Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, USA.
Ann Emerg Med. 2012 May;59(5):351-7. doi: 10.1016/j.annemergmed.2011.08.020. Epub 2011 Sep 29.
Optimizing resource use, eliminating waste, aligning provider incentives, reducing overall costs, and coordinating the delivery of quality care while improving outcomes have been major themes of health care reform initiatives. Recent legislation contains several provisions designed to move away from the current fee-for-service payment mechanism toward a model that reimburses providers for caring for a population of patients over time while shifting more financial risk to providers. In this article, we review current approaches to episode of care development and reimbursement. We describe the challenges of incorporating emergency medicine into the episode of care approach and the uncertain influence this delivery model will have on emergency medicine care, including quality outcomes. We discuss the limitations of the episode of care payment model for emergency services and advocate retention of the current fee-for-service payment model, as well as identify research gaps that, if addressed, could be used to inform future policy decisions of emergency medicine health policy leaders. We then describe a meaningful role for emergency medicine in an episode of care setting.
优化资源利用、杜绝浪费、调整供给方激励机制、降低总体成本、协调提供高质量医疗服务，同时改善医疗效果，这些一直是医疗改革措施的主要主题。最近的立法包含了几项条款，旨在摆脱当前按服务收费的支付机制，转向一种随着时间的推移为患者群体提供护理的模式，同时将更多的财务风险转移给提供者。在本文中，我们回顾了当前的医疗事件开发和报销方法。我们描述了将急诊医学纳入医疗事件方法的挑战，以及这种交付模式对急诊医学护理的不确定影响，包括质量结果。我们讨论了医疗事件支付模式对急诊服务的局限性，并主张保留当前的按服务收费支付模式，同时确定研究差距，如果加以解决，可用于为未来的急诊医学卫生政策领导人的政策决策提供信息。然后，我们描述了急诊医学在医疗事件设置中的重要作用。
