Emergency Care in Maryland: The Expanding Role of Evidence Based Medicine and the Medicare Waiver.

The 2014 Maryland Medicare Waiver alters the reimbursement model by transitioning from fee-for-service to global payments for hospitals. This increases the need for hospital-based emergency departments to become more cost-conscious, particularly regarding high-cost imaging and admission decisions. Evidence based medicine offers a potential solution to achieve these aims. Development and use of validated clinical decision rules and care pathways can reduce unnecessary testing and reduce hospital admissions where a patient could be treated as an outpatient. Paired with functional systems incorporating alternative care pathways and health information technology, clinical decision rules can reduce cost without sacrificing patient safety or experience.