The NHAMCS ED component has been the national source of data on ED visit demographics, reason for visit, diagnostic or screening services, procedures, medication therapy, type of clinicians seen, diagnoses, and expected sources of payment. These data support trend analyses and are used to support national health care strategies, track gaps in health care delivery, and drive policies developed by the Centers for Medicare & Medicaid Services (CMS). For over 28 years, the survey clearly has tracked increasing use by vulnerable populations and socioeconomic barriers to the use of other sources of health care. Groups that have had significant increase in the use of emergency services include persons of color, Medicare and Medicaid beneficiaries, residents of the South and West, and women.

Despite incredible work in adapting to increased volumes and acuities, payers have exploited opportunities to discredit emergency physicians and other health care practitioners and reduce reimbursement for emergency care. This year alone, emergency medicine and emergency physicians are facing major practice challenges related to decreasing reimbursement, with the implementation of the No Surprises Act (NSA). Emergency physicians are working to develop models for value-based purchasing, including the Merit-based Incentive Payment System (MIPS) and MIPS Value Pathways (MVP). There are also major coding and documentation guideline changes to ED evaluation and management services. Further, emergency physicians have had very inconsistent guidance on the application and reimbursement of telehealth in emergency care.

There must be a timely, reliable, and effective source of data for researchers, planners, and policymakers for the critical issues facing emergency medicine. NCHS has recognized that data in CEDR and other data collected by ACEP can be used as an important supplementary data source for their NHCS. ACEP members will recognize this as a huge testimonial to the College and will find value in how it ultimately supports bedside practice. As patients become older, sicker, and burdened by more chronic diseases, emergency physicians have been adaptable in using a broader range of diagnostics and treatments to deliver quality care. As mental health patients and those suffering ill effects of substance use have crowded into EDs, new strategies have evolved to guide care and increase the community application of out-of-hospital resources. And, emergency physicians have been extraordinarily resourceful in finding and sharing best practice information as COVID abruptly impacted communities.