In 2009, ACEP established a Value Based Emergency Care Task Force (VBEC) to focus on the issues being debated before the passage of the Affordable Care Act in order to move the needle forward on enhancing quality of care, measuring performance, and improving patient health and safety. To that end, the VBEC brought together diverse and previously disparate members of the emergency medicine community, including leaders from the ACEP Board of Directors; senior management; the Quality and Performance, Federal Government Affairs, Research, and Reimbursement committees; academia; practice management; rural health; and health information technology systems management. The VBEC identified four key areas to monitor and develop a strategic response plan regarding:

1. Care coordination (readmissions, medical home, transitions of care)
2. Episodes of care (the ED encounter as an episode)
3. Health Resources and Services Administration federally qualified health centers (exploring partnership with ACEP)
4. Emergency-medicine data registry (feasibility of a registry for quality improvement, reporting, maintenance of certification, benchmarking, etc.)

“High-functioning EDs are strategizing and partnering with their hospitals to ensure well-developed systems and resources are in place to minimize the time to thrombolytics or transfer to the cath lab and coordinating with nursing, laboratory, and pharmacy personnel to provide consistent treatment for pneumonia patients,” Dr. Granovsky said.

Prior to 2013, while many EDs were focused on other payment reforms—some of which include the four HVBP measures—the program had not been the target of specific efforts, according to the authors of a study early last year in the Annals of Emergency Medicine.¹

The study evaluated ED performance based on hospital characteristics for these four measures using Hospital Compare data from 2008 through 2010 and the 2009 American Hospital Association Annual Survey.

Of the 2,927 EDs examined, for-profit hospitals earned the highest performance scores, while public hospitals and those without Joint Commission accreditation scored lowest. However, public hospitals had the highest proportion of improvement scores, while for-profits had the lowest. The study could not conclusively account for these differences but recommended ED leaders monitor achievement and improvement across these measures.

The ED is now appropriately being perceived as the “front door of the hospital,” Dr. Granovsky said, stressing the relevance of efforts designed to improve overall patient experience and to focus on initiatives like HVBP.

“With Medicare as the dominant payer for hospital services, the 1.25% DRG withhold creates a strong incentive for hospitals to optimize their processes, improve outcomes, and increase patient satisfaction.”
–Michael Granovsky, MD, FACEP

On top of HVBP, many hospitals are also being hit with penalties for higher-than-expected readmission rates, and these fees will reach 3% by 2015. An additional program will penalize hospitals with high rates of hospital-acquired infections and patient injuries. And HVBP will include new measures as well, including hospital efficiency with respect to the cost of care.