In this evolving landscape, where exactly do physicians fit? Where specifically might emergency physicians in particular leverage their key strengths to become significant contributors and players in these networks? Spoerl notes strong physician leadership as being one of the three keys to making accountable care work. In particular he comments: “Accountable care organizations require strong physician leadership to meet the challenges of quality, communication and coordination of care in new delivery models. Such leadership is also required to guide the organizations in developing equitable distribution of revenue among various primary care and specialty arrangements in ways not necessary in a traditional fee-for-service model.”

Emergency physicians are certainly familiar with the issue of primary care shortages as they experience this virtually every day. Cantlupe notes the United States has about 350,000 primary-care physicians, but about 45,000 more will be needed by 2020, according to the Association of American Medical Colleges.

Let us look at some nuts and bolts issues facing everyone in this evolving new era.

ACEP President Dr. David Seaberg said, at the recent ACEP Leadership and Advocacy Conference, that the emergency department can reduce potentially avoidable admissions and reduce readmissions. This is an upcoming CMS initiative. Emergency physicians all see patients with high levels of recidivism in their departments and can be the most critical and key decision makers on this particular subset of patients that will cost hospitals potentially millions of dollars in lost revenue if the frequency of their ED visits is not addressed.

Emergency physicians, supported by hospitals, easily available primary care, and case management resources, can be on the front lines of addressing inappropriate emergency department utilization.

Be a rapid diagnostic center. One of the hallmarks of the diagnostic skill-set of emergency physicians is their ability to quickly assess the patient’s condition and determine the next course of action, routing patients to the most appropriate next step in the healthcare system.

Get patients back to work more quickly by providing “one-stop-shopping” for tests and treatments. This can be a strategic pitch for emergency physicians to both employers and payers alike.

Reduce unnecessary testing. Emergency physicians like Dr. Joel Klein in Maryland have already taken initiative in organizations such as the Chesapeake Regional Information System for our Patients, an organization whose function is to share health information electronically across current boundaries, with the goal of improved and more efficient patient care.

Provide disaster and syndromic surveillance services. In the event of any biologic, military, or natural disaster, emergency physicians will be on the front lines, as usual.