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November 18, 1988

Preadmission Screening of Medicare Patients

JAMA. 1988;260(19):2833-2834. doi:10.1001/jama.1988.03410190081018

To the Editor. —  Imperiale et al1 studied the clinical effect of preadmission screening and reimbursement denial for Medicare patients. They concluded that "preadmission certification programs can be implemented without major deleterious short-term medical effects." The limitations of their study design do not justify such broad claims for the safety of preadmission screening.This study did not examine the effects of preadmission screening on emergency admissions. Thirty percent to 40% of acute-care hospital admissions are through the emergency department.2 Because of preadmission screening requirements, how many of these patients were not offered admission, how many had their admission delayed, and how many were admitted only if they agreed to pay for the hospital bill? It is not surprising that no major adverse effects of preadmission screening were found by the authors, since they examined only the low-risk population.This study did not examine the effects on the 28