For Immediate Release
December 3, 1997
CONTACT:
Laura Gore
(202) 728-0610, ext. 3006
ACEP Journal Commemorates 25 Years of Emergency Medicine Research; Presents History, Examines Current Challenges, and Charts Course for the Future
Washington, D.C.--Celebrating 25 years of emergency medicine research, the December issue of Annals of Emergency Medicine publishes articles from prominent emergency physicians and medical commentators on topics that describe the history of emergency medicine, examine the specialty's challenges and role in the health care system, and chart its course for the future.
Health Care Reform
An article by Washington Post columnist E.J. Dionne and Jacob S. Hacker, author and fellow at the Brookings Institution, ("Health Care Reform is Dead--Long Live Health Care Reform") examines the progress of health care reform in America, the failure of President Clinton's health care reform legislation, and current reform efforts and challenges.
The article describes problems associated with the nation's current health care system, ranging from widespread dissatisfaction with managed care; increased out-of-pocket spending by patients; revolts by medical professionals against infringements on autonomy; and sharp cutbacks in hospital staffing, especially those serving the poor. It also describes the complexity of challenges to reform, ranging from public opinion, complicated alignments of interest groups, deep divisions over how to proceed, and practical difficulties of reforming a trillion-dollar medical system which is successful in certain respects but flawed in others.
"The Clinton reform effort was not the end of health care reform in America, but the start of a fiercely contested round of reform that may take another decade or two to complete," said Mr. Dionne. "The future of heath care reform is not nearly as bleak as once was thought because there is considerable room for incremental reform that includes expanding insurance coverage, improving quality, and controlling costs."
In addition, the article also examines the challenge of rising medical costs and the dilemma of physicians who find themselves caught between competitive pressures and the continuing, and in many cases, worsening plight of the uninsured and underinsured.
Future of the Private Practice of Emergency Medicine
An article by Stephen J. Dresnick, M.D., president and chief executive officer of the Sterling Healthcare Group in Miami, Florida, examines the future role of emergency medicine, analyzing current health care trends, including hospital consolidation, the emergence of publicly traded physician practice management companies (formerly "megagroups"), and increasing penetrations of managed care.
"Emergency physicians must continue to evolve in order to deal with the forces impacting the health care profession," said Dr. Dresnick. "They will need to take on new roles--even ones hardly imagined by the founders of the specialty 25 years ago. Emergency medicine has become more than just an isolated segment of the health care system. Its involvement spans such areas as prehospital care, observation units, and telemedicine."
The article discusses how hospitals have reinvented themselves to address decreases in admissions and length of stays related to advanced surgical techniques and improved medical treatments and how they have become multifaceted centers that include the entire spectrum of care: inpatient, outpatient, subacute, home care, and even long-term care.
Economic Credentialing
An article by R.W. Schafermeyer, M.D. of the Department of Emergency Medicine, Carolinas Medical Center, in Charlotte, North Carolina, describes the new practice environment where hospital managers evaluate physicians for appointment, reappointment, and privileges using financial criteria. It describes how hospitals are reducing costs by compelling physicians to meet certain economic standards, and the controversy over economic credentialing, which evaluates physicians based on such factors as billing patterns, frequency of procedures, consultations and admissions, claims histories, business credit reports, patient satisfactions, and ratings and resource use patterns.
"Economic factors must not be the sole criterion for credentialing physicians, and if economic criteria are used, they should reflect quality of care, not financial data pulled from hospital billing information," said Dr. Schafermeyer. "Also, when economic criteria are used, they must be verifiable, accurate, and appropriate to the specialty."
In addition, the article describes state efforts to address concerns over economic credentialing and the need for emergency physicians to work with hospital boards and administrators to develop credentialing criteria in a cost-driven managed care environment.
Key Issues in Emergency Medicine Workforce Planning
The article discusses the need for workforce planning in emergency medicine, especially in light of changes in the nation's health care system; describes factors that affect the supply and demand for emergency physicians; and proposes solutions to cutbacks in graduate medical education (GME) funding. It reports on studies that have predicted a shortage of emergency physicians until 2010, but indicates they are based on unverified assumptions, and announces that the American College of Emergency Physicians has undertaken the first national study to determine the current number of physicians practicing in the nation's emergency departments, which will be published next year in Annals of Emergency Medicine, to predict the future demand for emergency physicians.
"The goal of workforce planning is to match the supply of providers with the nation's demand," said Dr. John C. Moorhead of the Department of Emergency Medicine, Oregon Health Sciences University in Portland, Oregon, "Preserving funding for emergency services is imperative to maintaining the emergency physician's role in the delivery of acute care services."
The article discusses changes in the health care system that affect the demand for physicians, such as trends toward managed care and outpatient sites and regional consolidation of health plans, and current threats to the supply of physicians, such as the shift from generalist to specialist careers and GME funding decreases.
Expanding the Scope of Emergency Medical Services
In an article about the transformation that emergency medical services (EMS) systems are about to undergo (" Developing a Foundation for the Evaluation of Expanded Scope EMS: A Window of Opportunity That Cannot be Ignored"), authors express concern over the lack of scientific research for current EMS interventions and present a framework for developing measures to evaluate interventions that expand the scope of EMS and their effects on patients and the EMS systems.
"We have the opportunity--indeed, the responsibility--to evaluate the cost-effectiveness of expanded scope EMS, and we must pay the price of methodologically sound evaluation to ensure the most optimal benefit to society by EMS systems of the future," said Dr. Daniel W. Spaite, of the Arizona Emergency Medicine Research Centerat the University of Arizona. "Future EMS may include everything from communications centers that provide access points for health care systems to post-operative care, rehabilitation, and many other "primary health care" services."
Citing the difficultly in proving the effectiveness of the EMS systems through research, the monumental task of developing measures for evaluating an expanded scope EMS, and the concern that interventions may become "standard of care" without a scientific basis, authors present two approaches to developing an evaluation: (1) evaluating expanded scope interventions systemwide and their effect on the health care system's ability to continue responding to cardiac arrest, an intervention that shows EMS has a proven effect, and (2) evaluating the addition of an intervention without altering primary EMS response to minimize complications from the effort.
In another article about the forces reshaping EMS--Multiple Options and Unique Pathways: A New Direction for EMS?--authors propose a new multiple-option model for EMS, where 911/EMS dispatchers distinguish between callers who require dispatch and those who could be served by nonemergency services. Under this system, patients can be referred to a telephone triage center for management at home. The article describe two studies of the Portland, Oregon EMS system and emphases the importance of having a clear definition of emergency, working within the managed care environment, preserving the EMS mission to provide emergency services to those in need, and expanding the mission to getting the right patient to right place at the right time.
Other Articles
Emergency Medicine in Population-Based Systems of Care." This article discusses the need to develop a seamless health care system in communities by focusing health care delivery on populations and individuals (e.g., where teams of clinicians manage populations of patients) and integrate the health care system, for example, the ED with the primary care physicians.
NHTSA Notes: "Partners in Progress: Joining Together Against Impaired Driving" and "Current Research in Alcohol"
Case Reports: "Incarceration of a Gravid Fibroid Uterus," which discusses a rare complication of pregnancy in a 32-year old woman that could result in spontaneous abortion or preterm labor; "Successful Use of Propofol in Refractory Delirium Tremens," which discusses the use of propofol in treating alcohol withdrawal; and "Treatment of Methanol Poisoning With Intravenous 4-Methylpyazole," which describes a case of treating human methanol poisoning with an alcohol dehydrogenase inhibitor.
Editorial: "Fifty Years of Defibrillation," which describes the history of defibrillation and the need for the medical community to take the lead in educating the public and promoting the concept of home defibrillation.
Change of Shift: "Front Line Footage," about a 17-year old patient who tests positive for illegal drug use, but alleges "police brutality" in an emergency department.
Attached is a copy of the table of contents for the December issue of Annals of Emergency Medicine. Copies of articles can be obtained from the American College of Emergency Physicians.
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Annals of Emergency Medicine is the peer-reviewed journal of the American College of Emergency Physicians, a national medical society representing more than 19,600 physicians who specialize in emergency medicine. ACEP is committed to improving the quality of emergency care through continuing education, research, and public education.
Q: Dresnick: ABEM national survey--what are EPs doing?
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