As I travel around the country talking to healthcare executives, I often hear the same question: Where does the ER doctor fit into the equation of the shift to value-based payment models?
The legacy fee-for-service model has misaligned the interests of payers and providers, leading to a lot of frustration. On the one hand we live in a world where the Medicaid population is rapidly growing and the ER is seen as the first point of care for many patients (as a result of a nearly three week wait to see a primary care physician)—an environment that, at the end of the day, allows ER physicians to pay their bills. On the other hand, the entire healthcare ecosystem including the hospital systems that these ER physicians work for, is doing everything possible to reduce admissions and readmissions.
One tactic health systems have used to address their potentially avoidable utilization is to implement a telemedicine service, usually one of the Big Four. The problem is queue based, video conferencing telemedicine is not reducing emergency room visits, readmissions, or improving outcomes for chronically ill patients. Instead, it encourages disaggregated providers to churn and burn through patients who will never be seen by that physician again. Simply put, they’re not practicing good medicine.
Another failing of this approach is who they’re choosing to staff their telehealth offerings. Often times the doctors taking calls for the Big Four are primary care physicians. There’s nothing wrong with the ability of these doctors to provide the best care to patients, rather the problem is that the average wait to see a PCP in the U.S. is approaching 20 days. These doctors are already over scheduled, so why would we want them to take on virtual care as well?
ER physicians on the other hand are better equipped to handle large quantities of sick people they don’t know, building a trusted relationship with a patient within minutes. Plus, there is the added bonus that using ER doctors for virtual care visits allows health systems to reach the Quadruple Aim: 1) Improving the patient experience of care (including quality and satisfaction); 2) Improving the health of populations, 3) Reducing the per capita cost of health care; and 4) Increasing quality of life and identifying new revenue streams for physicians participating in both value-based payment models and fee-for-service.
By having ER physicians staff this dedicated virtual solution they’re opening up brick and mortar appointments for the PCP that still has fee-for-service patients. At the same time the ER physician is taking on the avoidable utilization, health literacy and shared decision making for the PCP’s patients allowing the PCP to hit their quality measures and benchmarks making them more money than ever before on their value-based contracts.