title: Episodes of care: is emergency medicine ready?
abstract: Optimizing resource use, eliminating waste, aligning provider incentives, reducing overall costs, and coordinating the delivery of quality care while improving outcomes have been major themes of health care reform initiatives. Recent legislation contains several provisions designed to move away from the current fee-for-service payment mechanism toward a model that reimburses providers for caring for a population of patients over time while shifting more financial risk to providers. In this article, we review current approaches to episode of care development and reimbursement. We describe the challenges of incorporating emergency medicine into the episode of care approach and the uncertain influence this delivery model will have on emergency medicine care, including quality outcomes. We discuss the limitations of the episode of care payment model for emergency services and advocate retention of the current fee-for-service payment model, as well as identify research gaps that, if addressed, could be used to inform future policy decisions of emergency medicine health policy leaders. We then describe a meaningful role for emergency medicine in an episode of care setting.
authors.affiliation: Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, USA. jennifer.wiler@ucdenver.edu
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Wiler
authors.forename: Dennis
authors.initials: D
authors.lastname: Beck
authors.forename: Brent R
authors.initials: BR
authors.lastname: Asplin
authors.forename: Michael
authors.initials: M
authors.lastname: Granovsky
authors.forename: John
authors.initials: J
authors.lastname: Moorhead
authors.forename: Randy
authors.initials: R
authors.lastname: Pilgrim
authors.forename: Jeremiah D
authors.initials: JD
authors.lastname: Schuur
mesh_terms: D004635:Emergency Medicine / Q000191:economics / Q000331:legislation & jurisprudence / Q000458:organization & administration; D017050:Episode of Care; D018588:Fee-for-Service Plans / Q000331:legislation & jurisprudence / Q000458:organization & administration; D018166:Health Care Reform / Q000331:legislation & jurisprudence / Q000458:organization & administration; D006801:Humans; D018803:Models, Economic; D058991:Patient Protection and Affordable Care Act; D012051:Reimbursement Mechanisms / Q000331:legislation & jurisprudence / Q000458:organization & administration; D014481:United States