Insurance Policy Change Prompts Response from ACEP


American College of Emergency Physicians pic
American College of Emergency Physicians

Emergency room physician Dr. Kenneth (Ken) Mwatha received his medical training at Johns Hopkins University. Currently employed in Baltimore, Dr. Ken Mwatha manages a busy emergency department, treats patients for a wide variety of medical conditions, stabilizes critically ill patients, and performs lifesaving procedures on trauma patients. Dr. Mwatha is a member of the American College of Emergency Physicians (ACEP).

The organization recently launched a campaign in response to a large insurer’s decision to deny emergency coverage for patients who receive a diagnosis that is later determined not to be an emergency.

Indianapolis based Anthem Blue Cross Blue Shield recently initiated a policy that denies coverage of emergency medical treatment that is administered in a non-emergency situation. The American College of Emergency Physicians has reacted to the shift by initiating a campaign that highlights the flaws of the insurer’s policy. The group’s videos highlight patients who are experiencing symptoms but are unsure if emergency treatment is needed. Because they fear a potentially high emergency room bill, they forego treatment and risk severe consequences.

The American College of Emergency Physicians argues that patients with no medical training should not be expected to discern whether their symptoms constitute an emergency. They also point out that the policy is a violation of a federal law known as the prudent layperson standard, which requires insurance companies to determine coverage based on a patient’s symptoms rather than a diagnosis.

In response to the national outcry over the new policy, Anthem Blue Cross Blue Shield has adopted exceptions that include physician advised visits to the emergency room, children under the age of 15, people who are traveling out of state, and patients who have recently undergone surgery or received medicines or IV fluids.


Patient Status – Critical Condition


American Hospital Association  pic
American Hospital Association

Dr. Kenneth “Ken” Mwatha provides emergency medical care at one of Baltimore, Maryland’s, busiest emergency departments. Among his many life-saving responsibilities, Dr. Ken Mwatha helps stabilize patients in critical condition.

When the media reports on the medical condition of a notable patient, hospitals and doctors often communicate using standard shorthand terms like “critical,” “serious,” and “stable.” Though these words have no hard-and-fast meaning, many medical facilities rely on definitions issued by the American Hospital Association (AHA) to give guidance to healthcare providers when describing patient status to media outlets.

According to the AHA, a patient in critical condition demonstrates unfavorable indicators regarding core vital signs like, for example, blood pressure and respiration that fall outside normal ranges. Moreover, a patient in critical condition may not be conscious.

The AHA guidelines recommend the use of the term “fair condition” when the patient in question has vital signs that fall within normal ranges and are stable. Fair condition patients are conscious, though they may not be comfortable. Overall, the outlook for fair patients is much more favorable than for those in critical condition.

The ACEP High Threat Emergency Casualty Care Task Force


American College of Emergency Physicians pic
American College of Emergency Physicians

An emergency physician in Baltimore, Maryland, Dr. Kenneth “Ken” Mwatha diagnoses and treats patients with a range of emergent and non-emergent medical conditions. This position also places him in charge of general patient flow in one of the highest acuity urban emergency departments in the city. To inform and augment his professional activities, Dr. Ken Mwatha holds active membership in the American College of Emergency Physicians.

In response to the growing number of active-shooter incidents and acts of terror in the United States, the American College of Emergency Physicians (ACEP) established the High Threat Emergency Casualty Care Task Force (HTECCTF) in 2016. The mission of the HTECCTF includes tracking and studying mass-casualty incidents to more effectively respond to future events of this kind. To further this mission, the HTECCTF has endeavored to optimize medical treatment strategies in an effort to address deficiencies in high-threat emergency trauma care from initial point of injury through definitive care.

Saint Agnes Hospital Emergency Care


Saint Agnes Hospital pic
Saint Agnes Hospital

A graduate of the Johns Hopkins University School of Medicine, Dr. Kenneth “Ken” Mwatha is certified by the American Board of Emergency Medicine and serves as an attending physician in the Department of Emergency Medicine at Saint Agnes Hospital in Baltimore, Maryland. In this position, Dr. Ken Mwatha treats patients and helps manage the patient flow in the emergency room.

For more than five decades, the Emergency Department at Saint Agnes Hospital has been serving residents in Baltimore and the surrounding areas. The department sees nearly 80,000 patients each year and boasts some of the shortest wait times in the area because of its multi-pronged approach to care.

In addition to general emergent care, the Saint Agnes ER also has specialized chest pain and pediatric ER units to help see those patients quickly and get them the specific care they need. Thanks to the latest technology being available to Baltimore’s emergency responders, it’s often the case that those in need of specialized ER care will have test results such as EKGs transmitted to the department in advance so that doctors have the information on hand before the patient arrives. For more information about the hospital’s emergency care, call (667) 234-2000.