In 2003, President George W. Bush signed legislation that started health savings accounts (HSAs) and encouraged the growth of high-deductible health plans that had lower premiums and allowed consumers to keep the savings that were not spent in their HSA. The rapid rise of high-deductible health plans over the years has put the “first dollar” coverage on the consumer, essentially making the patient a payer source. This summer, the American Medical Association reported that 23–24 percent of physician payments came from the patients themselves. That trend is likely to continue, and increasingly, we will see patients change their patterns of access to care and their choices of care. Let’s let them choose EM when it’s the best option.

These changes were responses by payers to perceived overutilization of expensive and unnecessary care, creating a move to value-based care and driving growth of retail and urgent care clinics for acute care needs. Let’s face it: the deductibles have gotten so high that patients simply won’t pay large bills. It’s a bit ironic that physicians and hospitals started health insurance back in the 1930s because patients couldn’t afford to pay their bills. Now, we’ve come full circle.

But facing these facts provides opportunity to thrive. I predict that there will still be patients and they will need our care. The opportunity here is to design cheaper alternatives for care by emergency physicians and an “EM team,” anywhere and anytime. If not, I can guarantee you that someone in Silicon Valley or Nashville is working on that solution right now—and at a profit. Now is a great time to lead these changes and redesign emergency care for all of our patients.

Dr. Martinez is chief medical officer and vice president of North Highland Worldwide Consulting and assistant professor of emergency medicine at Emory University School of Medicine, both in Atlanta. He attends at Grady Memorial Hospital.