Emergency Physicians as the Solution for a C-Suite Dilemma

John G. Holstein

John G. Holstein


Published July 19, 2013

The recent Healthcare Financial Management Association (HFMA) conference held in Orlando offers some great insights into the hospital-C-suite world. From my perspective, one of the most important lessons is that there is a direct opportunity for emergency medicine (EM).

As EM professionals, we are all subject to rules set forth by both the Centers for Medicare & Medicaid Services and the payer community. But ultimately, when push comes to shove, the C-suite holds the trump card for every emergency medicine physician — in the form of control over employment or contract renewal.

It is therefore imperative that emergency physicians bolster their communication and relationship with hospital executives — particularly by highlighting the contributions being made daily by every emergency department. The recent Rand report, The Evolving Role of Emergency Departments in the United States, provides a significant amount of information that can guide these important conversations.

It is common knowledge the HFMA conference brings many of the elite hospital C-suite executives together annually in one place. In many ways, the conference leadership sets the tone and the agenda for many within the healthcare executive strata. This year, the conference was filled with presentations focused on developing and defining metrics for measuring “value” in healthcare delivery systems, physician engagement and integration, value-based purchasing, ACO contracting and data analytics, along with the ever-present presentations on MAC and RAC audits.

In the context of finding an opportunity (i.e. opening) for emergency physicians, I noted the following points from three different presentations:

  • First, Civello and Marshall in their presentation referenced the “difficulty in getting physicians to participate as leaders” as one of the top three threats to hospital physician alignment strategy.
  • In a second presentation, Larkin-Carney and Xavier emphasized the importance of “understanding what was being measured.” They additionally stressed the emergency department as being key in the movement toward value-based purchasing.
  • Third, and perhaps most salient in this context, Marino and Zaman noted “the minimal attention given to clinical outcomes, due to difficulty in measuring the patient’s ‘full-cycle’ of care.”

What an incredible opportunity and invitation for EM physicians to fill in the gaps highlighted by these executives. The recent RAND study and Keith Kocher’s study on unscheduled hospital admissions through the ED both validate the revenue contribution being made by EM physicians who currently account for approximately half of hospital admissions. It is also critical to note these same physicians contribute significantly to the entire downstream revenue and delivery system of care for the treat-and-release patients. This is a point little understood and rarely recognized, particularly with the industry focused on admissions. Emergency physicians contribute substantially to the entire spectrum of care, both for the admitted patients as well as referrals for treat-and-release patients.

In this context, a very recent article by Studer titled “The Hospital CEO’s Dashboard: What to Check Daily, Yearly and Quarterly” recommended the following key metrics for demonstrating value in EDs:

  • “Door-to-doc” time
  • “Decision to admit to departure” time
  • Number of patients who leave without being seen in the ED

These and other critical patient care metrics will become increasingly important as the landscape continues to change. Within the context of the Acute Care Continuum, emergency physicians, in concert with hospitalists, make many of the critical care decisions within the healthcare system. These are not all foreign to the specialty, as these indices are typically monitored by every ED. But the point is they are indicative of the C-suite’s continued monitoring of the ED, with an implied assumption there will be more monitoring and very likely additional metrics developed as well.

It is time for EM physicians to seize the opportunity. Hospital C-suite executives are striving to engage physicians to establish the metrics under which physicians will be measured going forward. Emergency physicians are delivering a substantial amount of the care being scrutinized. Who better to describe and present the metrics than emergency physicians? It is an open invitation for the specialty to step up and seize this opportunity by highlighting the fact EM physicians are the nexus of the care continuum. The time is now to continue presenting solutions and answers for the C-suite’s questions.

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