Chaos: a fitting term to describe the innate disorderly and ever-changing nature of healthcare. Emergency and hospital medicine are no exception. There's too much to do, too little time to do it, more demands being made, and fewer resources to meet them.

Add to that the unprecedented changes in healthcare as a whole — rising costs, declining reimbursement, more patient care requirements, and unwelcome "efficiency busters" – like new EMR implementations — and it's easy to see the road signs: Chaos Ahead.

Current Drivers of Chaos

Overall revenues for EM and HM patient care are decreasing. In some areas, they are dropping precipitously, even since the first of this year. Most of this involves substantial reimbursement reductions by commercial insurers, such as United and Cigna. It also includes their exit from healthcare exchanges, which helped previously uninsured patients.

Patient care volume and acuity are increasing. Since overall revenue is decreasing, and volume and acuity are not, the “dollars per pound of work” are declining. Hospitals, outpatient services, and most specialties are challenged to continue delivering quality care to more patients with less resources.

The physician shortage is continuing. The U.S. EM and HM workforce is insufficient to meet patient care demands consistently in the current paradigm. The deficit varies considerably by geography and practice but is true overall. Meanwhile, often-heralded innovations like telemedicine are not advancing fast enough to compensate for the gaps.

Clinician rates of pay are rising out of proportion to payments by patients and insurance companies.

'Must Take' Steps to Thrive Amidst the Chaos

Surviving chaotic times calls for a combination of forward-looking solutions, together with focused and efficient management plans that align pay and coverage models with current realities.

Here are eight steps clinical leaders, hospital executives, and providers must take to continue to provide quality care to patients and thrive in the ever-changing healthcare climate. See which ones fit for you.

1. Focus on Value
Stay true to your organization’s mission and core values. Likely, these tie back to doing right by your patients, your clinicians and staff, and the communities you serve. If you align those fundamentals with your actions, you have a strong foundation of trust and respect to navigate changes, deploy new solutions, and “stay the course” when needed.

2. Institute New Staffing Models
To achieve cost efficiency while maintaining care quality, it is paramount to implement new staffing models that include the use of qualified NPs and PAs with appropriate physician collaboration and oversight.

3. Integrate Emergency Medicine and Hospital Medicine Practices
Patient care efficiency and quality improve when EM and HM practices are well aligned. For optimal outcomes, your EM and EM programs must be highly communicative, patient-centered, efficient, safe, and value-generating for patients, providers, hospitals, and payors.

4. Accelerate Efficiency
Using scribes, dictation solutions, and other resources where possible (perhaps including technicians, rounding nurses, virtual scribes, etc.), will ensure that providers can practice at or near top of scope, and use their expertise more productively.

5. Use Data for Feedback and Support
EM and HM must continue to use state-of-the-art technology, data, and analysis to deliver valuable feedback and practice support for providers. Done well, this embraces quality and reduces unhelpful variation in clinical practices.

6. Enhance Medical Director Effectiveness
Hospitals must increase the effectiveness of clinical leaders — Medical Directors, Lead NP/PAs, and others — aligning performance with the changes in healthcare more closely. Overall, new approaches will enhance the performance and results of this critical role.

7. Align Provider Pay and Coverage Models with Overall Revenue
You must align provider pay and coverage models with the economic realities of your organization and the community you serve. This will not apply to every practice in the same way but always requires both creativity and courage. (And not doing so risks the sustainability of your practice).

8. Implement Innovative Solutions
You must continue to implement innovative solutions (such as telemedicine and post-acute care) to thrive in a value-based environment, and enhance the patient care value inherent in EM and HM practices.


A thoughtful approach to using these eight essentials wisely (and at the right time) will help your organization navigate, survive, and thrive in the chaos surrounding healthcare.