Emergency medicine stakeholder perspectives on value-based alternative payment models: A qualitative study

• Published in: The American journal of emergency medicine Vol. 37; no. 3; pp. 535 - 538
• Main Authors: Wu, Austin, Carter, Caitlin, Pines, Jesse M.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2019; Elsevier Limited
• Subjects: Accountable care organizations; Cost control; Emergency medical care; Emergency medical services; Emergency services; Payment systems; Payments; Qualitative research
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2018.07.020

APMs have been a challenge to apply in some settings such as emergency departments (ED), where visits are episodic, providers do not control care demands, and operate under the Emergency Medicine Treatment and Active Labor Act (EMTALA) with is a requirement to medically screen every patient [1-3]. [...]there were mixed views on ED APMs, yet good consensus that EDs are an important player and many opportunities exist to improve delivery and reduce cost. Emergency physician or society involvement in stakeholder conversations about APMs 91 (14%) “So one of the trends I'm starting to see, but it's very very nascent, is as hospital service contracts are being renewed for non-employed groups, the group has to agree to participate typically with best efforts in general future quality programs so that as those payer relationships with the hospitals evolve over time and start to relate to cost and the real detail of alternative payment models, the ED group will ultimately be able to get in line.” Structural barriers to APMs (e.g. EMR, payment systems, etc.) 82 (12%) “Of course there's the IT infrastructure, there's so been so much written about that, but even in very sophisticated health systems that are now engaging specialists they've got real challenges due to disparate electronic health information.”