RT Journal Article SR Electronic T1 Macroeconomic trends and practice models impacting acute care surgery JF Trauma Surgery & Acute Care Open JO TSACO FD BMJ Publishing Group Ltd SP e000295 DO 10.1136/tsaco-2018-000295 VO 4 IS 1 A1 Andrew Bernard A1 Kristan Staudenmayer A1 Joseph P Minei A1 Jay Doucet A1 Adil Haider A1 Tres Scherer A1 Kimberly A Davis YR 2019 UL http://tsaco.bmj.com/content/4/1/e000295.abstract AB Acute care surgery (ACS) diagnoses are responsible for approximately a quarter of the costs of inpatient care in the US government, and individuals will be responsible for a larger share of the costs of this healthcare as the population ages. ACS as a specialty thus has the opportunity to meet a significant healthcare need, and by optimizing care delivery models do so in a way that improves both quality and value. ACS practice models that have maintained or added emergency general surgery (EGS) and even elective surgery have realized more operative case volume and surgeon satisfaction. However, vulnerabilities exist in the ACS model. Payer mix in a practice varies by geography and distribution of EGS, trauma, critical care, and elective surgery. Critical care codes constitute approximately 25% of all billing by acute care surgeons, so even small changes in reimbursement in critical care can have significant impact on professional revenue. Staffing an ACS practice can be challenging depending on reimbursement and due to uneven geographic distribution of available surgeons. Empowered by an understanding of economics, using team-oriented leadership inherent to trauma surgeons, and in partnership with healthcare organizations and regulatory bodies, ACS surgeons are positioned to significantly influence the future of healthcare in the USA.