During a town hall meeting at the 2011 ACEP Council in mid-October, several emergency medicine leaders discussed the landscape of the health care environment and its implications for emergency medicine.

“All of emergency care is just 2% of the national health care budget,” said Dr. Sandra Schneider, ACEP’s immediate past president. “For that 2%, [emergency physicians] provide 28% of all acute care, [and] treat 45% of the underinsured and more than 60% of the uninsured. This is really a bargain. We should be applauded,” she said, rather than have EDs erroneously branded as “expensive” or filled with patients making “unnecessary visits.”

Dr. Schneider noted that in addition to educating lawmakers about the value of emergency medicine, ACEP is pursuing strategies of securing liability coverage and staying vigilant to ensure that cost-cutting measures don’t end up adversely impacting quality.

Another evolving paradigm is physician reimbursement, including the recent proposal from the Medicare Payment Advisory Committee (MedPAC) that would freeze payments for primary care physicians for 10 years and would cut payments to others by 18% in the first 3 years, followed by a 10-year payment freeze.

ACEP is fighting MedPAC’s proposal and seeking a permanent fix to the flawed Sustainable Growth Rate (SGR) formula, as well as asserting the role that emergency medicine plays in value-based medicine proposals.

“Fee-for-service is going to fade out, and we have to start preparing for that,” said Dr. David Seaberg, ACEP President. “But none of those methodologies that have been discussed have thought about the role of emergency medicine.”

Dr. Seaberg added that emergency physicians could be the central hub of an ED “team of the future” in a comprehensive care program designed to keep patients well.

“We have to change the thinking so [lawmakers] realize that going to the emergency department is not a failure of the system,” he said.

The current trends in health care include an increase in government involvement and the need for physicians to band together in new ways, said Dr. Steve Stack, an ACEP member and chair-elect of the American Medical Association.

“We need to decide as doctors if there is more that binds us than divides us.”