EMS World

JUL 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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10 JULY 2018 | EMSWORLD.com T he NAEMT's EMS 3.0 Commit- tee continues to work on creating strategies for implementing the top recommendations of the Pro- moting Innovation in EMS (PIE) project. As a reminder, the PIE project was a collaborative initiative led by Drs. Kevin Munjal and James Dunford. The project included numerous stakeholders internal to EMS but also, just as important, from outside the EMS profes- sion, such as hospitals, payers, home health, and hospice agencies. The project was funded by NHTSA, HHS' Office of the Assistant Secretary for Pre- paredness and Response (ASPR), and the Department of Homeland Security (DHS). It sought to identify barriers to innovation in EMS and provided more than 250 recom- mendations. So far in this column we have offered potential strategies for national EMS associa- tions relating to innovations for quality met- rics, data and data integration, and financial sustainability. This month we outline strate- gies for another recommendation, this one contained in the Strategies for Overcoming Financial Barriers to Innovation section of the PIE report: "National EMS associations should continue to advocate in a unified way for the decoupling of reimbursement from transportation across all public and private payers." Many EMS innovators have illustrated the misalignment of incentives that results from payers reimbursing ambulance agen- cies based solely on the transportation sup- plied, as opposed to medical care. A recent study published in Health Affairs identified: 1 "12.9%–16.2% of Medicare-covered 9-1-1 EMS transports involved conditions that were probably nonemergent or primary care- treatable. Among beneficiaries not admitted to the hospital, about 34.5% had a low-acuity diagnosis that might have been managed out- side the ED… If Medicare had the flexibility to reimburse EMS for managing selected 9-1-1 calls in ways other than transport to an ED, we estimate the federal government could save $283–$560 million or more per year, while improving the continuity of patient care. If pri- vate insurance companies followed suit, overall societal savings could be twice as large." Thankfully there has been significant movement as payers begin to recognize the value of decoupling payment from transport: • In October 2017 Anthem announced it would begin paying the A0998 HCPCS code (for ambulance response and treat- ment with no transport) at 75% of its nor- mal rate for ambulance transport. 2 • Arizona Medicaid currently pays EMS agencies for treat-and-refer services at a rate of $203.80. 3 • At MedStar, a large commercial payer has begun paying a capitated payment (fixed amount per member/per month) for ambulance and MIH services. Under this arrangement there is no fee-for-service payment for ambulance transports, since it is prepaid each month. And Medicare reimburses ambulance pro- viders for the response and nontransport of cardiac arrest victims pronounced in the field. According to Medicare rules, if the patient is declared dead "by an individual authorized by the state to make such pronouncements" after dispatch but before the beneficiary is loaded onto the ambulance, Medicare pays the base BLS emergency rate, even if an EMS crew provides no treatment. 4 Strategies for Success Although these pockets of success are encouraging, there is still much work to be done toward the widespread adoption of payments to EMS agencies for response, assessment, treatment, and referral to appropriate medical care. What strategies can national EMS associations undertake? Get together—Note a key phrase in the PIE recommendation: "should continue to advocate in a unified way." Those of us who have the opportunity to meet with elected officials often hear the EMS community is fragmented when it comes to matters of PROMOTING INNOVATION IN EMS It's already happening in places—so let's run with the idea By Matt Zavadsky, MS-HSA, NREMT PIE Project Priorities: Decoupling Payment From Transport 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 (www.EMSInnovations.org). 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. Featured speaker at EMS World Expo, Oct. 29-Nov. 2, 2018, Nashville, TN. emsworldexpo.com

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