Editing Emergency medicine (section)

====Payment systems====

American health payment systems are undergoing significant reform efforts,<ref>{{cite journal |pmid=15923928 |year=2005 |last1=Bebber |first1=R. J. |title=Reimbursement challenges for emergency physicians |journal=The Health Care Manager |volume=24 |issue=2 |pages=159–64 |last2=Liberman |first2=A |doi=10.1097/00126450-200504000-00009}}</ref> Which include compensating emergency physicians through "[[Pay for performance (healthcare)|pay for performance]]" incentives and penalty measures under commercial and public health programs, including Medicare and Medicaid. This payment reform aims to improve the quality of care and control costs, despite the differing opinions on the existing evidence to show that this payment approach is effective in emergency medicine.<ref name="ReferenceA">{{cite journal |doi=10.1056/NEJMe1212133 |pmid=23134388 |title=Will Pay for Performance Improve Quality of Care? The Answer is in the Details |journal=New England Journal of Medicine |volume=367 |issue=19 |pages=1852–3 |year=2012 |last1=Epstein |first1=Arnold M.}}</ref> Initially, these incentives would only target primary care providers (PCPs), but some would argue that emergency medicine is primary care, as no one refers patients to the ED.<ref>{{Cite web|url=https://www.aamc.org/download/100598/data/|title=Recent Studies and Reports on Physician Shortages in the US: Emergency Medicine (2009) – "Emergency Care System Remains in Serious Condition"|date=October 2012|pages=13|archive-url=https://web.archive.org/web/20161021204254/https://www.aamc.org/download/100598/data/|archive-date=21 October 2016|url-status=dead}}</ref><ref name="ReferenceA"/> In one such program, two specific conditions listed were directly tied to patients frequently seen by emergency medical providers: acute myocardial infarction and pneumonia.<ref>{{cite journal |doi=10.1016/j.annemergmed.2006.06.032 |pmid=16979264 |title=Pay for Performance in Emergency Medicine |journal=Annals of Emergency Medicine |volume=49 |issue=6 |pages=756–61 |year=2007 |last1=Sikka |first1=Rishi}}</ref> (See: [[Hospital Quality Incentive Demonstration]].)

There are some challenges with implementing these quality-based incentives in emergency medicine in that patients are often not given a definitive diagnosis in the ED, making it challenging to allocate payments through [https://www.aapc.com/medical-coding/medical-coding.aspx coding].  Additionally, adjustments based on patient risk-level and multiple co-morbidities for complex patients further complicate attribution of positive or negative health outcomes. It is not easy to assess whether much of the costs directly result from the emergent condition treated in acutely care settings.<ref>{{Cite web|url=https://www.acep.org/Physician-Resources/Practice-Resources/Administration/Financial-Issues-/-Reimbursement/Emergency-Medicine-and-Payment-Reform/|title=Emergency Medicine and Payment Reform // ACEP|website=acep.org|access-date=2016-11-28|archive-url=https://web.archive.org/web/20161129021328/https://www.acep.org/Physician-Resources/Practice-Resources/Administration/Financial-Issues-/-Reimbursement/Emergency-Medicine-and-Payment-Reform/|archive-date=29 November 2016|url-status=dead}}</ref> It is also difficult to quantify the savings due to preventive care during emergency treatment (i.e. workup, stabilizing treatments, coordination of care and discharge, rather than a hospital admission). Thus, ED providers tend to support a modified fee-for-service model over other payment systems.<ref>{{Cite web|url=https://www.acep.org/Physician-Resources/Practice-Resources/Administration/Financial-Issues-/-Reimbursement/Emergency-Medicine-and-Payment-Reform/|title=Ibid|website=acep.org|access-date=2016-11-28|archive-url=https://web.archive.org/web/20161129021328/https://www.acep.org/Physician-Resources/Practice-Resources/Administration/Financial-Issues-/-Reimbursement/Emergency-Medicine-and-Payment-Reform/|archive-date=29 November 2016|url-status=dead}}</ref>