RI physicians oppose quick fix on prudent layperson

Providence, RI-Emergency physicians are threatening to oppose any prudent layperson's legislation introduced in the Rhode Island legislature that does not meet acceptable standards from the state's emergency medical community.

State lawmakers are apparently taking the threat seriously.

In March, sponsors of the latest measure mandating a prudent layperson's standard for hospitals and health insurers solicited the help of emergency physicians in fine-tuning the bill.

If enacted, the law would add Rhode Island, the nation's smallest state, to the growing list of others that have adopted a prudent layperson's standard for diagnosing patients seeking emergency department treatment.

Two previous attempts to enact a law were blocked, once by strong opposition from local emergency physicians themselves. The providers complained that the bill that was proposed at the time did not go far enough to protect patients and care givers against unwarranted payment denials.

Physicians threatened to oppose the present bill as well unless specific changes were made, according to Ben Walker, MD, chairman of emergency medicine at Newport Hospital. "We're willing to go with nothing at all if it doesn't approximate the federal standards," Walker says. Walker is referring to pending federal legislation that would establish a prudent layperson's standard nationwide.

Among objections to the present bill is a requirement that providers obtain telephone preauthorization from a managed care organization prior to completing treatment. Another provision bars hospitals and physicians from billing the patient for any portion of the medical claim denied by a payer.

The bill's co-sponsor, Sen. J. Clement Cicilline, (D-Newport), agreed to talk to physicians about parts of the measure that were considered unsuitable.

But the measure still faces an uncertain future. Opposition from the health insurance industry is expected to be strong. And after two previous defeats, the issue has lost its popularity with some lawmakers, Cicilline says.