Payment reform in emergency care

This chapter discusses payment reform initiatives beginning with early models, followed by more recently proposed approaches. It also highlights the impact of payment reform on emergency medicine as well as overall challenges to the implementation of various measures. The earliest payment reform initiatives focused on limiting costs with less emphasis on ensuring quality. Many of these reform initiatives had a number of shortcomings from the perspective of both the provider and patient: the prospective payment system, capitation models, and relative value scales. Providers must invest in the infrastructure needed to provide seamless care. Overall, seamless healthcare delivery models promise innovative new methods for improving health outcomes and reducing health care spending. Providers and health care systems willing to make the investments required to expand these models of care delivery may lead the national effort to streamline how care is provided in the United States.