As part of their candidacy, the three members vying for the office of President-Elect of ACEP answered the same three questions. You can find all the responses online at www.acep.org, in the “About Us” section under “Leadership.” The candidates’ answers to one question are below and are unedited in any way.

What can ACEP do for emergency physicians as they face the development of Accountable Care Organizations, bundled payments, and potential employment by hospitals?

Alex M. Rosenau, D.O., CPE, FACEP

The Accountable Care Act mandates the creation of Accountable Care Organizations (ACO’s), ostensibly to encourage the sound integration of the components of patient care delivery. Incentives and disincentives will be used, we are told, to bring value to the system. Value, meaning low cost/high quality, is the goal. Hospitals and physician groups have calculated that starting up an ACO according to the final rules will be a large, difficult to recover expense. Physicians are concerned that ACO’s could morph into Alternative Capitation Organizations leaning towards low cost rather than high quality. ACEP must address the regulatory process in real time.

ACEP will employ our resources (DC office, PR Dept, NEMPAC, EMAF, state chapters) to not only maintain a highly motivated, informed membership but also to stimulate public sector leaders (patient base) to use legislative pressure points, media attention and targeted legal action (via amicus briefs, DC consultants and legal firms) to achieve our goals. To survive and thrive regardless of care delivery models, ACEP should develop an educational program to train members for service on the PHO/IPA Board, Hospital Med Exec Committee, group compensation committees and contracting committees. Our Emergency Medicine Foundation is working to bolster our advocacy work by supporting grantees who concentrate on evidenced-based health policy research, an effort begun under my leadership as Chair of EMF. One emergency physician grantee has now achieved a position as a White House intern.

Bundling payments through acute care episodes potentially creates adversarial relationships among the specialties, endangering the independence of our members, potentially resulting in group penalties for activities not under our control. The application of EMAF resources to complement NEMPAC efforts is vitally important to a future that is safe for our patients and sustainable for our members. Whether hospital employed, an independent contractor, small democratic group member, large corporate employee, or academic educator, we all know instinctively that all must hang together or surely we shall all hang.

Right now, many are planning our future – and our independent future is at serious risk. We need to be the educated, involved architects of that future. Our members and our patients are counting on us.

Andrew E. Sama, M.D., FACEP

ACEP is and will continue to be the primary source of accurate up-to-date information, strategy development, and best practice data as new paradigms of payment and funds flow emerge. The current structure of Emergency Medicine practice is varied and will continue to remain well differentiated for the foreseeable future. The pressures to consider realignment while external forces attempt to influence practice structure in Emergency Medicine are real. The role of ACEP during this transformation will be to continue to facilitate the efforts of its members and leaders in gaining knowledge, sharing information, and strongly advocating nationally and regionally on behalf of Emergency Medicine physicians and our patients. Our annual Leadership and Advocacy Conference is an excellent example of ACEP’s outreach to and political efforts on behalf of our members. This year’s Advocacy event in Washington, DC had record attendance by members which increased the effectiveness of our work at the State and Federal level. ACEP committees and task forces work products will also help to ensure the success of ACEP’s advocacy for Emergency Physicians related to new or different payment methodologies.

Our number one priority must be building the capacity of all members to be fully informed about ways to insure fair payment, control their practice environment, and be properly supported during the negotiations of process change. As external pressures continue to exert influence on the field of Emergency Medicine, ACEP can support its members by creating structured guidance about the advantages and disadvantages of hospital alignment. We must be the repository of expertise on all issues that impact the lives and practices of our members.

The nature of our specialty demands collaboration and alignment with hospitals in the vast majority of our business efforts. Maintaining autonomy, fairness in negotiations and payment, and the leadership role in the structure of emergency medical care delivery systems are essential. ACEP will continue to support these efforts with College resources guided by the membership and leadership expertise. We will apply strategy and intellectual capital in a manner most consistent with achieving success and satisfaction for our membership and patients.

Robert C. Solomon, M.D., FACEP

What these trends have in common is that the drivers – chiefly third-party payers – are generally not thinking about the role of emergency medicine in the health care system when they press for the adoption of their favored models. The single most important thing ACEP can do in this arena, as in many others, is to position emergency medicine for visibility and to get all of the stakeholders to recognize the central role the specialty plays.

The impetus for ACOs and bundled payments is the desire to gain control of the total cost of caring for patients – sort of a “prix fixe” rather than à la carte approach to paying for care. While this is an understandable goal, most of us think it is important to preserve independence in the practice of emergency medicine. This means that EPs should continue to have an array of options, including status as independent contractors, partners in or employees of physician groups, and hospital employees. Many policymakers clearly care little about such professional issues and think a system in which all doctors are employees of hospitals or health systems is the best model.

While it is possible that our nation’s health care system will eventually evolve to look like that, for the present ACEP should continue to advocate for choice in professional practice and for fair treatment of emergency physicians who must negotiate with hospitals and health systems for their share of bundled or global payments.