WASHINGTON, Feb. 17, 2016 /PRNewswire-USNewswire/ -- The American College of Emergency Physicians (ACEP) and its Rhode Island Chapter today jointly took issue with a new report by the state's Executive Office of Health and Human Services (EOHHS) HealthFacts RI database, about "potentially preventable" emergency visits, calling it irresponsible and 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 presenting 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 the 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 Jay Kaplan, MD, FACEP, president of ACEP. "Patients never should be forced into the position of self-diagnosing their medical conditions out of fear of insurance not covering the visit. This applies 20/20 hindsight to possibly life-threatening conditions — such as chest pain — and it violates the national prudent layperson standard designed to protect patients' health plan coverage of emergency care."
Dr. Kaplan adds that a report like this could lay down precedent barring emergency patients from receiving care.
The data in the EOHHS study does 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.
"A report like this only serves to potentially scare patients away from the emergency department when they may need it most," said Christopher P. Zabbo, DO, FACEP, president of ACEP's Rhode Island Chapter. "Both harmless and deadly conditions often have the same presentations. Asking patients to make that determination while at home, anxious, and with inadequate information, is a recipe for disaster."
A key finding of the RI report cites "chest pain" as representing the "greatest opportunity for savings."
Dr. Zabbo adds that this is a very dangerous message for the state of Rhode Island to send to its citizens. 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 muscle pain, upset stomach or anxiety/panic attack, it was still right for that patient to seek emergency medical care, and his or her insurance should absolutely cover the visit.
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. Kaplan. "We are the only ones who see and treat anyone who needs care, regardless of their ability to pay, and we do so every hour of every day."
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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SOURCE American College of Emergency Physicians (ACEP)
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