Editor’s Note: This article is the third in a series looking at how quality-improvement and performance-reporting programs are affecting emergency medicine and will affect emergency departments in the future.

In an optimistic future-state view of how care delivery might be transformed from the fragmented, who’s-on-first reality of discrete patient encounters and individual provider accountability, visionaries—and, increasingly, health care payers—are eyeing a new model: one predicated on integrating episodes of care (EOCs) for a single event or diagnosis, and reforming reimbursement to accommodate value-based purchasing.

In that scheme, care settings and providers—from the primary care office to the emergency department to the skilled nursing care facility—would be inextricably linked throughout the care continuum, not just for the purposes of improving handoffs and safety. Providers would also be on the hook, individually and collectively, for patients’ outcomes and would be allocated a portion of the total payment accordingly.

Even if emergency physicians have heard little or nothing about EOC methodology, value-based purchasing, or yet another take on provider measurement and accountability, they soon will. Hospital administrators are facing mounting pressure to improve care coordination across settings and demonstrate the value of care through medium-term outcomes. ACEP is moving proactively to define emergency medicine’s role in that future state.

“It’s like that much-used analogy, ‘skating to where the puck will be,’ and that’s what we’re doing,” explained Dr. Angela Gardner, ACEP president and associate professor of emergency medicine at the University of Texas Southwestern in Dallas.

“I think the desired effect of this [integrated] approach is to get patients taken care of and well, before they reach the point of having to go to the ED, saving the emergency department visit for true emergencies and things that can’t be handled in an office environment,” she said.

In anticipation of the steps that commercial payers and the Centers for Medicare and Medicaid Services, through its value-based purchasing (VBP) initiative and demonstration projects, are already taking, ACEP last year convened the Value Based Emergency Care (VBEC) Task Force. That group, in a white paper available on the ACEP Web site (www.acep.org/WorkArea/DownloadAsset.aspx?id=46846), evaluated the various VBP strategies being considered and recommended that ACEP consider pursuing several initiatives that relate VBP to emergency care.

This year, three different task forces are evaluating considerations for ACEP regarding specific VBP strategies. The Episodes Task Force is evaluating the impact of episodes of care on emergency medicine and is expected to make recommendations regarding the feasibility of a risk-adjusted presenting complaint–driven emergency department EOC model. The Integration Task Force is working to more tightly define emergency department care coordination and continuity support within the vertical and horizontal health care landscape, and is exploring a possible partnership with Federally Qualified Health Centers to improve how patients are cared for as they move between the two settings. In tandem with those activities, a Data Registry Task Force is evaluating the possibility of developing a comprehensive emergency medicine care data registry to facilitate benchmarking, quality improvement, and reporting.