“That data doesn’t exist at the moment, but if we had it, we could better tailor care to the populations emergency physicians serve,” Dr. Gardner said.

Of the myriad activities occurring nationally to improve care and reduce costs, Medicare’s VBP initiative is likely to have the most dramatic effect. VBP’s purpose is to effectively move Medicare from a passive payer of claims to an active purchaser of care by linking payments to results, including the extent to which emergency department care quality reduces unnecessary readmissions.

“Our members are busy practicing full time on day-to-day basis and probably aren’t leaving their shift thinking about their 30-day readmission rate. But for ACEP and emergency medicine to find a fit with health care reform and VBP, we need to be actively engaged at a policy level to demonstrate the real value of emergency care,” said Dr. Dennis Beck, a VBEC Task Force cochair who also chairs the Episodes task force and ACEP’s Quality and Performance Committee. “There has been considerable attention, nationally, on who provides value and how that value can be objectively measured and in turn drive payment policy.”

More generally, for the measures the CMS incorporates into VBP, hospitals will be ranked against national benchmarks. That will translate into increasing pressure on emergency departments to improve performance, Dr. Beck noted, in the longitudinal picture of care. “What ACEP is doing right now is try to prepare for how emergency medicine might fit into the equation,” Dr. Beck said.

The three task forces are expected to issue their initial recommendations this month, and with the recent passage of health care reform legislation, ACEP is refocusing efforts of these task forces accordingly.

“We’re taking a fresh look at these task forces because of the [Affordable Care Act’s] heavy focus on measuring patient outcomes over an episode and using health information technology to facilitate quality reporting,” said Angela Franklin, ACEP’s Director of Quality and Health IT. “We’re also looking at the payment implications for hospitals.”

ED Care Patterns, Costs Scrutinized

EOC methodology is nascent in its development, several demonstration projects are already underway. However, other than the initiating emergency department visit as the first step in an acute care episode, most methodologies consider an emergency department visit during an episode to be “inappropriate” or representing a failure of the system. And government and private sector demonstration projects are in development to qualify care and quantify total costs for episodes such as hip fracture, myocardial infarction, and pneumonia.