It’s likely that ED groups will soon be asked by payers, hospitals, and accountable care organizations to assume financial risk for the cost of care driven by our discharge dispositions.
Success will soon depend on the ability to capture, track, and analyze data for populations at risk for costly post-ED discharge events.
Do you know what happens to patients who were seen last month in your ED? Were their admitting diagnoses correct? Did they stay in the hospital for one day or seven? Were they readmitted to another hospital? Did they go home and fall? Did they die?
The unfortunate reality is that emergency physicians can rarely answer these questions, and the health care system doesn’t provide payment incentives that allow us to focus on understanding these outcomes. That is about to change as emergency medicine is driven headlong into the world of payment for clinical outcomes.
Last year, a federally convened panel submitted a Report to the Secretary recommending that the Department of Health and Human Services implement the American College of Emergency Physicians’ emergency medicine-focused alternative payment model, which focuses on safe discharge as an alternative to hospital admission.
Last month, HHS Secretary Alex Azar formally responded, saying ED providers can influence transitions of care from the hospital and serve as a critical link in broader efforts to deliver coordinated, value-based care.
He then directed the Center for Medicare and Medicaid Innovation (CMMI) to consider how key components of ACEP’s Acute Unscheduled Care Model (AUCM) could operate as a component in a larger model dedicated to improving population health.
The bottom line is that it’s likely ED groups will soon be asked by payers, hospitals, and accountable care organizations (ACO) to assume financial risk for the cost of care driven by our discharge dispositions. Understanding the financial and clinical outcomes of our care will not be optional.
Success in this new world will be driven by three competencies:
- Modifying the ED care process to capture information that will identify eligible patients, assess the likelihood of a safe discharge, and support ED physician participation in shared decision-making during the disposition process.
- Efficiently identifying patients in need of post-ED discharge care coordination services to ensure appropriate follow-up care.
- Moving beyond the “on-call list” to schedule follow-up consults and testing at in-network sites of care.
Success in this new payment model is dependent on the ability to capture, track, and analyze data for populations at risk for costly post-ED discharge events.
Emergency department group leaderships should prepare for this transition now. An evaluation of your leadership structure, care coordination capabilities, and financial readiness will prepare you to compete in the world of outcome-driven ED payment models. Such an analysis is the first step toward adopting new information management strategies that track performance, monitor cost, and enable data-driven quality improvement activities that support efficient and effective care.
Dr. Susan Nedza, MD, MBA, is a nationally recognized emergency physician leader who is board-certified in emergency medicine and clinical informatics. Nedza serves as a strategic advisor to d2i, assisting in product development that helps clients capture, visualize, analyze, and act upon data that supports successful performance in alternative payment models.