Update on patient bill of rights: Don't be fooled
The Patient Bill of Rights will have far reaching effects on ED patients and staff, but how it will affect you depends on which version of the bill is passed. "From the perspective of emergency medicine, the Republican House version (HR-4250) is unfavorable to the Senate version (S-2330). But both versions are unfavorable compared with the Democratic Patient Bill of Rights," reports Charlotte Yeh, MD, FACEP, chief of emergency medicine at New England Medical Center in Boston and a member of HCFA's task force on EMTALA.
The Republican version is detrimental to emergency medicine, Yeh argues. "Yes, they allow the prudent layperson definition, but it's only for the screening exam, not any stabilizing treatment," she explains. "A person can get evaluated, but there is no guarantee that their treatment for that condition will be covered. That is unacceptable from a patient care perspective."
The bill doesn't even cover the minimum requirements under federal law, Yeh stresses. "We are required to provide the MSE [medical screening exam] and stabilizing treatment under EMTALA," she says.
Also, in the Republican version, "prudent layperson" language was changed to "prudent medical professional." "That individual, who isn't examining the patient, determines what is medically necessary," says Yeh. "As far as I'm concerned, it's codifying current restrictive practices and goes against something we have pushed very hard for-that patients should be able to get the MSE and stabilizing treatment without retrospective second guessing."
Currently, the Balanced Budget Act has a prudent layperson standard in place for Medicare and Medicaid recipients. "The Republican version clearly has a lesser standard of care," she says. "Right now, privately insured patients have less standards than Medicare or Medicaid recipients. So, patients who pay for insurance are potentially paying twice, once for their insurance premium, and once for coverage which is denied." ED nurses and physicians should push for a uniform, consistent standard across all MCOs, whether Medicare, Medicaid, or private insurers, Yeh emphasizes.
Also, the Republican version has no limits on cost sharing, such as copays and deductibles, unlike the Balanced Budget Act. "So while they might say they will cover prudent layperson, they could make copays so high for patients that it still presents a barrier to care," says Yeh.
President Clinton has stated that if the House Republican version goes to him in its current state, he would veto it. "Our hope is that the Senate will be able to put in more favorable language before it goes to the President to sign," says Yeh. "They use the right title, but they have totally turned around the intent of the meaningful patient protection we were aiming for. We need to get the word out that the Republican version may call it a patient bill of rights, but in reality, it's a sham."
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