In the future, theoretically, if there’s a global or bundled payment for an episode, each provider who encountered the hip-fracture patient along the continuum may be commensurately compensated—or docked—depending on respective care quality, explained Dr. Michael Granovsky, course director of ACEP’s National Coding and Reimbursement Conference and a member of the VBEC task force.

“Ultimately, CMS is looking at paying us directly related to outcomes, and there is some concern in emergency medicine that we either might not receive our fair share or that emergency physicians might be penalized for things that are outside our control,” he said. “That’s one reason the VBEC Task Force is being so proactive.”

Medicare is also looking at individual provider costs, especially in high-cost areas like cardiac procedures, Dr. Granovsky said. Although emergency physician contributions to total care costs haven’t been a predominant focus, emergency physicians may already be feeling the resource-utilization pinch in their hospitals through various utilization measurements or even in the form of “withholds” that are written into group or payer contracts.

“The first area where this is coming, and fast, is imaging,” he said, adding that emergency physicians may already be facing pressure to reduce their utilization of MRI and CT scans.

A concurrent national development that will affect emergency physicians is the creation of what are called accountable care organizations (ACOs). Loosely described, ACOs are collectives—actual or virtual—that share responsibility for treating certain patient groups and for treatment outcomes over the medium to long term and may share in savings that accrue from reducing care fragmentation. The movement, which is gaining favor on Capitol Hill and already being tried out in pilots throughout the country, is a progressive attempt to reduce care fragmentation while incentivizing providers along the spectrum to coordinate their efforts.

Many in health care think that ACOs as a model hold promise for improving overall care and reducing costs. But given emergency departments’ sometimes precarious positioning on the care spectrum, Dr. Granovsky maintains, it behooves ACEP and individual members to ensure that emergency medicine is appropriately represented in the changing payment landscape.

“What we really want to ensure right now is that whatever model emerges is revenue neutral and recognizes the value inherent to emergency medicine—and that we’re not beholden to other third parties we have no say or influence over,” Dr. Granovsky said. “There’s no question that all of these things going on do and will have a big potential effect on the specialty and our physicians’ daily practice lives.”