EMS World

DEC 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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PROMOTING INNOVATION IN EMS 12 DECEMBER 2018 | EMSWORLD.com especially outcomes data, is crucial. Strat- egies for implementing processes that bring value to EMS data may include: • Partnerships with organizations such as the American Heart Association, Ameri- can Stroke Association, and American College of Surgeons to incorporate spe- cific EMS data elements as a requirement for accreditation as a cardiac, stroke, or trauma center; • Development of a single data repository and reporting process for care of CPR, STEMI, stroke, and trauma; • Development of publicly accessible dashboards for comprehensive outcome reporting for care processes across the continuum (prehospital to hospital dis- charge) and patient outcomes; • Requiring EMS agencies and hospitals to report specific data elements as a con- dition of licensure, accreditation, and/or payment. Now is the time to begin creating high- value partnerships with stakeholders to demonstrate the value EMS brings to the care continuum. 4. Decoupling Payment from Transport Another top recommendation was that Medicaid and other health policy commit- tees should allow EMS reimbursement for response and treatment independent from transportation. Many EMS responses could be safely mitigated without a trip to the ED, but if ambulance agencies are only paid to transport, there is little motivation to do anything different. State Medicaid offices can be more innovative with payment policy by either working to pass legislation or simply allow- ing ambulance response and treatment without transport as a covered benefit. As an example, the Arizona Health Care Cost Containment System (AHCCS) has paid for EMS treat-and-refer services since 2016. A logical role for national EMS organi- zations would be to educate state Medic- aid offices on the economic and patient- experience benefits of patient navigation and advocate for them to change payment policy. The same organizations could work with state payer associations or directly with large payers on the value of patient navigation vs. ambulance transport. 5. One Voice A key term contained in the PIE recom- mendations is that national EMS stake- holders should continue to advocate in a unified way. We often hear that the EMS community is fragmented when it comes to matters of legislation. The PIE authors recognized this. The major associations that influence payment policy should agree on key tenets of decoupling payment from transport and all push in the same direction—perhaps even publish a statement on the compo- nents they agree on. 6. Education and Oversight EMS providers may lack the education and training to safely navigate 9-1-1 callers to alternative destinations. If we're serious about decoupling payment from transport to enhance patient outcomes and reduce expenditures (i.e., demonstrate value), we need to prepare providers to do it safety and effectively. This will require new edu- cation, protocols, and quality improvement processes. The National Association of EMS Physicians and American College of Emergency Physicians should work with the National Association of EMS Educators and NAEMT to develop education and training standards to prepare EMTs and paramedics for alternative delivery models. 7. Enhancing the Business Acumen of EMS Providers A recurring theme throughout the PIE proj- ect was the challenge for EMS agencies to develop their business acumen. The real- ity is that healthcare, whether in a fixed or mobile setting and regardless of organi- zation type, would generally benefit from being run more like a business. EMS lead- ers should understand things like fixed ver- sus variable costs, depreciation of capital assets, and marginal cost analysis. Under- standing the costs of service delivery helps determine the economic impact of imple- menting innovation in EMS agencies, but it's only one side of the equation. We hope you've enjoyed this series and can use the information to implement inno- vation in your agency. The authors of the PIE report stand ready to assist you in any way to enhance the value of your EMS agency. ABOUT THE AUTHORS Matt Zavadsky, MS-HSA, NREMT, is chief strategic integration officer at MedStar Mobile Healthcare, the exclusive emergency and nonemergency EMS/MIH provider for Fort Worth and 14 other cities in North Texas. He is a member of the EMS World editorial advisory board. Kevin G. Munjal, MD, MPH, is an emergency physician who completed an EMS fellowship with the New York City Fire Department. He is founder and chair of the New York Mobile Integrated Healthcare Association, an organization seeking to empower EMS providers to play a larger, more integrated role within the healthcare system.…

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