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Twenty-four-hour access to emergency care for children in managed care
J D Moody-Williams1, J Linzer, A Stern
1Emergency Medical Services for Children (EMSC) National Resource Center, Washington, DC 20010, USA. jmwilliams@emscnrc.com
Insights
Navigating pediatric emergencies can be confusing for families in managed care organizations (MCOs). This article clarifies emergency care pathways for children within evolving healthcare systems.
Area of Science:
- Pediatric Emergency Medicine
- Healthcare Management
- Managed Care Policy
Background:
- Children's medical emergencies require immediate attention, traditionally managed in 24-hour emergency departments.
- The shift towards managed care organizations (MCOs) introduces complexities for families seeking emergency pediatric care.
- Healthcare systems face challenges in balancing appropriate care delivery with cost containment strategies.
Purpose of the Study:
- To clarify the role and processes of managed care organizations (MCOs) in pediatric emergency care.
- To address the confusion families may experience when seeking emergency treatment for children under MCOs.
- To explore the challenges faced by emergency service providers and pediatric specialists within the MCO framework.
Main Methods:
- This article is part of a white paper series by the Emergency Medical Services for Children Managed Care Task Force.
- It synthesizes information on the current healthcare environment concerning pediatric emergencies and MCOs.
- The content addresses administrative and reimbursement issues for providers.
Main Results:
- Families may be unclear about accessing emergency care for children within MCOs.
- MCOs aim to provide appropriate care while managing costs effectively.
- Emergency service providers face administrative hurdles and reimbursement concerns.
Conclusions:
- Understanding the evolving landscape of pediatric emergency care within MCOs is crucial.
- Clearer guidelines and communication are needed for families and providers.
- Addressing provider challenges is essential for effective emergency medical services for children.
Abstract:
Children's medical emergencies occur around the clock. In years past, the emergency department, open 24 hours a day, was a familiar site for treating these emergencies. However, in today's health care environment, the scenario can be more confusing. As many families move from a fee-for-service system into a managed care organization (MCO), they may be unclear about what they should do in an emergency involving their child. MCOs want to provide appropriate care, and at the same time, operate within a system designed to contain costs through the establishment of effective health care delivery systems. Providers of emergency services, including specialists in pediatric medicine and emergency medical services responders, also must contend with a different set of problems, including administrative entanglements and concerns about reimbursement for their services. This article continues the white paper series by the Emergency Medical Services for Children Managed Care Task Force.