The picture emerging here is one where the audience emergency medicine plays to is fast moving toward establishing the metrics by which the quality and value of emergency care will be measured. The most significant issue here is the specialty needs to be defining the metrics by which you will be measured, not the audience!

So what are or could the emergency medicine-specific measures/

metrics be today? More importantly what are they as defined by the specialty? A preliminary list might include the following:

• Various Turnaround Times
• Door-to-doctor times
• Door-to-balloon times for MI
• Door-to-needle times for CVA
• Percent of patients admitted
• Patterns and percentages of readmissions over time
• Percent of patients leaving prior to medical evaluation (LWBS)
• Ancillary charges per encounter-Lab/X-ray/CT/MRI/Nuclear Medicine/Ultrasound
• RVUs/ hour of coverage
• Patients/hour/practitioner
• Patients admitted to ED observation
• Patients admitted to inpatient status after ED observation
• Patients discharged home after ED observation
• Patient satisfaction (“experience”) scores
• Feedback and rating from in-house departments
• Feedback and rating from sub-specialty colleagues
• Effective communication and care coordination with primary care physicians.
• Incidence of ambulance diverts.

This is by no means an exhaustive list and is not meant to be. The list will evolve, but the most important issue is that you have direct input into the measures and indices by which you will be evaluated. The message is clear. CMS, private payers and your hospital administration C-Suite colleagues are all moving toward defining these measures. It is time for you to call the signals by defining the measures specific to your specialty; the time is now, especially before someone else does it for you.

John G. Holstein is a director at Medical Management Professionals.