As part of their candidacy, the three members vying for the office of President-Elect of ACEP answered the same three questions. You can find all the responses online at www.acep.org, in the “About Us” section under “Leadership.” The candidates’ answers to one question are below and are unedited in any way.

What can ACEP do for emergency physicians as they face the development of Accountable Care Organizations, bundled payments, and potential employment by hospitals?

Alex M. Rosenau, D.O., CPE, FACEP

The Accountable Care Act mandates the creation of Accountable Care Organizations (ACO’s), ostensibly to encourage the sound integration of the components of patient care delivery. Incentives and disincentives will be used, we are told, to bring value to the system. Value, meaning low cost/high quality, is the goal. Hospitals and physician groups have calculated that starting up an ACO according to the final rules will be a large, difficult to recover expense. Physicians are concerned that ACO’s could morph into Alternative Capitation Organizations leaning towards low cost rather than high quality. ACEP must address the regulatory process in real time.

ACEP will employ our resources (DC office, PR Dept, NEMPAC, EMAF, state chapters) to not only maintain a highly motivated, informed membership but also to stimulate public sector leaders (patient base) to use legislative pressure points, media attention and targeted legal action (via amicus briefs, DC consultants and legal firms) to achieve our goals. To survive and thrive regardless of care delivery models, ACEP should develop an educational program to train members for service on the PHO/IPA Board, Hospital Med Exec Committee, group compensation committees and contracting committees. Our Emergency Medicine Foundation is working to bolster our advocacy work by supporting grantees who concentrate on evidenced-based health policy research, an effort begun under my leadership as Chair of EMF. One emergency physician grantee has now achieved a position as a White House intern.

Bundling payments through acute care episodes potentially creates adversarial relationships among the specialties, endangering the independence of our members, potentially resulting in group penalties for activities not under our control. The application of EMAF resources to complement NEMPAC efforts is vitally important to a future that is safe for our patients and sustainable for our members. Whether hospital employed, an independent contractor, small democratic group member, large corporate employee, or academic educator, we all know instinctively that all must hang together or surely we shall all hang.