By Chris Renner

This is the first installment in a series explaining how healthcare reform will affect individuals, companies, Medicare eligible individuals, and others…

The room was mostly dark, with just an overhead light and a recliner that showed more stuffing than fabric. A slightly wet khaki trench coat was draped over the back of the chair. Drops from a roof leak beat a very slow rhythm in one corner. A half rusted folding chair lay on the concrete floor. The operative, wearing his own standard issue unbuttoned trench coat, lit a cigarette and leaned against the only brick wall in the room. A few feet away, Childress stood with a rolled newspaper under one arm and the other hand unconsciously gripping the closed doorknob. “Alright,” he said forcefully, “Tell me what you know, what you don’t know, and what you think.”

Agent Ajemian lifted his hand and took the cigarette from his mouth, exhaled a cave of smoke, watched it rise for a second, and then flicked the stub across the room. It landed perfectly into the accumulating puddle. He shook his head slightly, and in a voice of resignation he responded, “I’ll tell you what I know… but it’ll be costly. I’ll tell you what I don’t know, but I’m not sure I’m going to tell you what I think!“

Our bi-weekly news updates are designed to keep you up to date with current developments relating to the Acute Care Continuum. Feel free to share your perspective on these stories or link to articles that you have found relevant to today’s healthcare environment.

Today we focus on budget estimates and healthcare spending, including new figures from the Congressional Budget Office, the ongoing battle over a Medicaid pay increase, and disturbing findings on the actual cost of emergency medical care.

By Jim Strafford

If you have practiced healthcare pretty much anywhere in the United States during the last five years, you have probably been involved in at least one Electronic Health Record (EHR) conversion or implementation. In some cases, you may have converted from a user friendly template to a less user friendly EMR. In other cases, your hospital may have converted from one EHR brand to another. Regardless of the specifics of your transition, it is likely that some degree of frustration happened at the point when you adjusted to the first EHR. And it is also likely that after months of frustration you contacted one of those Scribe companies.

EHRs are still in their relative infancy and continuously improving. Penalties for not automating will be implemented in 2015, so they are here to stay. Learning from implementation issues is critical to improving implementation and effective use of EMRs.

By Imamu Tomlinson, MD, MBA

In an era of healthcare when there is a call for emergency physicians and hospitalists to increase collaboration, and many working hard to facilitate this, I have seen this pairing blend together effectively just by putting together highly motivated and empowered physicians.

In 1996, my physician group signed an emergency department (ED) contract in Selma, CA. Since that time, we have been invited to staff three EDs, three inpatient departments, an urgent care center (UCC) and a skilled nursing facility (SNF)—all within the forty mile area that includes Selma. How did this come about?

Recently, Drs. Lee, Schurr, and Zinc published an article in Annals of Emergency Medicine that detailed three different approaches to estimating the percentage of total national healthcare costs that were expended for emergency department care. The statement in this article that most healthcare journalists have picked up on is related to the authors’ assertion that spending on ER care could amount to as much as 10% of the national healthcare budget. This clashes significantly with ACEP’s assertion that these costs represent just 2% of overall healthcare outlays. However, the key takeaway from this article is that we really don’t have accurate models and reliable data to be able to determine with any certainty just how much money is spent on ER care in our country. I even have doubts about the accuracy of the $2.6 trillion denominator (total costs for all care) used in calculating this percentage. In any case, the authors assert that “rather than minimize the issue of cost, we should recognize the economic and strategic importance of the ED within the healthcare system and demonstrate that costs are commensurate with value.” I am not sure how it will be possible to demonstrate the true value of emergency department care if we can not accurately determine the true cost of this care; but I agree with the authors that the question of how much is spent on ER care is not nearly as important as the question of how to maximize the value of this spending.

By Lori Winston, MD

According to the Association of American Medical Colleges (AAMC), the United States will face a shortage of 90,000 physicians by 2020 and 130,000 by 2025. And making it more difficult to climb out of this hole, the federal government is reducing Graduate Medical Education (GME) funding, both in the general budget and in sequestration cuts. As a result, the AAMC is pushing for Congress to lift the cap on Medicare-funded residency training programs which was adopted as part of the Balanced Budget Act of 1997. Last month, two bills were introduced to address the shortage. The House’s Training Tomorrow’s Doctors Today Act and the Senate’s Resident Physician Shortage Reduction Act of 2013 would phase in 15,000 residency positions over five years.

Kaweah Delta Medical Center, the hospital where I practice, has invested in starting its own GME department with the addition of residency programs in emergency medicine (EM), family practice, psychiatry, general surgery and transitional year training. This is a win-win on many levels for everyone involved. It will benefit the doctors accepted to the program, the hospital, my physician group, and the entire community.

Our bi-weekly news updates are designed to keep you up to date with current developments relating to the Acute Care Continuum. Feel free to share your perspective on these stories or link to articles that you have found relevant to today’s healthcare environment.

Today we look at some of the current events happening in emergency medicine — from dealing with mass-casualty events to efforts to diverting patients away from the ED (in one way or another).