Where does emergency medicine fit into the new era of medical homes , accountable care organizations and bundled payments? In a new editorial in the Annals of Emergency Medicine, several emergency physicians warn of the challenges of incorporating what ER docs do into new models that move away from the current fee-for-service payment to an episode-of-care approach that reimburses providers for caring for a population of patients over time. In particular, the ER docs fret that they haven’t been involved in current projects to develop new payment models, such as pilots being designed by federal health agencies, the National Quality Forum, the Brookings Institute and others. They call for more emergency-medicine participation in such projects, and an emergency-medicine research agenda that quantifies the economic value of emergency care within a CARE “episode.” David Seaberg, president of the American College of Emergency of Physicians, tells the Health Blog that ER docs are in a unique position to play a vital role in new care systems. In 2009, they saw 136 million patients and tens of millions of family members who accompanied those patients to the ED. “We should start using that access better, to do health-care

screenings, preventive services and disease management and serve as a link to integrated care delivery,” Seaberg says. “Maybe we are not the medical home, but we should be part of the medical neighborhood.” In the editorial, the ER docs  — who are from several large institutions — also warn that increased pressures on emergency physicians to save money could raise the probability of missed diagnoses, and boost medical-liability risks. ER physicians, who often make the decisions to admit patients to the hospital, will also face challenges given that hospitals are under pressure to limit admissions and readmissions, the editorialists contend. “Prevention of injury and disease is the ideal health objective, but in the real world, timely treatments, such as addressing hyperglycemia in a diabetic patient or preventing tissue damage in heart attack patients, provide both value and cost savings,” says Seaberg. “Medical emergencies are never planned, and the ability of an emergency department to conduct rapid diagnosis, intervene in acute illness and mobilize multiple resources to care for patients have tremendous value to both society and patients,” he says. Image: iStockphoto

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Emergency Docs Warn of Challenges in New Payment Models