EMS World Magazine is the most authoritative source in the world for clinical and educational material designed to improve the delivery of prehospital emergency medical care.
Issue link: https://emsworld.epubxp.com/i/516933
The Reimbursement Link The proven efficacy, or lack thereof, of clinical interventions in EMS may ultimately have profound implications for EMS reimbursement. Since 2012 Medicare, the largest payer for EMS services, has adjusted reimbursements to hospitals on the basis of a value-based purchasing (VBP) program that takes into account factors such as patient experience, outcomes and efficiency. A similar program will be applied to physician reimbursement starting in 2015. It is probably only a matter of time until value-based purchasing is extended to EMS. 15 Research will ultimately prove crucial to demonstrat- ing the value EMS provides to both patients and the healthcare system. useful information. Similarly, sophisticated statistical analyses can be used to minimize extraneous influences and compensate for imperfect study samples. That said, prospec- tive clinical trials and proper controls are still considered the "gold standard" in medical research. For this reason, retrospective trials are often an initial step prior to undertak- ing a randomized, prospective clinical trial. These challenges have two important implications for research in EMS. First, because the prehospital setting differs in many important respects from other research settings, researchers must account for multiple different and possibly con- founding variables. Second, research con - ducted outside the prehospital setting (e.g., in the hospital) may not be easily generaliz- able to EMS due to the presence of these confounding factors. For these reasons, it is important that EMS researchers make an effort to adapt clinical research methods to the prehospital setting, even if it proves more costly than simply conducting hospi- tal-based research. 21 Existing Data Many EMS systems already collect a large volume of information during their daily operations. These data include informa- tion regarding incidents (type of call and location), patients (identifying information and medical history), clinical presentations (symptoms and vital signs) and interven- tions provided by EMS. In most jurisdic- tions these data are reported to national and state databases such as the National EMS Information System (NEMSIS). For the most part, however, EMS sys- tems have not yet been able to translate this wealth of information into actionable clini- cal research. 26 Part of the reason is that the data they collect is often unreliable or incom- plete. EMS providers are inconsistent when it comes to information-gathering. Even when EMSWORLD.com | JUNE 2015 35 EMS1504S For More Information Circle 26 on Reader Service Card