Dr. David Seaberg
New President Brings Broad Perspective to National Role
David C. Seaberg, MD, FACEP, was installed as president of the American College of Emergency Physicians (ACEP) at the national organization's annual scientific meeting in mid-October.
Dean of the University of Tennessee College of Medicine – Chattanooga, the board-certified emergency medicine physician oversees the satellite campus while continuing to practice in the community and serve as a national leader in his field. Seaberg, who is beginning his seventh year on the ACEP board, didn't hesitate to step into his new role.
"It was an opportunity in my career to lead an organization that I really believe in," he stated. Citing his experience in a variety of venues from the classroom to the research lab to the domestic security arena to busy emergency departments, Seaberg said he brings a broad perspective to his new role.
Broadening the viewpoint of how EDs operate and deliver care, he continued, will be needed if this country is to meet increasing demand. "Our emergency department visits continue to go up each year," he said. "Our latest figures show 136 million visits in 2009."
Seaberg added the expectation is those numbers will continue to rise as the population ages and there is a lack of insurance coverage and primary care options for individuals. Besides, he noted, "We're a great place to take care of people, and people know that."
Somewhat a victim of their own success, Seaberg said boarding and crowding continue to be an issue for EDs across the country. It is among the key issues ACEP is working to address. He said it is vital that emergency physicians work with hospitals to get appropriate patients admitted in beds. Those efforts are already ongoing at both a national and local level. "We are working with CMS, the Joint Commission and hospitals looking at ways to improve throughput."
Tied into crowding concerns is the issue of medical liability. ACEP has joined forces with the American Medical Association to support advocacy efforts aimed at addressing the cost ... both in terms of time and money ... of practicing defensive medicine. "Medical liability concerns hamper our ability to practice emergency medicine efficiently," Seaberg stated. "Until we have some meaningful liability reform, it's going to be very difficult to reduce overall costs of medical care."
Specifically in emergency medicine, ACEP would like to see changes made to the federal Emergency Medical Treatment and Labor Act (EMTALA). The law, which requires emergency departments provide care to those who walk through the door regardless of ability to pay, means that emergency physicians provide more free care than any other specialty. Seaberg said his field assumes "roughly $157,000 per emergency physician for uncompensated care per year. There's no other specialty near it.
"We're okay with seeing patients," Seaberg stressed, "but we want additional protections for emergency care ... not just for ED doctors but also for orthopaedic surgeons, trauma surgeons ... anyone providing EMTALA care."
Currently, he noted, these clinicians have heightened liability risks because typically they don't know the patients coming through the doors. The result is decisions have to be made quickly in a stressful environment with an inadequate amount of background information. In an effort to limit that liability, additional testing is sometimes ordered more out of a desire to cover the bases than out a best clinical practice. When this happens, it drives up both cost and wait times.
Despite that, Seaberg said the irony is there is a broad misperception about the actual cost of emergency care in this country. He said emergency physicians comprise 4 percent of all physicians in America but emergency medicine only comprises 2 percent of all healthcare dollars. "Yet," he continued, "emergency care physicians provide 28 percent of all ambulatory care visits and two-thirds of ambulatory care visits after hours."
Furthermore, he said, only about 8 percent of the 2 percent of dollars spent has been deemed "non-emergent" by the Centers for Disease Control. "There are state Medicaid programs looking to limit ED visits," he noted. "It's the wrong focus."
Instead, Seaberg continued, emergency physicians are actually in a perfect position to deliver more care ... rather than less ... and do it in a cost effective manner. With the shortage of primary care physicians in this country, he said the opportunity exists for emergency departments to take advantage of the sheer volume of patients and relatives that come through the doors each year to serve as a bridge to more integrated care.
"Rather than just taking care of the acute episodes, we could be doing more towards prevention and wellness," he stated.
Although it's a bold concept, it's workable by using the front waiting areas to offer education, immunizations, smoking cessation, chronic disease management and other preventive services to the more than 120 million visitors annually who accompany those in need of emergency care. "We could be doing more because we've got this captive audience."
Seaberg concluded, "One of my big goals this year is to look at value-added services emergency departments could provide. We already provide value ... however, I want to take it to another level."