ER diversion talk just a diversion?

It was an act similar to pulling on Superman's cape, and Boston emergency medicine physician Dr. Stephen Epstein didn't win any friends in the primary-care world by doing so, but he did seize the moment at the recent American Medical Association House of Delegates meeting in Chicago.

The Wisconsin Medical Society introduced a somewhat motherhood and apple pie resolution requesting the AMA study the successful North Carolina Medicaid Patient-Centered Medical Home program so it could be duplicated elsewhere.

According to official AMA record, this is what happened: "One speaker raised many concerns about the North Carolina Medicaid Patient-Centered Medical Home and cautioned the AMA in studying it due to possibly contradictory or flawed data on the financial success of the program."

What happened was that Epstein, speaking as a delegate from the American College of Emergency Physicians, used the opportunity to oppose language that the medical-home model can save money by diverting patients from seeking the exorbitantly expensive care provided in hospital emergency departments.

"That's a myth," Epstein said, countering that emergency care's cost to the healthcare system has been greatly exaggerated.

That was echoed by Dr. Sandra Schneider, ACEP president, and Dean Wilkerson, ACEP executive director, when they visited Modern Healthcare's office the next day.

Citing statistics from the U.S. Agency for Healthcare Research and Quality, Schneider said annual spending on emergency care equals about $47 billion. A large sum to be sure, but Schneider said it only accounts for 2% of total healthcare spending or, as she put it, "budget dust."

Wilkerson said that ACEP is not being negative toward primary care and the push toward medical homes, "but people who are selling what they're selling" should stop using some hypothetical savings from ER diversions as a selling point.

It will be interesting to see if medical home proponents continue to cite ER diversion savings as a talking point and, if they do, it will probably be even more interesting to see how ACEP reacts.

The AMA House of Delegates did go on to support study of the North Carolina program. At this point, there isn't really any point to not doing so because, as American Academy of Family Physicians President-elect Dr. Glen Stream said at the AMA meeting, "if there is a poster child for dis-integrated care, it's our Medicaid programs."

By the way, the spat between ACEP and primary-care doctors wasn't the only dust-up regarding medical homes at the AMA meeting. Docs are also peeved with the Joint Commission, which is set to launch its new Primary Care Medical Home ambulatory-care accreditation program on July 1.

The Joint Commission's transgression in the eyes of AMA delegates was that its accreditation model doesn't require the medical home to be physician-led. It only requires the facility to be led by a "primary-care clinician," which can be a physician, physician assistant or nurse practitioner.

The American Nurses Association, of course, thinks it's a great idea.

Well, July is the perfect month for fireworks.

Follow Andis Robeznieks on Twitter: @MHARobeznieks.