RHealth care reform is sending a message to patients, hospitals, payers, and providers that business as usual is over. We emergency physicians need to figure out how to redesign ourselves so that we become part of effective change.

How did we get here? Health care spending is out of control. The Centers for Medicare and Medicaid Services projects that by 2018, we’ll be spending one-fifth of the total U.S. economy on health care costs. Hospitals currently account for about 32% of all health care spending in the United States. This is not sustainable. At the same time, we have a ballooning national deficit and an aging adult population.

The current political reality is sobering. Even now that the health care reform bill has passed, it’s not going to be easy sledding. A lot of massaging will go on in this bill.

People have argued, “Why not just contain costs first? Why don’t we bring things under control in what we spend before we expand care?”

At this year’s ACEP Leadership and Advocacy Conference in Washington, D.C., we learned from health care economist Len Nichols that the health care system is already stretched and that three-quarters of hospitals currently lose money on Medicare. If you just started to contain costs further, too many things would likely fall apart. Cost containment with coverage expansion is more likely to succeed, but we have to be careful how we do it.

Payment reform alone is not enough, because there are several components to payment. You have to change the culture of how we get reimbursed in our health care system. Documentation and proof of patient experience will need to be kept intact in some way.

Key provisions in the health care reform bill that directly affect emergency medicine include no prior authorization for EM services, expansion of the prudent layperson standard to all health plans, and an essential benefits package that includes coverage for EMS.

The bill also includes a program to strengthen ED and trauma center capacity by funding research projects and developing demonstration programs to design, implement, and evaluate innovative models for emergency care systems.

The bill also establishes a workforce advisory group, funding for wellness/prevention programs, a demonstration program to bundle payments for episodes of care, a 5-year demonstration grant program for states to develop and implement alternatives to tort litigation, and plans for a regular and reserve corps for public health and disaster preparedness.