BOSTON—Steven Stack, MD, FACEP, doesn’t think people understand emergency physicians well enough. Luckily, Dr. Stack—the first practicing emergency physician to be president of the American Medical Association—has a big pulpit.

“We’re problem solvers,” he said. “We’re troubleshooters. We make things work despite the fact that there are so many odds against us.”

But it’s ACEP’s job to help fight the odds. So Dr. Stack, ACEP President Jay Kaplan, MD, FACEP, and Immediate Past-President Michael Gerardi, MD, FAAP, FACEP, held a town hall-style Q&A session at ACEP15 on Wednesday to talk about the battlefronts and the need to adapt.

“What’s made us successful up to this point is not going to make us successful in the future,” Dr. Kaplan said.

Take retail health care clinics, for example. Dr. Kaplan said venture capital firms have spent billions of dollars setting up clinics that “skim off some of the profits from the paying patients and leave us with all the rest.”

But it’s not just retail clinics or telemedicine siphoning paying patients away from EDs. Declining reimbursements are also taking their toll. Consider a math equation where X is health care dollars, Y is the number of patients, and Z is dollars per patient.

“If X pays roughly the same and Y increases dramatically, as we know it will with 10,000 Americans every day turning 65 for the next 16 years,” Dr. Kaplan said, “Z will decrease dramatically. There’s no way of getting around that math. We’re going to get paid less for the patients we see, which means we’re going to have to see more patients.”

Another concern discussed was boarding. Dr. Kaplan said he’d like The Joint Commission to set better standards to deal with the issue. He will also update ACEP’s last boarding task force report, completed in 2008.

“We will put together a toolbox for our inpatient colleagues,” Dr. Kaplan said, “where we can go to our hospital leaders and we can go to our hospitalists and say, ‘Here’s the data. Here’s the literature. Here’s some proven methodology that will help you not only get better outcomes for your patients and get better patient satisfaction, but will bring you millions, millions of dollars.’”

Others mentioned quality metrics as an issue. Dr. Gerardi said that ACEP is working on patient databases, including its Clinical Emergency Data Registry (CEDR), which would measure quality and outcomes on a national level.

The initiatives are “going to give us data to show value,” he added, “but it’s also going to improve quality because we’re going to have much more information on our patients.”

Dr. Kaplan praised ACEP’s programs, but lamented the impact that electronic health record systems have had on emergency medicine.

“The problem with electronic health records is we have stopped talking to each other,” Dr. Kaplan said. “We’ve stopped talking to nurses who used to walk up and say, ‘Here’s what I want to do. Here’s what I want to order.’ Instead, we input it in an electronic interface. We lose a lot this way.”