EMS World

JAN 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.

Issue link: https://emsworld.epubxp.com/i/917718

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Page 43 of 51

EMSWORLD.com | JANUARY 2018 43 T he quest of American EMS provid- ers for more sensible reimburse- ment reached a key threshold on Januar y 1, 2018, when Anthem BlueCross BlueShield began paying for treatment without transport for patients in states where it offers commercial cov- erage. The major insurer's new policy marks a vital step toward the goal of sustain- ing community paramedicine and mobile integrated healthcare programs that have sometimes struggled to find ongoing finan- cial footing. "We spend a lot of money in this country on healthcare, and our quality outcomes are not as good as other industrialized countries that spend less," says Jay Moore, MD, senior clinical director for Anthem in Missouri. "We need to figure out a way to get a handle on that. We want to be able to provide healthcare in a way that's afford- able for people and sustainable for the future, and I think the only way to do that is to involve people at all levels of health- care. Whether it's physicians, nurses, para- medics, EMTs, whomever it might be, it's something all of us are going to have to work together to solve. In my view this is definitely a step in the right direction." The reimbursement will be offered for HCPCS A0998-coded 9-1-1 responses in California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, New York, Ohio, Virginia, and Wisconsin. The company hopes to include its Medicare and Medicaid plans as well, though there are varying state require- ments to navigate first. Due to those dif- ferences, not all 14 states officially began January 1. Payment will be at around 70% of the average reimbursement for an ambulance run in each state—"Less than the payment for an emergent response with transport, but not a lot less," says Moore. "And the resource utilization is presumably lower." While similar efforts have been piloted here and there, Anthem is the first major insurer to take such a global approach to compensating care that doesn't culmi- nate at the emergency department. The implications for EMS are large. "Ever since the EMS Agenda for the Future was published in 1996, EMS has been striv- ing to enhance our role in the healthcare system from being merely a supplier of transportation to a provider of health- care," says Matt Zavadsky, chief strate- gic integration officer at Texas' MedStar Mobile Healthcare and president-elect of the NAEMT. "Anthem's decision is a major step toward us being considered a provider of healthcare." "For the first time we have a major private payer who's looking to give reimbursement to EMS for services we normally don't get paid for," says Chris Cebollero, a veteran 'THE MOMENT WE'VE BEEN WAITING FOR': ANTHEM TO COMPENSATE EMS CARE WITHOUT TRANSPORT Under a new policy, the insurer will reimburse treatment that doesn't require the emergency department By John Erich, Senior Editor STATES IN WHICH REIMBURSEMENT WILL BE OFFERED EMSWORLD.com | JANUARY 2018 43 California Colorado Connecticut Georgia Indiana Kentucky Maine Missouri Nevada New Hampshire New York Ohio Virginia Wisconsin

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