ACEP Press Release:
The American College of Emergency Physicians (ACEP) and Minnesota ACEP today jointly took issue with a new report being promoted by the Minnesota Department of Health (MDH) about “potentially preventable” health care events, including emergency care, saying it could put patients at risk.
The report assesses whether emergency visits could have been avoided, based on the patients’ final diagnoses, not their symptoms. This analysis does not take into consideration the national “prudent layperson” standard, which says emergency visits must be covered by insurance companies based on patients’ symptoms, not their final diagnoses. This standard was included in the Affordable Care Act (ACA).
“It is very alarming that a report like this is being issued that directly undermines language in the ACA and patients’ responsible use of the emergency department,” said Michael Gerardi, MD, FACEP, president of ACEP. “Patients never should be forced into the position of self-diagnosing their medical condition out of fear of insurance not covering the visit. This applies 20/20 hindsight to possibly life-threatening conditions and it violates the national prudent layperson standard designed to protect patients’ health plan coverage of emergency care.”
Dr. Gerardi adds that a report like this could lay down precedent barring emergency patients from receiving care.
The data in the MDH study are generated by a research tool designed by Professor John Billings of New York University’s Wagner School of Public Service. Professor Billings has said that his tool is not intended for use as a triage tool or as a mechanism to determine whether emergency department use is appropriate.
“A report like this only serves to potentially scare patients away from the emergency department when they may need it most,” said Thomas E Wyatt, MD, FACEP, president of the Minnesota Chapter of ACEP. “Insurance companies historically have denied payment for emergency care based on patients’ final diagnoses, not symptoms. But symptoms are what determine whether visits are appropriate. Patients with chest pain should get immediate medical attention to determine whether or not they are having a heart attack. If the doctor discovers it was a panic attack, it was still right for that patient to seek immediate medical care, and his or her insurance should absolutely cover the visit.”
The data in the MDH study do not correlate with the latest national data on emergency visits from the Centers for Disease Control and Prevention, which found 96 percent of emergency patients needed medical care within 2 hours in 2011.
“Patients in Minnesota are no different from patients anywhere else in the country,” said Dr. Wyatt. “The levels of urgency here are just as high as they are everywhere else.”
According to a study published in the Journal of the American Medical Association in 2013, researchers found that discharge diagnoses do not identify “non-emergency” ER visits. The small number of emergency patients who are ultimately discharged with “primary care treatable” diagnoses come to the ER with the same symptoms as other patients who need immediate or emergency care, hospital admission or surgery.
“Emergency departments occupy a unique place within the American health care system,” said Dr. Gerardi. “We see and treat anyone who needs us, regardless of their ability to pay, and we do so every hour of every day. To our patients, the emergency department is the right place at the right time.”
ACEP is the national medical specialty society representing emergency medicine. ACEP is committed to advancing emergency care through continuing education, research and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies.
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