Daniel Tonellato, MD
Harvard Affiliated Emergency Medicine Residency
PGY 4
01/28/2020
After
having the opportunity to attend the Value-Based Healthcare Delivery Course in
January, I have been considering carefully how this can be applicable to the
emergency department, where I work. The
course mainly addresses how surgical procedures and other discrete episodes of
care can use time-driven accounting to address costing, and thus help determine
value. The applicability of this method
to acute care episodes, including in the emergency department, seems less
clear. I think it will be important to
carefully consider ho
w we calculate value, as I truly believe that the value of
physicians in the emergency department, and in general, go beyond the dollar
value generated in reimbursement.
Currently, salaries and dollars per hour for emergency physicians are
set based on historical reimbursement. This piece, recently in STAT,
discusses the future of healthcare and how artificial intelligence will
necessarily take over some part of decision-making and healthcare delivery.
Importantly, however, it discusses how people want doctors as their healthcare
providers. My point is, physicians are
not manufacturing widgets, we are treating patients. When calculating value in the emergency
department we need to consider the human effect of a patient seeing a
physician, and how this itself adds value.
This will take careful study and be a complex issue, but will be
necessary as costs continue to rise and reimbursements are under close
scrutiny.
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