The Pulse April 2011

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APRIL 2011 VOLUME XXXVI NO. 2

Presidential Viewpoints Thomas A. Brabson, D.O., MBA, FACOEP-D, President

We Have a Resounding Voice When It Comes to Emergency Medical Care

Once again spring is finally here. I don’t think there was any place in the US spared from the harsh winter we just experienced. Fortunately though, as osteopathic emergency physicians, we pride ourselves on accepting new challenges, and as we are all aware, there are many new challenges occurring in the world today. Since our last issue, I have had the opportunity to represent the ACOEP at two very important meetings. The first meeting was the second “Future of Emergency Medicine Summit” which was hosted at the ACEP headquarters. Drs. Christiansen, Mitchell and I traveled to Dallas where we joined representatives from ACEP, AAEM, ABEM, AACEM, CORD, ENA, EMRA, SAEM, SEMPA, American Society for Healthcare Risk Management, and the Emergency Department Practice Association. It was a very productive and collegial two days. We discussed the work force issues that challenge the future delivery of emergency medicine.

The issue of how to staff every emergency department with residency trained emergency physicians was again a topic of discussion. This remains a significant difficulty in rural America. We discussed the advanced practice nurses and physician assistants and how they can help to fill the need. Each of these groups has much to offer but they have very few formal training programs specific to emergency medical care. The passage of the Patient Protection and Affordable Care Act has added to our challenges. With the estimated 32 million more people receiving medical insurance, our emergency departments will likely see our volumes soar. The Accountable Care Organization (ACO) provision in the Act also generated much discussion. As I have mentioned before, I believe that the emergency physician should be an active participant in all of the planning of the ACOs. There is a broad consensus that the next phase of reform must slow the growth of health care costs and improve value through payment reforms this will include: bundling of payments, including payments for episodes of acute care. It is thought that some savings will occur as a result of innovative care models including the ACOs, medical homes, transitional care, home care and community-based care. I believe that emergency medical care will be an integral part of all of these innovative care models.

The PULSE APRIL 2011

Therefore, as osteopathic emergency physicians, we must aggressively seek opportunities to participate in the planning and implementation of the innovative models. We need to assure that our role of serving and protecting is maintained while we accept a new role of helping to guide the patient through a new health care system. We currently need to make a decision to admit to the hospital or discharge to home. In the near future, we may be called upon to make the additional decisions to triage a patient to a primary care physician’s office, to a specialty clinic, or even an urgent care center as opposed to being evaluated in the ED. The number of diagnostic studies ordered, specialty consultations, and ‘unnecessary’ admissions will all whittle away at the bundled payment. The question still remains as to who will receive the bundled payment. Many people think that for the hospital based services, the hospital will receive the bundled payment and they will be responsible for the disbursement of the funds. Imagine how that will potentially change the dynamics of the relationship between the physicians and the hospitals. The physicians and hospitals working corroboratively will take on a whole new meaning. We will be partnering for more than just an employment contract, we will be partnering to develop the innovative continued on page 19

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