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Special Report: 2010 ACEP Scientific Assembly: Building a Better Future

2010; Lippincott Williams & Wilkins; Volume: 32; Issue: 9 Linguagem: Inglês

10.1097/01.eem.0000388455.25003.2f

1552-3624

Anne Scheck,

Health and Medical Research Impacts

Designed in 1956 by Betty Willis, this sign has become a treasured Las Vegas icon.The federal government is moving toward value-based purchasing, CMS wants to make bundled payments for episodes of care, and emergency medicine will need to develop strategies to keep pace with the new system. Will you and your emergency department flourish or flounder? The Scientific Assembly of the American College of Emergency Physicians offers practical advice for thriving in the era of health care reform. The Medicare Bus Tues., Sept. 28, 12:30 p.m. In his presentation, “Will Outcomes Equal Incomes? The Medicare Bus — Be on It or Under It,” Michael Granovsky, MD, will impart his reasons for being optimistic, and for exercising caution, by showing how such value-based payment plans make health care organizations more accountable for outcomes and efficiency. The good news is that emergency medicine already functions at high-throttle efficiency in many institutions, providing timely and high-intensity services, he said before the annual Scientific Assembly of the American College of Emergency Physicians (ACEP), to be held Sept. 28-Oct. 1 in Las Vegas. The coming insurance expansion will likely emphasize such value-driven treatment and procedures, observed Dr. Granovsky, the president of Medical Reimbursement Systems, Inc., and the CFO for Greater Washington Emergency Physicians. “This is early on in the process, but we need to marshal our strategy and be thoughtful,” he said. One example: Geisinger Health System in Danville, PA, which charges a flat fee for several major procedures. Doctors, departments, and services throughout the hospital share in this fee. How? Standard procedures are used to meet consistent outcomes, and there are built-in incentives to improve efficiency. Coronary artery bypass grafting (CABG) at Geisinger has 41 discrete patient-care steps. And there is an upfront, single, fixed price for all of the medical services provided by the physicians and the hospital. This bundled payment is then divided up among the providers who contributed to the patient's care. ACEP's value-based task force is analyzing the best approach to position emergency medicine in this changing health care environment. Goals support improved access to care and recognition of emergency medicine's contribution as the front door of the health care system and the safety net, while boarding the Medicare bus. Interventions that Matter Fri., Oct. 1, 8 a.m. Knowing the comparative advantages of one treatment over another slashes more than the bottom line; it helps preserve another asset in increasingly short supply — time. In his presentation, “Pinpointing ED Interventions that Matter Most,” David Newman, MD, will address the finer points of this general concept, which he said has received far less consideration that it deserves. “Now we have to work in, for lack of a better description, ‘economies of care,’” he noted. Old habits die hard, at least in some cases, said Dr. Newman, the director of clinical research in emergency medicine at Mt. Sinai Medical Center and an associate professor of emergency medicine at Mt. Sinai School of Medicine in New York City. “We are living in a time of crowding,” which largely has become a way of life for emergency physicians during some of their shift work, he said. The decision-making load of deadline-a-minute demands on them, while improving morbidity and mortality, he said. Dr. Newman will share his own experiences can be lightened, however, using a literature review to learn how to “choose wisely and choose quickly.” Take heparin for coronary syndromes, for example. It doesn't work in many of the cases in which it is used, while BiPAP for congestive heart failure and steroids for asthma are high-impact treatments with little adverse effects when administered appropriately, so time can be slashed by putting them to immediate use in patients who may be good candidates. “When you are sitting there with 25 patients waiting, what you want to know is where you can make the most impact for the minutes you spend,” Dr. Newman said. “What everyone [in the ED] relies on is their teaching,” he said, explaining that this generally means residency training and continuing medical education that zero in on learning specific procedures. “But there is some great literature that can help us choose more wisely and more efficiently.”Located downtown, the five-block Fremont Street pedestrian promenade features 10 casinos and more than 60 restaurants and lounges. Overhead is Viva Vision, the largest big screen on the planet that features light shows.Hoover Dam, 35 miles southeast of Las Vegas, tamed the Colorado River, and created North America's largest manmade lake, Lake Mead. The 726-foot-high, arch-gravity dam is 660 feet thick.The scenic Red Rock Canyon is just a few miles west of the Las Vegas Strip. Visitors can hike, rock climb, and take a drive through the park.Las Vegas has everything from celebrity chef restaurants to nonstop nightlife and headlining entertainment.Know Before You Go Tues., Sept. 29, 5 p.m. Providing emergency care in a developing nation stretches clinical skills and expands professional growth. Its practice mix can include treatment of parasitic infections and labor complications at the same time, sometimes even in the same patient. That is the message in “Know Before You Go: International Emergency Medicine,” by Ravi Morchi, MD, the director of the medical screening examination program in emergency medicine at the Harbor-UCLA Medical Center and an assistant professor of medicine at UCLA's David Geffen School of Medicine. Dr. Morchi has been traveling to Africa to provide emergency medical care for the past seven years, spending time in rural areas in the east, west and central parts of the continent. Compared with practice in the United States, “you are more of an all-around physician,” Dr. Morchi said, practicing even gynecology and surgery. In one case, he surgically removed a ball of Ascaris worms from the blocked intestine of a patient who had eaten them. (http://bit.ly/Maasai.) It wasn't until he was inside the body cavity that Dr. Morchi was able to see the cause of the intestinal problem. “There is no CT scan in these situations. In fact, you could say infrastructure is absent,” said Dr. Morchi, also the author of Harbor Pearls, a column in EMN's monthly enewsletter EMNow. http://bit.ly/EMNowCollection.) “Interest is growing” in international emergency medicine, he observed, particularly among residents. Many medical training programs now offer fellowships in international care, and new medical graduates seem more attracted to such opportunities, he said. Though his impression is based on encounters at meetings and other anecdotal evidence, he said he likes to believe there is more awareness of the need. The experience is one of intangible but significant rewards, including the strengthening of “a sense of global human ties,” said Dr. Morchi. The pull of such places is a little bit like an infection, he noted. “You catch it, and it sort of keeps calling to you.” Comments about this article? Write to EMN at[email protected]. Click and Connect!Access the links in this article by reading it onwww.EM-News.com.