Reduce liability risk when treating...elderly patients

As a physician, you assume a certain amount of risk every time you go to work. Not the physical kind, like police officers or fire fighters face, but the economic kind--risk that you won't get paid for your services or, worse, that you'll be named in a costly and career-threatening malpractice suit. If you're a primary care physician, avoiding liability is especially tricky because you see an eclectic group of patients, each presenting a different set of legal hazards. In the following article--the first of a four-part-series--we discuss risks specific to the elderly and how to avoid them. Future articles will focus on liability pitfalls when treating children and adolescents, people with physical and mental handicaps, and patients with limited or no English proficiency.     

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The Emergency Medical Treatment and Active Labor Act (EMTALA) requires that Medicare-participating hospitals screen and stabilize all individuals appearing in their emergency departments, regardless of expected compensation. To counter the incentive to prioritize revenue-generating patients, the law also prohibits facilities from delaying care to under-insured individuals. I estimate whether timeliness of emergency care is, in fact, unaffected by payer source as mandated. Using the National Hospital Ambulatory Medical Care Survey, I first examine the direct effect of under-insurance and find that under-insurance is associated with an approximately 6–10 % increase in emergency department wait time. Because of concerns that the effects of under-insurance may be mediated by triage assignment, I subsequently estimate the relationship between under-insurance and triage assignment, using the office hours of general practitioners as an exogenous source of variation in payer source. Instrumental variable results suggest that under-insured patients are inexplicably assigned higher triage scores which are known to lengthen waits. Contrary to the stipulations of EMTALA, discrepancies in timeliness of care do exist. Yet, this noncompliance is not readily apparent; roughly 80 % of the increase in under-insured individuals’ wait times are masked by adjustments to triage scores.