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U.S. Department of Health and Human Services


Putting Patients First: Reforming Emergency and Acute Care Delivery in the U.S.

Author: Aisha Hasan, Policy Analyst, Emergency Care Coordination Center, HHS/ASPR Division of Health System Policy
Published Date: 2/25/2016 11:40:00 AM
Category: Hospital Preparedness; Public Health Preparedness; Innovations;

Meet 22-year-old John. He’s visiting his older sister, Ann, on Monday evening when he starts to throw-up and develops severe abdominal pain. John is in pain and Ann is scared. At around 7 p.m., Ann takes him to the urgent care center a block from her apartment.

Due to his persistent vomiting and history of kidney stones, John is sent to the closest emergency department (ED). He typically goes to a different hospital in town closer to his apartment and had a CT scan there last week. There is no health information exchange shared by the competing hospitals. Phone calls to the other hospital result in a faxed medical record release form that will sit in medical records until the daytime clerk’s next shift. Without the ability to access John’s recent imaging studies, the emergency physician orders another CT scan, increasing cost and radiation exposure.

As John’s case demonstrates, emergency and acute care touches Americans’ lives, and the way this care is delivered is ripe for change. We need a more integrated and patient-centered way to deliver care during our most vulnerable moments.

So, how can we help John get the individualized care he needs?

Challenges facing the healthcare system are being addressed by the delivery system reform initiative announced by Health and Human Services’ (HHS) Secretary Burwell last year. The Secretary outlined a vision to ensure all healthcare delivery components are patient-centered by supporting better care, smarter spending, and healthier people through:

  1. Incentives: Bringing proven payment models to scale, aligning quality measures, and promoting value-based payment systems by testing new alternative payment models (APMs) and increasing the linkage of Medicaid, Medicare fee-for-service, and other payments to value. HHS announced that 30% of Medicare payments will be tied to quality through APMs by the end of 2016 and 50% by the end of 2018. By the end of 2016, 85% of all Medicare fee-for-service payments will be tied to quality or value, reaching 90% by the end of 2018.
  2. Care Delivery: Bolstering the integration and coordination of clinical care services throughout the healthcare continuum of care, improving population health, and promoting patient engagement via shared decision making.
  3. Information: Creating transparency on cost and quality information, bringing electronic health information to the point of care for meaningful use, and supporting joint consumer and clinical decision making.

Many important factors will shape healthcare delivery in the future, and medical success stories are integral in advancing healthcare to be patient-and community-centered. Key among these are changes in population demographics such as an aging population, an increased proportion of the population who lives with multiple chronic medical conditions, rapidly evolving innovation in technology, and the extension of a consumer culture into the healthcare marketplace. Many of these factors are relevant in the emergency and acute care setting as chronically ill and medically complex patients with fragmented healthcare seek outpatient solutions that don’t yet exist when they get sick.

Changes in healthcare delivery and payment models are shifting from volume-based care to value-based care. This is a critical time for the acute care system to connect the dots between providers, be the just-in-time solution when patients are sick, injured, and scared, and deliver on the promise of a better, smarter, and healthier U.S. healthcare system.

Stay tuned to read about the evolving role of acute and emergency care reform as part of this three-part series.

This blog post is the first part of a three-part series that discusses how the emergency and acute care system can be reformed to ensure patient-centeredness, integration into the broader healthcare system, high-quality, and the ability to respond to public health emergencies and disasters. To stay up-to-date as new blog posts are published, subscribe to the ASPR Blog RSS feed, follow @PHEgov on Twitter, Like us on Facebook or follow us on LinkedIn.


Public Health Nursing should not be fragmented

Eighty percent of patients admitted to the hospital are seen in the emergency department. Only 20 percent of patients seen in an emergency department are admitted to a hospital. This means that eighty percent of the patients seen in the emergency department could have been cared for in the community. Should Emergency Nursing or Medicine be combined or carved our of public health? These can include both physical and psychiatric conditions--should psychiatric nursing or medicine be carved out of emergency or public health? Which organizations allowed fragmentation in the care of communities?
3/1/2016 9:30:12 AM

Patient Care Should Be Triaged By Emergency Room Nurses

Emergency room nurses are highly trained nurses that can easily save patients, hospitals and insurance companies unnecessary costs for patients who may not need emergency care. It is well known in all emergency rooms that there multiple patients who enter the emergency room for complaints that can easily be treated in an outpatient setting but fail to do so for a number of reasons. The first and foremost is the ability to get what they need from a doctor sooner than later. Usually, when a person becomes ill and they want to be seen by a doctor their primary doctor may not be able to see them for days, or they may not have a doctor or they may be out of town and are not sure of where to go to get the kind of medical care they need. The ER is a catch all for these patients. What we need is a triage nurse to see patients first than be able to send them to an urgent care, or primary care doctor or advise them of how to treat themselves using over the counter medication. Most people are so uneducated on how there body works and how to treat the most simplest problems they come in due to fear of the unknown. We don't have enough doctors to fill the need of the communities health complaints and insecurities. Emergency Nurses can contribute so much more than they do now if there were less constraints place on their practice. The best thing about emergency nurses is that they are highly educated and can detect if it is a true emergency. If they can triage the patient to the level of care needed they care save patients, hospitals and insurance companies needless health care costs.
5/11/2017 8:50:00 AM

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