Is the integration of urgent, emergent, inpatient and
care of patients with
acute medical conditions.
If the perception is that a visit to the ED represents a failure of the health care system, it sure makes it difficult for ACEP to assert that emergency physicians routinely provide valuable services to patients and insurers. Apparently, many policy makers hold this perception. It reflects the consequence of cost shifting (especially by hospitals) to cover the care of the under- and uninsured, which makes it appear that EPs are wasteful and inefficient. Health plans have aggressively promoted this misperception, using very distorted data. A good example is a recent study (“Many-ED Visits Could be Managed at Urgent Care Centers and Retail Clinics”) from the California Health Care Foundation, a very pro-managed care organization. Is it reasonable to compare the cost of treating strep throat in the ED versus the Urgent Care Center when the UCC turns away every patient with no money and no insurance? The attitude of the Health Plans is: “the uninsured are not our problem,” and would prefer to ignore our service to the uninsured in calculations of the value based proposition. The uninsured are not going away with Health Reform, and emergency physicians need to make sure that, in the value based purchasing calculation, no one takes for granted our mission to provide care to everyone regardless of ability to pay.
Fortunately, it’s really not all that difficult to challenge misperceptions about the value of ED care. The continuing growth in ED visits every year is perhaps the best testimony of the value that our patients ascribe to the care and service they receive in the emergency department. There are innumerable examples of the failure of our health care system in this country. A visit to the ED for acute appendicitis does not represent a failure of managed care, whereas a ruptured appendix that results from a patient being encouraged to wait until the morning to see their primary care physician certainly might.
With the demise of the idea of a national emergency care patient registry, it may not be easy to prove the value proposition for emergency medicine; but we don’t really need to prove our value so much as we need to substantiate it. First, we need to make sure that in comparing care in the ED to care in the office based practice; apples are compared to apples. Would all those assertions about ED patients not meeting the prudent layperson standard hold up if, for example, we could show that the incidence of peri-tonsilar abscess in patients with sore throat was three times the incidence of this complication in the PCP’s office? I think ED physicians all believe that children with fever in the ED are different than children with fever in the UCC, but try convincing a pediatrician. This will take some studies directed specifically at the value-based proposition, and that is where we should put the Emergency Medicine Foundation’s contributions to work. We heard at this year’s Council meeting (2010) about a compilation of hundreds of studies showing the value of good ED care (early antibiotic treatment in pneumonia, ED physician activation of cath labs, etc). This compilation needs to be translated into an easily digested summary with bullet points for the media and policy makers.
Although I am not a great fan of public relations, when you are faced with a perception problem, you need a well-financed, highly organized campaign. The ED has become the premier provider of diagnostic services and acute care; and in some EDs, half the patients who are discharged from the ED were sent to the ED by their PCP for evaluation and treatment. ED physicians provide four times as much charity care as any other specialty. These types of factoids need to be widely disseminated, because they change perceptions, and re-frame the value proposition. ACEP needs to provide the science, the sound bites, and perhaps the professional PR team; but this is not just a challenge for ACEP’s D.C. office, it is a challenge for every state chapter, and every emergency physician in every ED and every state. The next time you hear someone say how expensive ED services are, take the time to explain cost shifting, talk about 24/7/365, remind them about all the patients we manage to keep out of the ICU. With ACOs, bundled payments, and cost-containment, we are in a fight for the economic survival of our specialty.
Risk sharing is our third challenge. I will try to cover that in PART III.
Today during the inaugural month of the VBP implementation, Riner’s series of three blogs about this that he published two years ago are still topical. This post was first published in The Fickle Finger.
Trackback from Perspectives on the Acute Care ContinuumIn one week we will be counting down the top 3 most read blogs of the year. We challenge you to guess the number 1 blog from 2012 and win!
In the poll below we invite you to choose which post you think was the most popular from 2012. All correct answers... ...
Click here to cancel reply.
Email (*) will only be visible to blog administrators
Remember my details
Notify me of followup comments via e-mail
Enter your email address:
By Kevin Kruse
While acute care hospitals are veterans in the fight to contain costs, healthcare reform is bringing greater focus to other aspects...
By Bruce Friedberg, MD
The northern San Diego region is growing rapidly, and last year, Palomar Health unveiled a state-of-the-art hospital to meet...
By Mike Harrington
About thirty years ago, I was an accountant for Arthur Young. One of my auditing clients was a young emergency...
By Ted Kloth, MD, FACEP
The time is coming when consolidation and transparency will reign supreme, and the effects are already being felt throughout...
By Josh Sheridan, MD, MS
The hospital system I work for has an ED and two Urgent Care Centers (UCCs) in the same city. Between the two UCCs, we serve...
Re: Who Will Rescue Healthcare and Solve The EMR Debacle? We Need Another Steve Jobs
golf marbella I have been absent for some time, but now I remember why I used to love this web site....
Re: Healthcare's Evolution from Johnny Carson to Jimmy Fallon, and Beyond
I'm not sure the world is ready for Jimmy Fallon reviewing a CT Scan and dispensing advice! But if he...
Re: Your EMR Conversion: What Can Go Wrong (Often Did)
These are great tips! In the systems where I've supported EMR implementation one of the biggest challenges...
todocajas.com.ar That is very good comment you shared.Thank you so much that for you shared those things...
Re: All the World’s A Stage for this (Pay for) Performance
Acute care settings include but are not limited to: emergency department, intensive care, coronary care...