Study lauds emergency "prudent layperson" laws

These standards didn't lead to a jump in inappropriate use of emergency departments by managed care patients.

By Joel B. Finkelstein, AMNews staff. May 10, 2004.

Washington -- Patients can be prudent about their need to visit the emergency department.

That is the conclusion of a new study showing that adoption of "prudent layperson" laws enacted in 47 states in recent years didn't lead to a surge in inappropriate use of EDs by managed care patients.

The laws generally require that the urgency of a patient's condition be judged based on presenting symptoms, and that the symptoms reasonably warrant immediate attention, from the perspective of an ordinary person.

"Prior to the laws, most managed care plans would determine the necessity for emergency care based more on ultimate diagnosis than on the symptoms that prompted patients to seek emergency care," said Mark Hall, professor of law and public health at Wake Forest University in North Carolina and author of the study, published in the May Annals of Emergency Medicine.

The laws were spurred by incidents of patients with genuine acute illness who delayed care for fear of being stuck with the hospital bill, said John C. Nelson, MD, president-elect of the American Medical Association.

While there were likely few cases in which someone having a heart attack sat in the hospital parking lot debating whether to go in, prudent layperson provisions "swung the pendulum the other way," he said, allowing patients to be safe rather than sorry.

The study was based on interviews with 87 stakeholders, including insurers, regulators, physicians and other medical professionals, patient advocates, and industry observers. It found that prudent layperson mandates have spread beyond just plans that are covered by state law.