EMS World

FEB 2017

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.

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HIGH-PERFORMANCE EMS By Matt Zavadsky, MS-HSA, EMT This is the second in a yearlong series of articles devel- oped by the Acade- my of International Mobile Healthcare Integration (AIMHI) to help educate EMS agencies on the hall- marks and attri- butes of high-per- formance/high-value EMS system design and operations. Find January's opening installment at www. emsworld.com/12285703. Hi g h -Va lu e EM S: T h e K e y t o O ur F u tur e What does value mean in EMS, and how can we demonstrate it? I n our last column we explained the system design elements for high-per- formance EMS (HPEMS) as a service delivery model, primarily as a lead-in to the concept of turning HPEMS into high- value EMS (HVEMS). The concept of value is a main driver today, especially in healthcare delivery. The Centers for Medicare & Medicaid "you call, we haul" model of EMS delivery is being challenged. If a hospital is transition- ing into APMs that may include shared-sav- ings agreements such as accountable care programs and bundled payments based on episodes of care, its leaders may be more interested in the potential of improved out- comes and expenditure savings by avoiding unnecessary ED visits and admissions than the potential revenue generated from that utilization. Similarly there is growing financial pres- sure in local governments for traditional public safety services such as police, fire and EMS. Savvy taxpayers, city/county managers and elected officials are begin - ning to ask tough questions about the return on investment for EMS services. The pension funding issue also tops the priority list for many large cities strapped with millions of dollars in unfunded pen- sion liabilities. Questions about the clinical value of EMS— The actual clinical value of tra- ditional EMS has been questioned in research publications such as the Journal of the American Medical Association, as well media outlets such as the New York Times, Philadelphia Inquirer and Washington Post. Although the methodologies of some recent studies are questionable, the head- line shock value cannot be overstated: 3–5 "Police Transport a Good Bet for Shooting Victims, Study Finds" "Need an Ambulance? Why You May Not Want the More Sophisticated Version" "More Advanced Emergency Care May Be Worse for Cardiac Arrest Vic- tims: Study" Fraud and abuse in the ambulance indus- try— Walk the halls of Congress or state leg- islatures and ask about changing payment models for EMS. The response from elect- ed officials is often something like, "What are you going to do about the fraudulent billing issues we already have?" Services (CMS) has articulated its desire to move healthcare away from a fee-for- service, volume-based economic model to a value-based model, with a goal of 50% of Medicare payments through alterna- tive payment models (APMs) and 90% of Medicare payments linked to quality by 2018. 1 Second only to taxpayers, Medi- care is the largest payer for EMS services, accounting for $5.3 billion of expenditures in 2011. 2 Why Value Matters Why does EMS really need to focus on the value proposition for the service we provide? Changing stakeholder expectations— The expectations of our stakeholders are changing. As the rest of the healthcare sys- tem moves from volume to value, the old While the incidence of fraudulent billing in the ambulance world generally amounts to a few unscrupulous providers billing for nonemergency services, headlines like these do not help demonstrate the value EMS provides America: 6–8 "Ambulance Company Operators Face Health Care Fraud Charges" "Millions Lost Yearly to Ambulance Companies Acting Like a 'Taxi Ser- vice'" ("Every year," this story reported, "$350 million in ambulance services is lost to or ripped off by companies…") "Think the E.R. Is Expensive? Look at How Much It Costs to Get There" How to Demonstrate It Our success as an industry depends on our ability to prove we bring value in new ways—the ways our healthcare stakehold- ers and funders perceive value. That spe- cifically includes patient safety and quality, outcomes, utilization and cost of care, and experience of care. CMS and the Agency for Healthcare Research and Quality (AHRQ) have out- lined their National Quality Strategy, which features three broad aims for healthcare quality: 9 » Better care—Improve overall quality by making healthcare more patient-centered, reliable, accessible and safe; » Healthy people/healthy communi- ties—Improve the health of the U.S. popu - lation by supporting proven interventions to address behavioral, social and environ- mental determinants of health in addition to delivering higher-quality care; » Affordable care—Reduce the cost of quality healthcare for individuals, families, employers and government. In implementing its value-based pur- chasing strategy, CMS has laid the foun- dation for what healthcare providers such as EMS will be held accountable for (see Table 1). 10 So far these measures have been applied to hospitals, physicians, 14 FEBRUARY 2017 | EMSWORLD.com

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