PATIENTS’ RIGHTS: ER Provision Stirs Debate
NPR's Julie Rovner reported yesterday on the key issue of payment for emergency room care as a managed care reform measure, specifically the "prudent layperson" standard that both Republican and Democratic proposals have imposed on plans. She notes that the detail of the two parties' plans are very different. "Among our patient protections, we guarantee emergency access to emergency rooms, so that during emergencies, folks won't be forced to drive miles past" an emergency room to find one that's in their plan, Rep. Dennis Hastert (R-IL) said recently. "All the bills now under consideration would do that. But that's about all they have in common," she notes. The Senate GOP measure would only cover the estimated 48 million Americans in large, self-insured plans, reported Rovner, but the remaining 77 million with employer-provided insurance would only be covered if their states passed these laws.
Not Very Happy
Emergency room doctors are "even more upset" by the House GOP bill passed last month. Rovner reported that according to Dr. Charlotte Yeh, "It requires HMOs to pay for the initial examination but not necessarily for the care needed to treat the condition." Emergency physicians also object to a measure in the Republican bills that would "require a prudent emergency room professional to approve care that a prudent layperson thinks is an emergency." Yeh said that would "write into law the current practice of having decisions made long-distance by a doctor or nurse who works for the plan." But that is not the only interpretation, Rover notes. Rep. Bill Thomas (R-CA), who helped write the bill, "suggested by demanding the power to make the decisions on the spot, emergency room doctors are undercutting the whole concept of managed care." He said, "Perhaps the argument these folks are making is to make them the exclusive person, and it gets back to the prudent portion of the definition. It may make some sense at certain times for the prudent person to be in the room, physically present. It may not at others" ("All Things Considered," 8/6).