Last, the NQF is in the early stages of developing palliative care and regionalized emergency care measures. A group spearheaded by the University of North Carolina developed a white paper on regionalized emergency care for the NQF. Comments from ACEP were submitted in August 2011 during the solicitation period. A steering committee for palliative and end-of-life care was gathered at the end of July 2011 to discuss a set of 12 new measures that may affect emergency medicine.

Another group of quality measures that may soon affect emergency medicine reimbursement involves the new episode of care (EOC) prototype. Passage of the Patient Protection and Affordable Care Act (ACA) legislation in 2010 includes methods to develop and test novel models of health care delivery and payment reform. The goals are to reduce costs by eliminating waste and to improve patient health outcomes by aligning provider and hospital incentives. The proposed reforms are based on the VBP paradigm, rather than the current fee-for-service payment system, which reimburses providers and institutions based on the volume of services provided. The ACA-mandated development of global payment systems reimburses both hospitals and providers for the complete management of a patient over a defined period of time. Only time will tell how the ACA will affect ED practice.

On the Horizon

Hospitals are beginning to focus on the Hospital Readmission Reduction Program (HRRP). This starts in 2013 and focuses on pneumonia, heart failure, and MI readmissions within 30 days of discharge. It is reported that in 2015, the HRRP will expand to include COPD, CABG, PTCA, and potentially other high-cost and high-volume conditions.

In addition, for FY2015, CMS has adopted a proposed efficiency outcome measure titled Medicare Spending Per Beneficiary. It was originally adopted for FY2014, but because of the requirement that hospital performance on measures be posted on the Hospital Compare website for at least 1 year prior, it has been delayed 1 year.

Conclusion

Quality measures continue to exert considerable influence on the practice and reimbursement of emergency care. While provider-based measures focus mainly on the clinical care of specific medical conditions, an overwhelming number of hospital-based measures address ED throughput, timeliness of care, imaging utilization, and system issues. There is uncertainty surrounding the ACA and its affect on emergency medicine; however, it is clear that there will be further transition to pay-for-quality systems.