Payment Innovation in Emergency Care: A Case for Global Clinician Budgets

Authors

Jesse M. Pines, Clinical Innovations, US Acute Care Solutions, Canton, OH; Department of Emergency Medicine, George Washington University, Washington, DC. Electronic address: jesse.pines@gmail.com.
Bernard S. Black, Pritzker School of Law and Kellogg School of Management, Northwestern University, Chicago, IL.
L Anthony Cirillo, Clinical Innovations, US Acute Care Solutions, Canton, OH.
Marika Kachman, Clinical Innovations, US Acute Care Solutions, Canton, OH.
Dhimitri A. Nikolla, Clinical Innovations, US Acute Care Solutions, Canton, OH; Department of Emergency Medicine, Allegheny Health Network - Saint Vincent Hospital, Erie, PA.
Ali Moghtahderi, Department of Emergency Medicine, George Washington University, Washington, DC.
Jonathan J. Oskvarek, Clinical Innovations, US Acute Care Solutions, Canton, OH; Department of Emergency Medicine, Summa Health System, Akron, OH.
Nishad Rahman, Clinical Innovations, US Acute Care Solutions, Canton, OH.
Arjun Venkatesh, Department of Emergency Medicine, Yale University, New Haven, CT.
Arvind Venkat, Clinical Innovations, US Acute Care Solutions, Canton, OH; Department of Emergency Medicine, Allegheny General Hospital, Pittsburgh, PA.

Document Type

Journal Article

Publication Date

5-1-2024

Journal

Annals of emergency medicine

DOI

10.1016/j.annemergmed.2024.04.002

Abstract

The fee-for-service funding model for US emergency department (ED) clinician groups is increasingly fragile. Traditional fee-for-service payment systems offer no financial incentives to improve quality, address population health, or make value-based clinical decisions. Fee-for-service also does not support maintaining ED capacity to handle peak demand periods. In fee-for-service, clinicians rely heavily on cross-subsidization, where high reimbursement from commercial payors offsets low reimbursement from government payors and the uninsured. Although fee-for-service survived decades of steady cuts in government reimbursement rates, it is increasingly strained because of visit volatility and the effects of the No Surprises Act, which is driving down commercial reimbursement. Financial pressures on ED clinician groups and higher hospital boarding and clinical workloads are increasing workforce attrition. Here, we propose an alternative model to address some of these fundamental issues: an all-payer-funded, voluntary global budget for ED clinician services. If designed and implemented effectively, the model could support robust clinician staffing over the long term, ensure stability in clinical workload, and potentially improve equity in payments. The model could also be combined with population health programs (eg, pre-ED and post-ED telehealth, frequent ED use programs, and other innovations), offering significant payer returns and addressing quality and value. A linked program could also change hospital incentives that contribute to boarding. Strategies exist to test and refine ED clinician global budgets through existing government programs in Maryland and potentially through state-level legislation as a precursor to broader adoption.

APA Citation

Pines, Jesse M.; Black, Bernard S.; Cirillo, L Anthony; Kachman, Marika; Nikolla, Dhimitri A.; Moghtahderi, Ali; Oskvarek, Jonathan J.; Rahman, Nishad; Venkatesh, Arjun; and Venkat, Arvind, "Payment Innovation in Emergency Care: A Case for Global Clinician Budgets" (2024). GW Authored Works. Paper 4996.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/4996

Department

Health Policy and Management