The Role and Value of the Emergency Department in an Accountable Care Organization

With more than 354 million unscheduled acute care visits annually in the United States, emergency departments (EDs) and emergency physicians (EPs) are critical to the care and cost of care provided to patients. Since the passage of the Affordable Care Act (ACA) and the piloting of Accountable Care Organizations (ACOs), EDs and more specifically, emergency physicians will have an even greater role and responsibility in the coordination and cost of care for millions of patients. Additionally, in 2015, President Obama signed into law the Medicare Access and CHIP Reauthorization Act (MACRA) which effectively repealed the troubled Medicare Sustainable Growth Rate (SGR). Under the law, by 2019 5-9% of physician payments will be tied to the value-based purchasing MIPS program (merit-based payment system)—a replacement for the PQRS (physician quality reporting system). With the passage of MACRA and the affirmation by the courts of the ACA, alternative payment models (APM) including ACOs are here to stay. Therefore, understanding the themes, goals and challenges of development and implementation of an ACO will be important due to significant shifts in reimbursement.