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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PROMOTING INNOVATION IN EMS 12 JULY 2018 | EMSWORLD.com legislation. The PIE authors recognized this and deliberately included a statement about unification. The major associations that influ- ence payment policy, such as the American Ambulance Association (AAA), NAEMT, Inter- national Association of Fire Fighters (IAFF), and International Association of Fire Chiefs (IAFC), should agree on key tenets of decou- pling payment from transport and all push in the same direction, perhaps even publishing a statement on the components they agree on. Enhance education, medical direction, qual- ity improvement, and the economic model— Most EMS providers may lack the education and training to safely navigate 9-1-1 callers from the scene of a call to an alternative destination. If we as a profession are serious about decoupling payment from transport, we need to prepare providers to do it safely and effectively. This will require new edu- cation, protocols, and quality improvement processes. The National Association of EMS Physicians (NAEMSP) and American College of Emergency Physicians (ACEP) should work with the National Association of EMS Educa- tors (NAEMSE) and NAEMT to develop edu- cation and training standards that prepare EMTs and paramedics for alternative delivery models that provide patient navigation. As part of this model change, if EMS pro- viders are going to have the opportunity to refer patients to alternative destinations, national EMS associations should reach out to peer associations to build QA feedback structures. For example, urgent care centers should be encouraged to provide patient out- come data to any EMS agency that refers patients to urgent care instead of an ED. The same would be true for primary care clinics and even primary care physicians. The Urgent Care Association of America might be a logi- cal group to collaborate with to promote this new EMS service-delivery model. 5 Many EMS agencies have billed for treat- ment without transport for years, but typi- cally at a nominal fee because in most cases the patients are the ones paying. As more third-party payers cover services as a way to save downstream expenditures, EMS agencies may need assistance developing an economic model and legal framework. Forward-thinking national EMS associations may find it valuable to provide templates and education to their members on how to build the economic model and contracts for this service delivery. Start small—The associations above have invested an impressive amount of time, energy, and resources to influence federal payment policy that decouples payment from transport. Changing such policy is hard, and to date these efforts have not resulted in any significant movement. For example, the concept of reclassifying ambulance ser- vices from a "supplier" of transportation to a "provider" of medical care has been both a regulatory and statutory challenge. However, states such as Arizona have implemented Medicaid policy changes that facilitate payment for nontransport. Similarly, commercial insurers have changed policy to decouple payment from transport. In addition to Anthem, Blue Cross Blue Shield of Georgia just announced it will begin paying the A0998 HCPCS codes for commercially insured members and add Medicare and Medicaid members as states and the federal govern- ment approve this payment model. 6 Perhaps the message here is that more effort should be directed by national EMS associations to help facilitate this change at the state and local levels by working with state legislators, regulators, and payers. Medicare is a large payer for EMS services, but for many agencies Medicaid and commercial insurers combined represent a larger payer mix than Medicare. Build coalitions—Just as important as the national EMS associations getting together will be building coalitions to decouple pay- ment from transport. There are many exter- nal stakeholders who would likely be willing to join us to influence this change. Commercial and managed Medicare/Med- icaid payers such as Blue Cross Blue Shield, Kaiser Permanente, Humana, Aetna, Cigna, and UnitedHealth have all been working with local EMS agencies to change payment policies. Their national trade association, America's Health Insurance Plans, may also be willing to form a closer coalition with some national EMS associations. 7 The Catalyst for Payment Reform is an active advocacy group for large employers such as AT&T, Boeing, Google, Walmart, and others that is pushing for changes in healthcare payment policy. 8 The National Governors Association has been promoting Medicaid policy changes and has worked with agencies such as MedStar, REMSA, and oth- ers to promote payment for new models of EMS service delivery. 9 The National Associa - tion of ACOs (part of the Patient-Centered Primary Care Collaborative) would also be a logical partner. 10 ACOs have recently shown a keen interest in alternative destination/treat- and-no-transport EMS models and may be another logical partner to help decouple pay- ment from transport. Is the Horse Out of the Barn? Decoupling payment from transport is a logical EMS evolution that's already started in some areas. If national EMS associations are willing to get involved, decoupling pay- ment from transport could be scaled in a much more coordinated fashion, employ- ing the use of best practices from pay- ers and agencies that are already doing it. Now is the time for these associations to realize it's already happening and help provide the framework for expansion. REFERENCES 1. Alper t A , Morganti KG, Margolis GS, et al. Giving EMS flexibilit y in transpor ting low-acuit y patient s could generate subs tantial Medicare savings. Health Af f (Millwood), 2013 Dec; 32(12): 2,142– 8. 2. Erich J. ' The Moment We've Been Waiting For ': Anthem to Compensate EMS Care Without Transpor t. EMS World, ht tps://w w w. emsworld.com/news/218925. 3. Arizona Health Care Cos t Containment Sys tem. Treat and Refer Recognition Program, ht tps://w w w.azahccc s.gov/PlansProviders/ NewProviders/treatandrefer.html. 4. J Emerg Med Ser v. Do You Bill for Deceased Patient s? 2008 Jul 31. 5. Urgent Care A ssociation of America, ht tps://w w w.ucaoa.org. 6. BlueCross BlueShield of Georgia. New Reimbursement Polic y— Scope of License (Professional), ht tps://w w w11.bcbsga.com/ net workupdate/ar ticles/archive/dec2017_ ambRes.html. 7. America's Health Insurance Plans, ht tps://w w w.ahip.org. 8. Catalys t for Payment Reform, ht tps://w w w.catalyze.org. 9. National Governors A ssociation. Health Division, ht tps://w w w.nga. org/cms/center/health. 10. Patient-Centered Primar y Care Collaborative. National A ssociation of ACOs, ht tps://w w w.pcpcc.org/executive/national- association-acos. ABOUT THE AUTHOR 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.

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