AAEM Takes Firm Stance to Defend “Prudent Layperson” Definition of Medical Emergencies

FOR IMMEDIATE RELEASE
June 28, 2017

MILWAUKEE — The American Academy of Emergency Medicine (AAEM) has released a whitepaper outlining the “prudent layperson” standard for defining a medical emergency and detailing why this definition must be retained and no state should be allowed to alter it.

Emergency Departments Keep the System Afloat
America’s emergency departments (EDs) are vital to our health care system. As the entry point for those who lack insurance coverage and the acutely injured or seriously ill, emergency departments care for any patient who comes through the door. America's EDs see 130.4 million patient visits per year — that’s 41.9 visits per 100 persons.

“Prudent Layperson” Standard
One of the most important principles supporting the medical safety net is the “prudent layperson” standard for defining an emergency, which requires health insurance plans to base reimbursement on a patient’s presenting complaint rather than the final diagnosis.

This means insurers must cover emergency department care, for example, when a patient's severe chest pain turns out to be heartburn rather than a heart attack. Such a determination often takes hours, multiple diagnostic tests, and the considered judgment of an experienced emergency physician. Under the prudent layperson standard, insurers cannot use the final diagnosis as an excuse to deny coverage.

Emergency Care Must be Protected
As noted by Megan Healy, MD FAAEM, AAEM board member,

“Emergency physicians are deeply concerned that if emergency care is not protected in current and future health care legislation, the safety net will come apart and leave all patients in danger — insured and uninsured alike. The goal of this whitepaper is to highlight AAEM’s position that the prudent layperson definition of medical emergency must be retained and no state should be allowed to alter it.”

 

###
The American Academy of Emergency Medicine (AAEM) is the specialty society in emergency medicine today. As an organization, AAEM believes achievement of board certification represents the only acceptable method of
 attaining recognition as a specialist in emergency medicine.

For more information, please visit www.aaem.org or call 800-884-2236.