tremendous work that is just beginning.

Russ Johanson, M.D., Dave Grove, M.D., Anne Zink, M.D., Tom Check, M.D., Kevin Del Duca, M.D., and Cecilia Sorensen M.D., are all members of Mat-Su Emergency Physicians providing Emergency Physician services at Mat-Su Regional Hospital.

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