As I see it, the most interesting and most challenging aspects of the health care reform bill are the plans to establish a nonprofit Patient-Centered Outcomes Research Institute to identify research priorities and clinical effectiveness, as well as the plans to establish an Independent Payment Advisory Board (IPAB).

This board will examine what’s being paid in health care and will determine if spending targets are being met.

If they’re not, the board will make a recommendation to make sure what’s being spent comes in line with what should be spent—bypassing Congress.

I suspect that this board could potentially have tremendous power over how we get reimbursed in the future. Many people are concerned about IPAB having this kind of latitude.

The bill also creates an innovation center within the CMS to test and evaluate different payment structures and methodologies to reduce program spending.

One of the strategies being explored is the bundling of payments for episodes of care.

Among my concerns about the bill is that current Medicaid and Medicare rates do not equal fair payment.

There’s also no specific mention of emergency medicine workforce issues or the ongoing problems we routinely encounter in terms of boarding and overcrowding.

In the future, I believe that the pressure to deliver value, not just volume, will intensify over time. Better care will require better information systems, incentives, coordination, management and leadership, patient engagement, and employer buy-in to force multipayer cooperation.

How emergency medicine physicians will fit into this new paradigm is unclear—but we are the most talented, most diverse group of physicians to lead this change.

Why? Because we do it every day. We’re always being innovative. We’re always thinking outside the box. We’re always thinking of ways to get around systems that are obstructing us.

The road ahead may not be so clear. But the best way to predict the future is to create it.

Dr. Johnson, a member of the ACEP Board of Directors, practices emergency medicine at Mission Hospital Regional Medical Center in Mission Viejo, Calif.

He is also a member of the California Commission on Emergency Medical Services.