Emergency Physicians; The emergency medicine specialty holds a crucial role as the nation’s healthcare safety net. This responsibility presents a unique set of clinical and financial obstacles for emergency medicine physicians, which are magnified by trends such as an aging Medicaid population and payers’ narrowing provider networks.
“Hospital networks understand the central role of emergency departments to access, population healthcare and financial success. Emergency medicine has emerged from its status as a place of last resort and is the hub of the system. The ED is the essential healthcare safety net, having evolved into a rapid diagnostic and decision center.
It’s important to realize emergency physicians and emergency medicine are safety nets. We’re the ones who are there 24-7, 365 days a year. We’re the ones that see half Medicaid patients and two-thirds self-pay patients. We are providing the underlying care, and emergency physicians are mission-driven in that way. I picked the specialty to take care of all kinds of patients. The reality is we are always there, and we see everyone. No other specialty does that, and I am proud of that.”
“Emergency physicians are master diagnosticians, educated and trained to evaluate and treat the clinical presentation of their patients, many times with no perspective nor past medical history. Since inception of the specialty as strong patient advocates, they also know and understand the appropriate “next-step” along the care continuum for their patients.
This is an exceptional skillset, especially as our healthcare landscape is constantly in flux as sites of service continue to shift to outpatient settings. Emergency physicians on a daily basis encounter the entire spectrum of human accident, illness and/or infirmity, treating every patient regardless of their ability to pay 24-7, 365 days a year.
Streamline chart documentation
Certainly, this effort on the federal and state level around ‘surprise bills’ is a significant issue for us. I think there is a lot of misconceptions about why those happen. The fact of the matter is, most emergency physicians want to be in network with most payers. They think the reverse is also true, as well. But right now, insurers can have a higher deductible for out-of-network care than in network care.
“In the emergency medicine reimbursement area, the most important issues today and over the next 18 months are resolving out-of-network balance billing payment issues; the reconsideration of emergency department evaluation and management code valuation; and the current efforts to streamline chart documentation to lessen the administrative burden on providers.
They’re incredibly successful for being a relatively new specialty. People continue to ‘speak with their feet,’ as they say. They’re showing up to EDs in increasing numbers because they want prompt, accurate and efficient care. They are misunderstood, though, because people think many of these visits are for non-emergencies. This has led to what I call a ‘moral injury’ leading to stress for our physicians and nurses.
Moral injury starts with our specialty being devalued and undervalued, resulting in payers trying to figure out ways to not pay us. We practice with an unfunded mandate, EMTALA the act that truly defines who we are. We take care of anyone at any time, regardless of their ability to pay. But that doesn’t mean emergency medicine should be devalued. Our country must find a way to fund our medical safety net. In America, people view healthcare as a right, but fund it as a privilege.