As recently as March, CMS broadened its view, as evidenced by its release of information on emergency department wait times with the following introductory note: “Long waiting times in hospital emergency departments can increase risks for patients, especially those who have serious illnesses. Waiting times at different hospitals can vary widely, depending on the number of patients seen, emergency department staffing, efficiency, admitting procedures, or the availability of inpatient beds.”

The landscape is changing as the metrics are mounting by which emergency medicine is and will be measured, with some impacting your revenue today (i.e. especially PQRS), and potentially more metrics on the way; ultimately the bottom line will be about cost. It is likewise very wise for emergency physicians to ready themselves for reporting indices to the other two audiences, namely the private payer industry and hospital administration. Regarding the private payer audience, an interesting comment was made recently in similarly noting the rhetoric about quality is not the issue of importance. Rather, said managed care consultant Ron Howrigon at the 2013 ACEP Reimbursement Conference in February, it’s about cost savings – measures such as lower incidence of CT scans and reduced admissions.

The message is clear that others are developing their metrics and measures, and it’s ultimately about cost, but where is emergency medicine in establishing these metrics by which you will likely be measured? A strong notice of the hospital audience chiming in occurred when the New York Health and Hospitals Corporation announced earlier this year in a press release that it will award up to $59 million in bonus payments to physicians for hitting their defined quality and efficiency targets. Where does the Hospital C-Suite stand fit into this equation? A glimpse of this was described recently by Sinai Health System CEO Alan Channing, when he included the following measures in his list of “How to Keep the Hospital Happy” measures.

• Build business
• Keep referral sources happy
• Good communications
• Simplify management issues
• High HCAPS scores
• Consistent and high quality scores
• Rapid through-put
• Minimize hospital’s financial participation
• Support the hospital’s mission, vision and values

This list represents the circumstances under which the emergency department group gets and/or keeps the contract. Does it matter? Absolutely, because the C-Suite is mandating the metrics that literally define how your services will be measured. Meet the metrics and you have a job; miss the mark and you could be history. It doesn’t get any more important than that; it means survival.