EMS World

OCT 2018

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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12 OCTOBER 2018 | EMSWORLD.com N ow that we've covered the basics of conducting a financial analysis of traditional EMS service delivery, we can explore the cost analysis for implementing more innovative models. It's important to capture all potential costs to help ensure the revenue derived from any innovation at least covers its cost to the agency, which is crucial for sustainability. Marginal Cost/Shared Resource Analysis In our last column we provided mechanisms for determining the overall activity, or uti- lization of resources, in the EMS system. Unit-hour utilization (UHU) is a rough cal- culation based on the number of staffed unit-hours the system has on duty and the time those resources are committed on patient care activities. In our prior example Anytown EMS had an average task time— the time from unit dispatch to unit available for another call—of 60 minutes and oper- ated at a response UHU of 0.114, essentially meaning its units were on a call 11.4% of the time they were on duty. It may be that Anytown EMS can add marginal activity to these units and still maintain relatively high availability for EMS responses. We use the term marginal to imply there may not be a need to create additional resources to conduct additional activity. Generally there is lower cost associated with creating additional activity for units already on duty. Let's use this example: Suppose Anytown EMS enters into an agreement with Anytown General Hospital to provide a single follow- up home visit for recently discharged heart failure patients. Anytown EMS agrees to conduct visits consisting of an environmen- tal assessment, medication inventory, ensur- ing understanding of the patient's discharge instructions, and a fall risk assessment. It anticipates the time required to complete this visit to be one hour. The hospital antici- pates referring about five patients per week into this program, so it will likely create five hours per week of additional EMS activity. The good news is that generally, when Anytown EMS performs these home visits, those providers could still be available for an emergency call. Upon arrival at the home, the crew could explain to the patient and fam- ily that, in the event they're needed for an emergency call, they will have to leave but will return later to finish the visit. Patients and families are very understanding of this, and many EMS agencies use this approach when they have the capacity to do so. Recall from our earlier discussions that the ambulance unit-hour cost for Anytown EMS is $82, including the cost of physician over- sight. Some might presume that if the home visit takes an hour of time, the cost to Anyt- own EMS would be $82—but that's a logical determination only if the Anytown unit was out of service for the home visit. Since the ambulance is available for a call during the visit, the $82 per hour is really the "cost of readiness" for an EMS response and already allocated, even if Anytown didn't conduct the additional activity. Therefore the home visit does not cost $82 but rather a small fraction of that amount. There are some costs to consider for this model. It's likely the EMS personnel will require several hours of additional training by a qualified instructor. The medical direc- tor may need a stipend for protocol devel- opment, additional training, and quality assurance activities. There will also likely be a need to purchase equipment such as an i-STAT blood analyzer, a scale, and medi- cation pill boxes to help patients remember which medications to take and when. Some medical supplies will need to be purchased for use on home visits as well. For example, an i-STAT uses single-use cartridges that cost about $25 each. Finally, there are costs related to traveling to the home visit, such as fuel and perhaps even wear and tear on the vehicle. Taking these costs into account and pre- suming the program lasts one year, Table 1 shows what a detailed cost analysis reveals. As long as Anytown can keep using exist- ing capacity in its system, it's likely any pay- ment amount in excess of $34.88 would cover the cost of the visit. However, it may not make the program financially sustainable in the long term. If the program is successful, Anytown may exceed its ability to use exist- ing resources, so leaders must consider the costs associated with scalability and build them into cost determinations. PROMOTING INNOVATION IN EMS A lack of business acumen may slow innovation—start developing it now By Matt Zavadsky, MS-HSA, EMT, and Kevin G. Munjal, MD, MPH Business Acumen Part 3: The Costs of Innovation Over 2018 EMS World, in conjunction with the National Association of EMTs, will provide detailed implementation strategies for key recommendations of the Promoting Innovation in EMS (PIE) project. The PIE project utilized broad stakeholder involvement over four years to identify and develop guidance to overcome common barriers to innovation at the local and state levels and foster development of new, innovative models of healthcare delivery within EMS. Each month we will focus on one recommendation and highlight the document's actionable strategies to continue the EMS transformation. Matt Zavadsky is a featured speaker at EMS World Expo, Oct. 29-Nov. 2, 2018 emsworldexpo.com

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