Value-Based Healthcare in the Emergency Department

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.