Developing the Value Proposition for Emergency Medicine

By John G. Holstein

The specialty of emergency medicine is in a pivotal point of time, specifically in terms of establishing and promoting the value message emergency physicians bring to the table. Understanding who defines value metrics, how to apply emergency practice data, and ways to effectively navigate the new high-deductible patient population can create positive impacts in the field.

Who Defines the Value Metrics?

In the evolving and very rapidly changing healthcare landscape there are three parties that are positioning themselves to define the metrics by which physician practices will be measured. These parties are respectively CMS, the hospital c-suite and private insurers.

The bottom line is, if you do not define the metrics by which you will be measured, one or all three of these parties will be more than happy to do it for you. Components of this value message might include the following:

  • Adult and Pediatric Emergency Departments are fundamentally different.
    • Emergency Departments are characteristically defined along predictable visit thresholds.
    • Emergency Departments today account for 68% of hospital admissions. Although hospitals continue to move services to outpatient settings, they still survive on inpatient revenue.
    • As emergency physicians you are strategically poised at a critical position along the care continuum and as such hold a critically important position as master diagnosticians for the proper disposition of your patients.
    • As emergency physicians you can assist your hospital partners in their struggle with the admission/re-admission problem they are being fined for today. Observation services as an option for assessing admission and your master diagnostician skills are vital to critically evaluate re-admissions, both issues of utmost significance for your hospitals' financial success.
    • Your position along the care continuum also places you at the hub of both upstream hospital revenue as well as downstream physician, sub-specialty revenue. You are master play-callers for the appropriate disposition to sub-specialists.
    • You have the best handle on both the frequent ED patient user as well as the mental health patient populations.
    • Do not recreate the wheel. Benchmark data exists and it is critical to the success of your practice. Your professional or hospital billing partner should be able to provide you with practice metrics important to your financial and political success. Emergency Department Benchmarking Alliance is a wonderful resource for benchmark data analytics.
  • Know Your Own Practice and Your Own Data

    The landscape is shifting almost daily. It is imperative to monitor all acuity, billing, clinical and demographic measures of your practice as well as your own individual metrics. The overall cash/visit collected is a vital metric to know, understand and monitor for every emergency physician.

    These are days of increasing partnering with insurance companies. Know and understand although it is definitely a different day, historically virtually every major insurer previously went through a class action settlement for inappropriately denying and/or bundling of claims, with millions of dollars paid back to physicians, although years after the original dates of service. Always, always remember insurance companies have far more data than you will ever have in a negotiation.

    You must know your own data. You travel at your own risk without that knowledge.

    The New High-Deductible Patient

    Self-pay has always been a challenge for emergency medicine. The new, high deductible patient presents both a revenue issue, but also a potential PR issue if these accounts are not handled correctly and efficiently. Usage of yesterday's processes, protocols and technology is hazardous to your practice's health. Carefully and creatively planned campaigns using a sophisticated blend of people, processes and technology are necessary to be successful with these patients. Patient mixes are changing and this is a critical patient to monitor.

    In closing, a challenge for emergency physicians! you have the data, experience, knowledge, and skills and today you are in a critical position to be a game-changer in the health care industry. It's now up to you.

    Note: A special thank you to James Augustine, MD for his ACEP Reimbursement presentation this year entitled "How Do You Measure Up? ED Benchmarking and Hospital Perception." Your information was invaluable to this article.

    John G. Holstein is a director of business development with Zotec Partners.