The health care industry is changing daily and at a very rapid pace. Some of the changes surrounding and impacting emergency medicine are:
- Patients self-directing their care.
- The explosion of the urgent care industry.
- Hospitals moving into the insurance business.
- Telemedine and its potential applications for EM.
- Increasing demand for quality and value metrics.
- Retail competition in the delivery of health care and the issue of cost.
- Dramatic increase in high-deductible insurance plans.
- Medicaid expansion and the changing uninsured population.
- Out-of-network care and the associated patient balance billing issue.
- Increasing shift of patient care from inpatient to outpatient settings.
Where does emergency medicine fit into this emerging framework? Does it fit at all—does it even have to fit, or can it remain effectively outside and immune from this new world order of health care? How do we add value as the transformation occurs? To some degree, in the early days of managed care, the specialty did remain somewhat outside of the industry changes, although the specialty certainly took its hits, especially in the reimbursement arena via inappropriate and erroneous claims denials. Virtually all major insurers saw class action lawsuits filed against them and emergency medicine did recoup a substantial amount of previously lost revenue, but the recoupment came years after the original services were provided.
Today there are certain emerging trends that the specialty will be forced to address and it would be prudent to prepare sooner rather than later. This article is focused on the emerging trends requiring the establishment of metrics for quality and value and, very importantly, who will define these metrics as they apply to EM.
Rappleye includes “persist in driving change” as one of her seven steps to leading health care transformation.1 If EM is, in fact, to emerge as a leader in effecting change and transformation, this may very well include partnering with other specialties, particularly to address the care continuum and continuity of care issues. We in emergency medicine will need to expand our role, especially as it relates to transitions of care. One way or another, it is imperative that EM define and stake out its ground by defining the performance metrics under which it will be measured and judged. The specialty should drive the process of developing and implementing these metrics, especially in the context of how others presently define quality and value. Let us review in terms of financial value.