ACEP weighs in against GOP versions of patients’ rights bills

Washington, DC—The American College of Emergency Physicians (ACEP) in Dallas, TX, is taking a wait-and-see attitude toward Congressional moves to water down the patient access elements of the pending consumer rights legislation.

But the trade group is confident that emergency providers will be able to preserve patient access protections that were passed in the 1997 Balanced Budget Act (BBA) and apply to Medicare and Medicaid patients.

The current House and Senate Republican versions of the patients’ rights bill substantially weaken protections adopted by ACEP, which uses the prudent layperson standard as the defining factor in a medical emergency. The BBA adopted the standard for Medicare and Medicaid patients, and ACEP wants the standard as it is used in the act extended to all managed care enrollees.

The GOP versions "unfortunately create a two-tiered test for defining a medical emergency and determining coverage," says Charlotte Yeh, MD, who until recently chaired ACEP’s managed care committee. Under the GOP plan, the prudent layperson standard alone would not be sufficient to obtain coverage.

Under many circumstances, health plans could require the additional assessment of a "prudent medical professional, "who may not necessarily be an emergency physician," Yeh indicated. The House GOP version has also been criticized by including the term "severe pain" in defining an emergency. The bills also emphasize a "retrospective criteria for coverage, while the prudent layperson standard takes a prospective approach to defining and paying for emergency services.

However, Yeh says she is hopeful that the Democratic plan, which comes closer to protections enacted in the BBA, will eventually win passage. However, ACEP has stopped short of endorsing the Democrats’ version. "I find it difficult to believe that Congress in the end will pass something that differs so substantially from what’s already in the Balanced Budget law," she told The Managed Care Emergency Department.